High-Risk Medication Prescriptions in Older Adults Post-ED
Publication Title: High-Risk Medication Prescriptions Among Older Adults Discharged from the Emergency Department
Summary
- Question
- This study investigated the prevalence of high-risk medication prescriptions among older adults discharged from emergency departments (EDs). The researchers aimed to assess how often potentially inappropriate medications (PIMs), as defined by the Geriatric Emergency Medication Safety Recommendations (GEMS-Rx), were prescribed without valid clinical exceptions.
- Why it Matters
- Older adults are at greater risk of adverse drug reactions, which can lead to serious health complications, hospital readmissions, and even death. Emergency departments are critical care settings where medication decisions are made rapidly, often influencing patient outcomes post-discharge. Understanding PIM prescribing patterns is crucial for improving medication safety and optimizing care transitions for this vulnerable population.
- Methods
- The researchers conducted a cross-sectional analysis of ED encounters involving patients aged 65 and older from January 2023 to May 2025. Data were drawn from the Epic Cosmos database, which aggregates electronic health records from multiple sites. They focused on prescriptions given at discharge and analyzed prescribing rates across 1,842 EDs, stratified by medication class and patient age.
- Key Findings
- Approximately 6.5% of ED encounters resulted in PIM prescriptions, with the likelihood decreasing as patient age increased. For example, 8.3% of patients aged 65-74 received PIMs, compared to 1.8% of those aged 95 and older. The most frequently prescribed PIMs were skeletal muscle relaxants (3.7% of encounters) and first-generation antihistamines (2.1%). The specific medications most commonly prescribed included methocarbamol and cyclobenzaprine (both muscle relaxants), and meclizine (an antihistamine). Significant variation was observed in PIM prescribing rates between EDs.
- Implications
- The findings highlight the need for improved prescribing practices in emergency settings to reduce the risk of adverse drug events in older adults. Standardized interventions, such as electronic health record-integrated decision support tools, could help guide safer medication choices. Additionally, targeted education for clinicians on alternatives to commonly prescribed PIMs could enhance patient safety during care transitions.
- Next Steps
- Future research should explore strategies to standardize and improve medication safety protocols in EDs. This includes evaluating the effectiveness of decision support tools and non-pharmacologic alternatives. Additional studies could also investigate the downstream effects of PIM prescriptions on patient outcomes and healthcare utilization.
- Funding Information
- This research was supported by the National Center for Advancing Translational Science (NCATS) of the National Institutes of Health (award KL2 TR001862) and the National Institute on Aging (NIA) of the National Institutes of Health (award P30AG021342). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Full Citation
Iscoe M, Sangal R, Hwang U, Fried T, Meeker D, Conner T, Gettel C, Follman S, Wright D, Venkatesh A. High-Risk Medication Prescriptions Among Older Adults Discharged from the Emergency Department. JAMA Internal Medicine 2026, 186: 483-486. PMID: 41661555, PMCID: PMC12887836, DOI: 10.1001/jamainternmed.2025.7883.
This AI-assisted summary has been reviewed and approved by at least one of the study's authors to ensure it accurately reflects the research.
Authors
Mark Iscoe, MD, MHS
First AuthorAssistant Professor of Emergency Medicine and Biomedical Informatics and Data Science
Arjun Venkatesh, MD, MBA, MHS
Last AuthorAnthony N. Brady Professor of Emergency Medicine