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

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.