Time to benefit
Time to benefit is how long a group of people needs to take a medicine before a benefit shows. A meta-analysis of eight statin trials for primary prevention, in 65,383 adults aged 50 to 75, estimated that 100 people needed to take a statin for 2.5 years to prevent one major cardiovascular event. Only one of the eight trials showed fewer deaths 26.
Those trials did not include frail people in residential care, so the figure is a guide, not a measurement for this group 26.
Life expectancy is hard to predict for an individual. The question is often better put another way: is this medicine likely to help within the time that matters to this person, and is it causing any burden now?
The evidence
Stopping a statin near the end of life
Promising, not yet provenIn one trial, stopping statins in people expected to live less than a year did not clearly increase deaths, and quality of life was better.
The evidence
A US pragmatic trial randomised 381 people with an estimated life expectancy of one month to one year, who were taking a statin and had recently declined in function, to stop or continue it. Deaths within 60 days were 23.8% after stopping and 20.3% with continuing, a difference that was not statistically significant, although the trial did not meet its formal test for non-inferiority. Quality of life was better in the group that stopped, and cardiovascular events were few in both groups (13 against 11) 15.
In practice
Participants were in palliative care settings, about half had cancer and about one in five had cognitive impairment. The trial was not blinded 15.
Aspirin to prevent a first heart attack or stroke after 70
Risk outweighs benefitDaily low-dose aspirin did not extend life free of dementia or disability, and it increased major bleeding.
The evidence
The ASPREE trial randomised 19,114 people in Australia and the United States, most aged 70 and over, without cardiovascular disease, dementia or disability, to aspirin 100 mg daily or placebo. After a median of 4.7 years there was no difference in the combined outcome of death, dementia or persistent disability (hazard ratio 1.01, 95% CI 0.92 to 1.11). Major haemorrhage was more common with aspirin (3.8% against 2.8%; hazard ratio 1.38, 95% CI 1.18 to 1.62) 27.
In practice
ASPREE enrolled healthy people living in the community and tested aspirin for primary prevention. It does not answer whether aspirin should be stopped in someone who has already had a heart attack or stroke 27.
Reducing blood pressure medicines in very old residents
Not supportedIn a large nursing home trial, stepping treatment down did not change survival, and adverse events did not differ. It showed no benefit and no harm.
The evidence
RETREAT-FRAIL randomised 1,048 French nursing home residents aged 80 and over, taking more than one antihypertensive with a systolic pressure below 130 mm Hg, to a step-down strategy or usual care. Over a median potential follow-up of about three years, deaths were 61.7% and 60.2% (adjusted hazard ratio 1.02, 95% CI 0.86 to 1.21). The step-down group ended on 1.5 medicines on average against 2.0, with systolic pressure about 4 mm Hg higher, and there were no apparent differences in adverse events 28.
In practice
The trial did not show that reducing treatment is harmful in this group, so it remains a reasonable choice for a resident who is dizzy on standing, falling or wants fewer tablets. The falls section’s medicines page covers observational data linking newly started blood pressure medicines with falls and fractures.
Bone medicines
Treatments for osteoporosis raise their own questions about time to benefit and about how some of them should be stopped. These are covered on the bone health page of the falls section.
Talking about it
For families, a suggestion to stop a preventive medicine can sound like giving up. It is better understood as matching treatment to what the person wants now. A medicine that is unlikely to help within the time that matters, and that adds a tablet, a blood test or a side effect, is a reasonable thing to stop.
The decision belongs to the resident, or their substitute decision-maker, with the GP. Some people prefer to keep a medicine they have taken for years, and that is a legitimate choice.
Related pages on this site
Sources cited on this page
- 15 Kutner JS, Blatchford PJ, Taylor DH, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med. 2015;175(5):691–700. (Palliative care settings; unblinded.) View source
- 26 Yourman LC, Cenzer IS, Boscardin WJ, et al. Evaluation of time to benefit of statins for the primary prevention of cardiovascular events in adults aged 50 to 75 years: a meta-analysis. JAMA Intern Med. 2021;181(2):179–85. (8 trials, 65,383 adults; not in residential care.) View source
- 27 McNeil JJ, Woods RL, Nelson MR, et al. Effect of aspirin on disability-free survival in the healthy elderly (ASPREE). N Engl J Med. 2018;379:1499–508. (19,114 community-dwelling adults in Australia and the United States.) View source
- 28 Benetos A, Gautier S, Freminet A, et al. Reduction of antihypertensive treatment in nursing home residents (RETREAT-FRAIL). N Engl J Med. 2025;393:1990–2000. View source
See every source cited across the medicines and deprescribing section →
Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at October 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. Evidence and Australian regulatory, PBS and program arrangements change — always confirm current advice with the treating GP, pharmacist or specialist.
This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.