A panel of 10 emergency department (ED) physicians with expertise in geriatrics and a pharmacist with expertise in geriatric pharmacotherapy have prepared the first expert consensus-based list of types of medications that should not be prescribed to older adults in the ED.

Called GEMS (geriatric emergency medication safety recommendations)-Rx, the list is the result of the team’s review of more than 30 medications deemed inappropriate for use in older adults by the American Geriatrics Society's Beers Criteria.

Medications were ranked by the experts for overall priority for avoidance (Round 1), risk of short-term adverse events and avoidability (Round 2), and reasonable medical indications for high-risk medication use (Round 3).

After Round 1, benzodiazepines, skeletal muscle relaxants, barbiturates, first-generation antipsychotics and first-generation antihistamines were prioritized for avoidance.

In Rounds 2 and 3, hypnotic “Z” drugs, metoclopramide, and sulfonylureas were prioritized for avoidability. All eight medication classes were included in the final list. 

Reasonable indications for prescribing high-risk medications included seizure disorders, benzodiazepine/ethanol withdrawal, end of life, severe generalized anxiety, allergic reactions, gastroparesis, and prescription refill.

To read the abstract of the GEMS-Rx study, published in the Annals of Emergency Medicine, click here

To download a pocket guide to the Beers Criteria, click here