Martin F Casey, MD, MPH

Appropriateness of Antiplatelets and Anticoagulants Among Older Adults Experiencing Falls Prevalence of Medication Appropriateness Index (MAI) Subdomains by Medication. The chart demonstrates the rates of each subdomain for each antithrombotic as well as the overall rate of likely or pote...

Happy to share my most recent study! Among older adults presenting to the ED after a fall, 82.5% had potentially or likely inappropriate antithrombotic use—aspirin topped the list.

agsjournals.onlinelibrary.wiley.com/doi/10.1111/...

ED visits are a key opportunity to reassess these meds.

We talk with Todd Semla & Mike Steinman about their new recommendations of Alternative Treatments to the AGS Beers Criteria published recently in JAGS. #medsky
 
We start with Todd's new pothole analogy😂
 
👉 Full episode: bit.ly/GeriPalEp369
😀 hosts @alexsmithmd.bsky.social | @ewidera.bsky.social

Comparative Safety of Medications for Severe Agitation: A Geriatric Emergency Department Guidelines 2.0 Systematic Review Background Managing undifferentiated, severe agitation in older adults may require antipsychotic or sedative medications to prevent harm to self or others. Unfortunately, these medications are assoc.....

Forgot the link, I'm not so good at this tweeting thing ... agsjournals.onlinelibrary.wiley.com/doi/10.1111/...

And @jdniznik.bsky.social !!!

Thanks to the amazing Geri ED Guidelines team that made this review happen!! @rachelskains.bsky.social @agem-saem.bsky.social @selmanmd.bsky.social

3/ Use geriatric-friendly principles when faced with older adult with severe agitation, including:

-Avoid anti-psychotics/sedatives if possible via redirection, stimulation reduction, reorientation, and caregiver engagement
-PO > IV/IM agents where possible
-Use the lowest effective dose

2/ Please no more co-administered antipsychotic-benzo for agitation in older adults. DO NOT USE A 'B52'

1/ 🚨 New study alert! 🚨 Excited to share GEDG's latest on managing severe agitation in older adults. Antipsychotics or sedatives can lead to serious adverse events. Benzodiazepines, especially midazolam, pose the highest risk. Quetiapine shows fewer adverse events.

Change in Default Prescription Length and Statin Prescribing Behavior This quality improvement study examines the association of changing the default supply for statin prescriptions to 90 days with clinician prescribing behavior.

If you have to take a daily pill to reduce your risk of heart disease, wouldn't it be easier get your meds at the pharmacy 4 days/yr instead of 12?

We made a simple tweak in the default order that made things easier for patients and reduced disparities... 🧵👇#nudge
jamanetwork.com/journals/jam...

Emergency Department Programs to Support Medication Safety in Older Adults This systematic review and meta-analysis evaluates whether any emergency department–based medication programs for adults aged 65 years and older are associated with lower adverse process or clinical o...

SR: emergency department initiatives to improve med. safety in older adults.

Interprofessional teams (pharmacist-led med reviews, geriatrician teleconsultations), clinician education and decision-support tools contribute to increased #deprescribing & reduce PIM use:
jamanetwork.com/journals/jam...

✨Congratulations✨to our 2025 AGEM annual excellence award winners! 🤩

@saemonline.bsky.social
#emergencymedicine #saem #agem #geriatricmedicine #emergencydepartment

Still more work to be done to detect how decreased use of PIMs impacts clinical outcomes on a granular level. Nevertheless, this is fantastic work by @rachelskains.bsky.social @selmanmd.bsky.social @agem-saem.bsky.social. Delighted to be part of this team!

Multiple approaches were effective at decreasing use of PIMs including pharmacist review, clinician education, and clinical decision support systems.

ED can measurably decrease use of PIMs without detectable increases in downstream ED visits.

Emergency Department Programs to Support Medication Safety in Older Adults This systematic review and meta-analysis evaluates whether any emergency department–based medication programs for adults aged 65 years and older are associated with lower adverse process or clinical o...

