High-Risk Medication Prescribing Among Older Adults in the Emergency Department: A National Assessment.

IF 3.2 3区医学 Q1 EMERGENCY MEDICINE

Academic Emergency Medicine Pub Date : 2026-05-01 DOI:10.1111/acem.70321

Sarah E Follman, Maureen Canavan, Craig Rothenberg, Mark Iscoe, Arjun K Venkatesh, Reshma Ramachandran, Cameron J Gettel

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引用次数: 0

Abstract

Objectives: Potentially inappropriate medication prescribing remains a common and preventable source of adverse drug events among older adults, particularly during transitions of care such as ED discharge. We assessed the prevalence and trends of older adults with high-risk medication fills based on the Geriatric Emergency Medication Safety Recommendations (GEMS-Rx) list.

Methods: We conducted a cross-sectional study using the 2017-2022 Merative™ MarketScan® Medicare Database. We included ED visits by older adults (65+ years of age) discharged from the ED. The primary outcome was met if a GEMS-Rx medication was filled within 3 days of ED discharge. Multivariable logistic regression estimated associations between patient- and system-level factors and GEMS-Rx fill after ED discharge.

Results: Among 616,980 unique ED visits, 58,284 (9.4%; 95% CI: 9.4%-9.5%) had a GEMS-Rx medication filled within 3 days of discharge. In 2017, 13,746 (11%) ED encounters resulted in a GEMS-Rx medication fill within 3 days of ED discharge compared to 6,524 (7%) ED encounters in 2022. Medication fills declined over time, with each additional year associated with a lower odds of GEMS-Rx medication fills. Benzodiazepines (37%), first-generation antihistamines (22%), and skeletal muscle relaxants (11%) were the most frequently filled GEMS-Rx medication classes. Female sex (OR 1.43, 95% CI: 1.41-1.46) and younger age (75-84 years: OR 0.69, 95% CI: 0.68-0.71; ≥ 85 years: OR 0.47, 95% CI: 0.46-0.48) were associated with higher odds of receiving a GEMS-Rx medication.

Conclusions: Nearly 1 in 10 older adults filled a high-risk GEMS-Rx medication within 3 days of ED discharge between 2017 and 2022. Despite a decline in GEMS-Rx medication fills over time, younger cohorts of older adults and females were more likely to fill a high-risk medication upon ED discharge. These findings highlight opportunities to continue improving geriatric medication safety through targeted education, decision support, and system-level interventions.

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急诊科老年人高危药物处方：一项全国评估

目的：潜在的不适当的药物处方仍然是老年人药物不良事件的常见和可预防的来源，特别是在护理过渡期间，如急诊科出院。我们根据老年紧急药物安全建议（GEMS-Rx）清单评估了老年人使用高风险药物填充物的流行程度和趋势。方法：我们使用2017-2022年Merative™MarketScan®医疗保险数据库进行了一项横断面研究。我们纳入了从急诊科出院的老年人（65岁以上）的急诊科就诊。如果在急诊科出院后3天内服用了GEMS-Rx药物，则达到了主要结局。多变量logistic回归估计患者和系统水平因素与急诊科出院后GEMS-Rx填充之间的关联。结果：在616,980例急诊就诊中，58,284例（9.4%;95% CI: 9.4%-9.5%）在出院3天内填写了GEMS-Rx药物。2017年，13746例（11%）急诊科患者在急诊科出院后3天内服用了GEMS-Rx药物，而2022年这一数字为6524例（7%）。药物填充随着时间的推移而下降，每增加一年，gem - rx药物填充的几率就会降低。苯二氮卓类药物（37%）、第一代抗组胺药（22%）和骨骼肌松弛剂（11%）是最常见的GEMS-Rx药物类别。女性（OR 1.43, 95% CI: 1.41-1.46）和较年轻的年龄（75-84岁：OR 0.69, 95% CI: 0.68-0.71；≥85岁：OR 0.47, 95% CI: 0.46-0.48）与接受GEMS-Rx药物的较高几率相关。结论：在2017年至2022年期间，近十分之一的老年人在ED出院后3天内服用了高风险的GEMS-Rx药物。尽管随着时间的推移，GEMS-Rx药物填充量有所下降，但老年人和女性的年轻队列更有可能在ED出院时填充高风险药物。这些发现强调了通过有针对性的教育、决策支持和系统级干预措施继续改善老年用药安全性的机会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Academic Emergency Medicine 医学-急救医学

CiteScore

7.60

自引率

6.80%

发文量

207

审稿时长

3-8 weeks

期刊介绍： Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine. The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more. Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.