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'

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.

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

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