Evidence on interventions that target prescribing appropriateness in older adults attending the emergency department and other acute care settings: a scoping review

Introduction: 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 (AGUs), no review has focused specifically on interventions targeting PIP, as defined by validated criteria, across both ED and AGU settings. Aim: This scoping review aimed to map the evidence on interventions addressing PIP in older adults attending EDs or AGUs, identify evidence gaps and highlight areas for future research. Method: This scoping review was conducted in accordance with Joanna Briggs Institute (JBI) methodology and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. Medline, Embase, CINAHL Ultimate, Web of Science, Cochrane CENTRAL and grey literature sources were searched from 1991 to 2025 for studies evaluating interventions targeting PIP, defined using validated criteria, in adults aged ≥ 65 years attending the ED or AGUs. Results: Our search returned 8643 results. Twenty-one studies were identified for inclusion, four of which were randomised controlled trials. The 18 interventions identified encompassed pharmacist-led medication reviews, clinical decision support systems (CDSS), educational/academic detailing programmes or combined approaches. 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 educational/academic detailing were the main intervention approaches identified. Evidence was heterogeneous and focused mainly on prescribing-related outcomes, with limited assessment of clinical outcomes, prescriber adherence, communication pathways and stakeholder feedback. Future studies should incorporate longer-term follow-up and evaluate patient-centred and implementation outcomes.