Journal article
Emergency Department Programs to Support Medication Safety in Older Adults: A Systematic Review and Meta-Analysis
JAMA network open, Vol.8(3), e250814
03/03/2025
DOI: 10.1001/jamanetworkopen.2025.0814
PMCID: PMC11897843
PMID: 40067297
Abstract
Given that older adults are at high risk for adverse drug events (ADEs), many geriatric medication programs have aimed to optimize safe ordering, prescribing, and deprescribing practices.
To identify emergency department (ED)-based geriatric medication programs that are associated with reductions in potentially inappropriate medications (PIMs) and ADEs.
A systematic search of Scopus, Embase, PubMed, PsycInfo, ProQuest Central, CINAHL, AgeLine, and Cochrane Library was conducted on February 14, 2024, with no date limits applied.
Randomized clinical trials or observational studies focused on ED-based geriatric (aged ≥65 years) medication programs that provide ED clinician support to avoid PIMs and reduce ADEs.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for abstracting data and the Cochrane risk-of-bias tool were used to assess data quality and validity. Abstract screening and full-text review were independently conducted by 2 reviewers, with a third reviewer acting as an adjudicator.
Process (ordering, prescribing, and deprescribing PIM rates) and clinical (ADE, health care utilization, and falls) outcomes.
The search strategy identified 3665 unique studies, 98 were assessed for eligibility in full-text review, and 25 studies, with 44 640 participants, were included: 9 clinical pharmacist reviews (with 28 360 participants), 1 geriatrician teleconsultation (with 50 participants), 8 clinician educational interventions (with 5888 participants), 4 computerized clinical decision support systems (CDSS; with 9462 participants), and 3 fall risk-increasing drug (FRID) reviews (with 880 participants). Clinical pharmacist review was not associated with decreased hospital admission or length of stay, but 2 studies showed a 32% reduction in PIMs from deprescribing (odds ratio [OR], 0.68 [95% CI, 0.50-0.92]; P = .01). One study also found that ED geriatrician teleconsultation was associated with enhanced deprescribing of PIMs. Three clinician educational intervention studies showed a 19% reduction in PIM prescribing (OR, 0.81 [95% CI, 0.68-0.96]; P = .02). Two computerized CDSS studies showed a 40% reduction in PIM ordering (OR, 0.60 [95% CI, 0.48-0.74]; P < .001). FRID reviews were not associated with reduced time to first fall or fall recurrence at 12 months.
In this systematic review and meta-analysis of ED-based geriatric medication safety programs, a multidisciplinary team, including clinical pharmacists and/or geriatricians, was associated with improved PIM deprescribing. Furthermore, computerized CDSS, alone or in combination with ED clinician education, was associated with enhanced geriatric ordering and prescribing practices. These findings will inform the Geriatric ED Guidelines version 2.0 update.
Details
- Title: Subtitle
- Emergency Department Programs to Support Medication Safety in Older Adults: A Systematic Review and Meta-Analysis
- Creators
- Rachel M Skains - University of Alabama at BirminghamJane M Hayes - Massachusetts General HospitalKatherine Selman - Cooper University HospitalYue Zhang - University of Alabama at BirminghamPhraewa Thatphet - Khon Kaen UniversityKazuki Toda - Christiana Care Health SystemBryan D Hayes - Harvard UniversityCarla Tayes - University of North Carolina at Chapel HillMartin F Casey - University of North Carolina at Chapel HillElizabeth Moreton - University of North Carolina at Chapel HillRichard E Kennedy - University of Alabama at BirminghamSangil Lee - University of IowaShan W Liu - Massachusetts General HospitalGeriatric Emergency Department Guidelines Medication Safety Group
- Resource Type
- Journal article
- Publication Details
- JAMA network open, Vol.8(3), e250814
- DOI
- 10.1001/jamanetworkopen.2025.0814
- PMID
- 40067297
- PMCID
- PMC11897843
- NLM abbreviation
- JAMA Netw Open
- ISSN
- 2574-3805
- eISSN
- 2574-3805
- Publisher
- AMER MEDICAL ASSOC
- Grant note
- National Institute on Aging (NIA): R33AG058926, R03AG082923, R21AG084218 Society for Academic Emergency Medicine Foundation/Emergency Medicine Foundation: GEM2023-0000000008 NIA: R21AG084218, R01AG060993 Health Resources and Services Administration: 2 U1QHP287310400 AstraZeneca: ESR-22-21814 Stepping Strong FoundationJohn A. Hartford FoundationWest Health
Dr Skains was supported by research grants from the National Institute on Aging (NIA) (grant Nos. R33AG058926, R03AG082923, and R21AG084218) and Society for Academic Emergency Medicine Foundation/Emergency Medicine Foundation (grant No. GEM2023-0000000008). Dr Kennedy was supported by research grants from NIA (grant Nos. R21AG084218 and R01AG060993). Dr Lee was supported by research grants from the Health Resources and Services Administration (grant No. 2 U1QHP287310400) and AstraZeneca (grant No. ESR-22-21814). Dr Liu was supported by the Stepping Strong Foundation, the John A. Hartford Foundation, and West Health.
- Language
- English
- Date published
- 03/03/2025
- Academic Unit
- Emergency Medicine; Injury Prevention Research Center
- Record Identifier
- 9984799675302771
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