Medication Safety Strategies for Geriatric Patients in the Emergency Department: A Narrative Review

Population aging is reshaping emergency care. Older adults already account for 15%-25% of U.S. emergency department (ED) visits and, compared with younger patients, present with greater numbers of comorbidities, higher resource utilization, longer stays, and markedly higher admission rates (35%-45%), return visits, and mortality. Medication exposure is a central driver of risk with an estimated ~10% of older-adult ED visits being medication-related. We conducted a narrative review of the literature surrounding medication safety for geriatric patients presenting to the ED and strategies that can be employed to optimize pharmacotherapy management. Medication-safety elements include medication reconciliation, the systematic reduction of potentially inappropriate medications using tools such as Beers, STOPP/START, or GEMS-Rx, and geriatric-tailored order sets for common presentations (e.g., pain, delirium, hip fracture). Additionally, system-based interventions such as utilization of Clinical Decision Support Systems (CDSS), Geriatric Emergency Department Accreditation (GEDA), and alignment with regulatory agencies are explored. The combination of robust emergency medicine pharmacist integration, clinical decision support, and disciplined measurement offers a pragmatic path to reduce potentially inappropriate prescribing and ADEs resulting in improved safety and outcomes for older adults in the ED.