Interventions that Target Prescribing Appropriateness in Older Adults Attending the Emergency Department and Other Acute Care Settings: A Scoping Review

Abstract Background Potentially inappropriate prescribing (PIP) has been associated with various adverse clinical outcomes, particularly in the context of ageing, multimorbidity and polypharmacy. Despite growing interest in front door frailty initiatives in the emergency department (ED) and acute geriatric units, to date there has been no comprehensive overview of interventions to address PIP in older adults in these settings. We set out to map the breadth of evidence on studies assessing PIP-targeted interventions in emergency care settings. Methods This review was conducted in accordance with the Joanna Briggs Institute (JBI) guidelines for scoping reviews and reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. We conducted a search from 1991-2025 across five bibliographic databases and grey literature. Results Our search returned 8119 results. Nineteen studies were identified for inclusion, four of which were randomised controlled trials. The 16 interventions described in these studies encompassed pharmacist-led medication reviews, clinical decision support systems (CDSS), quality improvement initiatives or a combination of these. While PIP was frequently a primary outcome measure, few studies reported clinical outcomes or explored prescriber adherence and experiences of older adults and prescribers. Conclusion Pharmacist-led medication reviews, CDSS and quality improvement initiatives were the main categories of prescribing interventions in the literature. Future studies should focus on clinical outcomes, enhancing communication (between pharmacists, prescribers and older adults), impact on prescriber adherence to interventions, and should incorporate longer-term follow-up.