Excited to share the latest research on enhancing medication safety for older adults in emergency departments! Our systematic review and meta-analysis provide insights into effective ED-based medication programs for those aged 65 and above. Read the full article here: jamanetwork.com/journals/jam...

Concerning data from the Public Health Agency of Canada: benzodiazepines are increasingly present in toxic drug supplies & are contributing to more deaths in Canada. They were present in 30% of opioid-related toxicity deaths in 2023, compared to 12% in 2018. More info:
www.canada.ca/en/public-he...

This ASAM guidelines is a real step forward in BZD management. However, it is an indictment on medicine at large that it took until now to develop such a guideline. Further only 3/10 recs in guideline were based on evidence. We need more studies on how & when to stop medications #deprescribing

Key points con't
(3) Monitor closely for BZD withdrawal & re-emergence of mental health sx (i.e., discuss anticipated clinical course after an ED visit)
(4) Leverage adjuvant therapies (eg, CBT) to make it easier for pts with physical dependence. This requires real doctoring & empathy

Key points
(1) 5-10% dose reductions every 2-4 weeks (an initial dose reduction can be done from the ED after a BZD-related fall or the like!)
(2) Collaborate & educate pts on BZD-related harms and benefits of dose de-escalation. Related, do not confuse physical dependence for BZD use disorder

Amazing work by ASAM! Putting together the first meaningful clinical guideline on BZD tapering for all doctors, including ED physicians who routinely manage pts experiencing BZD-sequalae ... www.asam.org/quality-care...

Science is under attack by this administration. @choo.bsky.social and I explore the extent of these attacks, but are left with one question: why?
www.bmj.com/content/bmj/...

shocking to see an editor of @jama.com argue that public opinion determines what is settled science

NO

if people say the world is flat, its still settled science that its not

more research = veiled attempt to validate vaccine hesitancy

🙏 please everyone, even in a room of children, be an adult 🙏

Some NIH study sections will resume grant reviews, but final funding decisions are still in limbo While some NIH study sections will resume, advisory council meetings, which make final funding decisions, seem to still be held up.

Some NIH study sections will resume grant reviews, but final funding decisions are still in limbo… maybe some progress… sigh www.statnews.com/2025/02/24/s... via @statnews.com

February Spotlight featuring:

Justine Seidenfeld, MD, MHS

Risk factors/stratification approaches for delirium screening: a geri ED guidelines review

Co-authors: Dr. Sangil Lee, Dr. Luna Ragsdale, Dr. Christian Nickel, Dr. Shan Liu, Dr. Maura Kennedy

shorturl.at/Pol6F

@saemonline.bsky.social

Even if the administration allows meetings to resume, there is already a huge backlog of applications and far fewer federal officials to process the backlog.

2025 will go down as a dark year for American science. We need to keep speaking out about this.

#NIHMatters #ScienceMatters

Most importantly, Americans won't benefit from the cutting edge science #NIH funds to find cures for cancer, Alzheimer's disease, obesity, and more.

This will affect the quality of care in hospitals in academic medical centers and elsewhere.

Many of our quality programs are grant funded.

3/

What does this mean practically?

In the shortterm, it means scientists will have to lay off research staff and may need to find other jobs.

In the longterm, it will deincentivize younger folks in biomed to seek careers as scientists and those that do persist will lack mentors.

2/

The funding freeze is NOT over.

Biomedical grants can't get reviewed or funded because of a "loophole" the current administration is exploiting.

The NIH timeline for reviewing and funding was already LONG, now this process is frozen indefinitely.

1/

On Friday night, HHS ordered CDC to take down all flu vaccine campaign materials from its website. Materials are starting to come down.
For example, a campaign explaining that flu shot can reduce flu severity from "wild to mild" is now offline. Left image is from Friday, right is now

Meanwhile...

Happy to share my new review article on 'Pain management in the older adult'. Includes important info on how to grade pain in the cognitively impaired, approaches to multimodal analgesia & dosing to minimize anticipated harms ... authors.elsevier.com/a/1kcho_GhwI...