With the upcoming implementation of the new CMS age-friendly hospital measure, hospitals will be required to attest that they review medications to identify potentially inappropriate medications (PIMS) for older adults. Dr. Martin Casey, MD, MPH is an Assistant Professor in the Department of Emergency Medicine at UNC School of Medicine. Dr. Caseys’ work has focused on the identifying PIMS and finding opportunities to reduce the use of, and deprescribe, potentially harmful medications in the emergency department.

In this episode, Dr. Christina Shenvi and Dr. Martin Casey will discuss strategies for ED physicians who face unique challenges when assessing older patients’ medications. Using case examples of deprescribing in practice, they illustrate how deprescribing is a nuanced skill and how to approach it.

• Deprescribing is an individualized process and there are various methods that should be considered.
  • Following identification of PIMs, a physician may consider dose reduction or adjustment, switching to alternative medications, and/or discontinuing the PIM.
  • It is important to include patient education to raise awareness of potential adverse effects is key.
• Assessment of medications should occur at various critical moments, including before admission, prior to procedures and in the event of significant changes in a patients’ clinical status.
• Emergency Department physicians often lack key patient information that is crucial when considering deprescribing. Collaboration with primary care physicians is valuable throughout the process of deprescribing.
• Diagnosing adverse drug events (ADEs) is essential; physicians should explicitly communicate issues with problematic medications to both patients and outpatient prescribers through systems.
• While current deprescribing guidelines vary depending on the medication being considered, further guidelines are expected as the CMS age-friendly hospital measure is implemented.
  • For example, aspirin in the absence of identifiable cardiovascular disease has clear guidelines for deprescribing.
  • Medications used for symptom management (eg. opioids, benzodiazepines, gabapentin) can be more complex as the removal of these medications can potentially lead to adverse events.