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Appropriate prescribing in the elderly can be challenging. While most of the older patients suffer from multiple comorbidities and undergo physiological changes with aging, no clinical guidelines account for these unique characteristics of the elderly adequately. Our commentary proposes a continuous process of prescribing and deprescribing as a necessary step for providers to prevent adverse drug events associated with unnecessary polypharmacy, a result of clinical guidelines working in silos. In addressing this issue, we employed Dr. Nick Barber’s four tenants of appropriate prescribing – maximize effectiveness, minimize risk, minimize cost, and respect patient choice – as a framework to guide providers through actionable insights on how to optimize the intended effects of their clinical treatment while also achieving desirable humanistic and economic outcomes.