Older adults with limited life expectancy (life expectancy less than 24 months) continue to be consumers of health care resources, including preventive medications for chronic diseases that provide questionable benefit. At the end of life, consider shifting from curative to palliative goals of therapy with subsequent modifications in medication use concerning a patient’s goals of care. To identify older adults for whom medications are most likely to benefit (and most likely to harm), a framework that compares a patient’s life expectancy with the time to benefit has been proposed. Time to benefit may be defined as the point in time at which patients are expected to derive a benefit from treatment. Time to benefit is increasingly considered in addition to other measures of medication effectiveness to understand and contextualize the benefits and harms of a therapy for an individual patient. Reducing the use of unnecessary medications may reduce pill burden and adverse drug events and has the potential to improve quality of life. Some recent studies have highlighted medications to manage dementia (cholinesterase inhibitors and memantine) and possibly statins as medications of questionable benefit for older adults with advanced dementia.