Latest news with #geriatric
Medscape
02-06-2025
- General
- Medscape
Beta-Lactam Allergy De-Labeling Safe, Effective in Seniors
Beta-lactam allergy de-labeling was safe and effective for older adult patients, successfully removing false allergy labels in 87.3% of cases, with no patients requiring hospitalization or adrenaline administration. METHODOLOGY: Researchers conducted a decade-long retrospective analysis to evaluate the safety and efficacy of beta-lactam allergy evaluations in older adult patients previously labeled as allergic. The analysis included 166 older adult patients (mean age, 71 years; 72.9% women) who were evaluated between 2009 and 2019 for suspected beta-lactam allergy. All participants underwent comprehensive anamnesis, skin testing, and, when indicated, an oral challenge; those who were successfully de-labeled underwent long-term follow-up to monitor beta-lactam use and outcomes. TAKEAWAY: Beta-lactam allergy was ruled out in 87.3% of patients; 9.6% had immediate-type hypersensitivity reactions, 2.4% had severe delayed-type hypersensitivity reactions, and 0.6% experienced a benign rash. No participant required hospitalization or emergency adrenaline treatment during the evaluation. In a long-term follow-up (3-13 years) of 106 patients, 35.8% were treated with the previously suspected beta-lactam agent, and no immediate-type or severe delayed-type hypersensitivity reactions were reported. IN PRACTICE: 'Increased awareness is crucial for enhancing allergic workup in the geriatric population bearing beta-lactam allergy labels,' the authors wrote. 'We believe that establishing the removal rate of false BL [beta-lactam] allergy labels as a healthcare quality metric and making it mandatory under the supervision of health authorities will improve outcomes for both the general population and the geriatric population,' they added. SOURCE: Saray Sity-Harel, MD, with Tel-Aviv University, Tel-Aviv, Israel, was the corresponding author of the study, which was published online in Journal of Clinical Medicine . LIMITATIONS: This study had a single-center design and limited patient follow-up data, which may reduce the generalizability of the findings and the validity of the outcomes. DISCLOSURES: The authors reported having no conflicts of interest.
Medscape
29-05-2025
- General
- Medscape
Geriatric CDS Tool Boosts Safe Prescribing in the ED
The use of an electronic health record (EHR)–based clinical decision support (CDS) system in emergency departments (EDs) increased adherence to geriatric prescribing recommendations for potentially inappropriate medications (PIMs). METHODOLOGY: In this retrospective study, the researchers analyzed 6745 ED orders during 5814 patient encounters (median age, 72 years; approximately 70% White and 22.7% Black) and 1440 discharge prescriptions for PIMs in adults aged 65 years or older between August and December 2021. In October 2021, a geriatric CDS system was implemented into the EHR, which provided dosing recommendations and suggested alternative medications for 12 high-risk PIMs. The primary outcome was adherence to CDS recommendations. Secondary outcomes included the use of the CDS panel and adherence rates by medication type. TAKEAWAY: Following the implementation of CDS, the proportion of targeted PIMs adherent to geriatric recommendations increased from 52% to 71% for ED orders and from 0.5% to 31.7% for discharge prescriptions. Utilization of the geriatric CDS order panel reached 62.1% for ED orders and 36.7% for discharge prescriptions. Among orders placed through the geriatric CDS panels, 90% of ED orders and 80.4% of discharge prescriptions adhered to geriatric CDS recommendations. Adherence to geriatric CDS improved for most ED orders, except for a few drugs such as diphenhydramine, indomethacin, oral and intravenous ketorolac, and oral lorazepam. IN PRACTICE: "Geriatric clinical decision support implemented in the ED for targeted potentially inappropriate medications significantly increased the proportion of ED orders and discharge prescriptions adherent to geriatric drug therapy recommendations," the authors wrote. "As the volume of older patients in the ED increases, electronic health record–based clinical decision support can allow for care that is both better tailored and safer for this vulnerable population," they added. SOURCE: The study was led by Gina A. Elder, PharmD, Cleveland Clinic, Cleveland. It was published online on May 13 in Academic Emergency Medicine . LIMITATIONS: Prescriber behavior changes and shared decision-making with patients could have influenced the findings. Data on important patient covariates such as ethnicity, preexisting dementia history, primary language, and rurality were not collected. Differences in patient volumes and site-level variations were not considered. DISCLOSURES: The authors did not report any funding information and reported no relevant conflicts of interest.
