BEER PIMS AND GEMS-RX PRESCRIBING IN TREAT-AND-RELEASE ED VISITS AMONG OLDER VETERANS: A PROOF-OF-CONCEPT STUDY

Sep 29, 2026

Nearly half of older Veterans (≥65 years) visiting emergency departments receive new medications, and existing potentially inappropriate medication (PIM) tools often focus on long-term use rather than ED prescribing. This proof-of-concept retrospective study examined Geriatrics Emergency Medicine Safety Recommendations (GEMS-Rx), a Beers subset of high-risk ED drugs. Using VA Corporate Data Warehouse data, it analyzed ED presentations during 10/2021–3/2024 across 12 VA hospital-in-home programs, including 20,034 ED visits. Among 35% with any ED medication, 34% were Beers PIMs, and 68% of Beers PIMs met GEMS-Rx criteria, highlighting age-specific medication safety gaps and the potential value of ED-focused guidance.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Background and rationale

GEMS-Rx and Beers Criteria for ED medications

Study design and data source

Convenience sample and retrospective CDW analysis

Patient population and medication findings

ED visits, demographics, and prevalence of PIMs

Implications for medication safety

1160 Innovation in Aging, 2025, Vol. 9, No. S2 Abstract citation ID: igaf122.3889 BEER PIMS AND GEMS-RX PRESCRIBING IN TREAT-AND-RELEASE ED VISITS AMONG OLDER VETERANS: A PROOF-OF-CONCEPT STUDY Michael Zanchelli1, Kimberly Judon2, Orna Intrator3, William Hung4, and Ula Hwang5, 1. James J. Peters VAMC, Bronx, New York, United States, 2. James J. Peters VA Medical Center, Bronx, New York, United States, 3. James J Peters VA Medical Center, New York, New York, United States, 4. James J. Peters Department of Veterans Affairs Medical Center, New York, New York, United States, 5. NYU Grossman School of Medicine, New York, New York, United States Nearly half of older Veterans (≥65 years) visiting emergency departments (EDs) receive new medications. Potentially inappropriate medication (PIMs) lists, such as Beers Criteria, primarily address long-term use, yet consideration of indications, dosing, and shorter therapies with ED prescribing may not apply. The Geriatrics Emergency Medicine Safety Recommendations (GEMS-Rx) is a Beers subset of high-risk ED medications that include first-generation antihistamines, first-generation antipsychotics, benzodiazepines, barbiturates, hypnotics (“Z-Drugs”), metoclopramide, skeletal muscle relaxants, and long-acting sulfonylureas. This proof-of-concept study used a convenience sample of Veterans to provide initial understanding of GEMS-Rx use in VA EDs. We conducted retrospective analysis used VA’s Corporate Data Warehouse (CDW) for Veterans who received care in 12 VA Hospital-In-Home (HIH) programs between 10/2021 and 3/2024 and among them any presentation to the ED during this period. Data included patient demographics, ED visit details, and medications prescribed from the ED. Among 20,034 ED visits by 3,684 unique Veterans, mean age was 76 years ± SD 7.7, 60% were non-Hispanic White, 12% were non-Hispanic Black, 5% were female. Of these, 7,112 (35%) of the ED visits had at least one ED medication prescribed. 2,450 (34%) of these ED prescribed medications were categorized as Beers PIMs. 1,674 (68%) of the Beers PIMS were considered high-risk ED medications according to the GEMS-Rx criteria. Many ED medications prescribed to older Veterans are considered potentially inappropriate or even high-risk, underscoring gaps in age-specific medication safety. Incorporating ED-focused guidance such as GEMS-Rx could promote safer medication selection and potentially reduce adverse events.

FAQs

Why is ED prescribing different from long-term medication use when considering PIMs?

Many PIM lists like the Beers Criteria primarily address long-term medication use, while ED prescribing requires attention to indications, dosing, and shorter therapies.

What medications are included in the GEMS-Rx subset?

GEMS-Rx includes first-generation antihistamines and antipsychotics, benzodiazepines, barbiturates, hypnotics (“Z-Drugs”), metoclopramide, skeletal muscle relaxants, and long-acting sulfonylureas.

What proportion of ED visits involved Beers PIMs and how many met GEMS-Rx criteria?

Of 20,034 ED visits, 35% had at least one ED medication prescribed; 34% of those ED prescribed medications were Beers PIMs, and 68% of the Beers PIMs met GEMS-Rx high-risk ED medication criteria.

Sep 29, 2026

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