UMEM Educational Pearls

Title: Geriatric prescription guidance

Keywords: Geriatric, prescriptions (PubMed Search)

Posted: 6/7/2026 by Robert Flint, MD (Updated: 6/8/2026)
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Expert consensus recommends not prescribing these eight classes of medications to older adults mostly due to sedative affect and fall risk. 1. Benzodiazepines 2. Barbiturates 3. Muscle relaxants 4. 1st generation antihistamines 5. Sulfanylureas 6. 1st generation antipsychotics 7. Zolpidem 8. Metocloprimide

A recent study shows marginal improvement in not prescribing these medications to older ED patients.

References

Skains RM, Koehl JL, Aldeen A, Carpenter CR, Gettel CJ, Goldberg EM, Hwang U, Kocher KE, Southerland LT, Goyal P, Berdahl CT, Venkatesh AK, Lin MP. Geriatric Emergency Medication Safety Recommendations (GEMS-Rx): Modified Delphi Development of a High-Risk Prescription List for Older Emergency Department Patients. Ann Emerg Med. 2024 Sep;84(3):274-284. doi: 10.1016/j.annemergmed.2024.01.033. Epub 2024 Mar 12. PMID: 38483427; PMCID: PMC11343681.

Academic Emergency Medicine Volume 33, Issue 5 e7032

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

Sarah E. Follman, Maureen Canavan, Craig Rothenberg, Mark Iscoe, Arjun K. Venkatesh, Reshma Ramachandran, Cameron J. Gettel https://doi.org/10.1111/acem.70321