PubMed Central, : RMMJ Rambam Maimonides Medical Journal Rambam Health Care Campus 2026; 17(2): e0015. ISSN: 2076-9172Published online 2026 April 26. doi: 10.5041/RMMJ.10575

Pillars of the Garfinkel Palliative-Geriatric Method
Pillar 1	Vulnerable very old subpopulations with comorbidity, dementia, frailty, and limited life expectancy: These patients often see many specialists who lack an integrative approach, and no single physician takes responsibility for the overall medication burden.
Pillar 2	Limited trial evidence in older, frail populations: Clinicians often extrapolate findings from randomized controlled trials in younger, healthier participants when prescribing for older, more vulnerable patients, which can lead to inappropriate clinical judgments and reduced quality of care.
Pillar 3	The relationship between inappropriate medication use and polypharmacy: The most effective solution is to reduce the overall drug count through deprescribing multiple medications.
Clinical Application of the Garfinkel Palliative-Geriatric Method
Step 1	Comprehensive geriatric assessment: Evaluate the patient’s overall health.
Step 2	Patient and family involvement: Discuss the pros and cons of every drug with the patient or their family.
Step 3	The Garfinkel algorithm: Evaluate each medication following a specific decision-making algorithm. Check evidence: Is there evidence-based consensus for the drug’s indication in this specific age and disability group? Do benefits outweigh likely harms? Validate indication: Is the indication still relevant to the patient’s current health and disability level? If not, stop the drug. Weigh risk/benefit: Do known adverse reactions outweigh the possible benefits? If yes, switch to another drug. Identify side effects: Are there any current symptoms or signs possibly related to the drug? If yes, switch to another drug. Consider alternatives: Is there a superior drug available? If yes, switch to that drug. Test dose reduction: Can the dose be safely reduced? If yes, reduce the dose.
Step 4	Implementation and follow-up: Deprescribe as many non-life-saving drugs as possible and monitor outcomes for at least three months; follow up at least annually to assess clinical outcomes and satisfaction with care.