Inside the West Health Accelerator at Mass General Brigham: Improving Medication Safety for Older Adults

Medications are an important component of inpatient care. They treat disease, relieve pain and other symptoms, and support recovery. But for older adults, even everyday medications can be harmful. Through its systemwide efforts, the West Health Accelerator at Mass General Brigham is training clinicians across our nine hospitals on how medications affect people as they age and helping care teams provide safer, more consistent care to hospitalized older adults. 

 Medications Can Be Riskier for Older Adults  

Within the Accelerator, medications are not viewed in isolation, but as one of the 4Ms — medications, mobility, mentation, and what matters — a framework used to guide evidence-based care for older adults. Because aging affects how medications work in the body, medication decisions influence nearly every part of an older adult’s hospital experience. “Aging physiology really matters,” explains the Accelerator’s E-Care Clinical Director, Lynne O’Mara, MBA, PA-C. “Altered receptor sensitivity, slower metabolism, changes in organ function — all of these increase the risk of toxicity and side effects in older adults.” Two processes help explain why:  

• Pharmacodynamics, or how medications affect the body: With age, receptors can become more or less sensitive to medications. Many older adults metabolize medications more slowly, allowing drugs to remain in the body longer and increasing the risk of accumulation and side effects. 

• Pharmacokinetics, or how the body processes medications: Older adults often experience slower blood flow and digestion, increased body fat, reduced muscle mass, and declining liver and kidney function. These changes affect how medications are absorbed, distributed, metabolized and eliminated.  

Together, these age-related changes mean that even commonly used medications can pose greater risks for older adults. Known as potentially inappropriate medications (PIMs), these drugs are more likely to contribute to complications such as delirium, falls and avoidable readmissions.  

Medication Safety Is a Shared Responsibility 

One of the Accelerator’s central goals is to shift medication safety from an individual responsibility to a shared, systemwide approach. Through the West Health Champions program, clinicians across disciplines are learning how aging physiology affects older adults’ response to medication and how thoughtful prescribing, administration and monitoring can prevent harm. “Medication safety is really a team effort,” says O’Mara. “Everyone caring for an older adult — providers, nurses, pharmacists, therapists, nutritionists — plays a role in identifying high-risk medications and preventing adverse events.”  

That shared responsibility shows up in many ways: nurses pausing to question a dose, physical therapists factoring medications into fall risk or teams working together to reconcile medications. “Stopping a medication should be done with the same consideration as starting one,” O’Mara explains. “We have to be just as intentional when we deprescribe as when we prescribe.” She adds that communicating clearly with patients is equally important, so they and their loved ones understand which medications are temporary, which are long-term and when to follow-up after discharge. 

Hardwiring Safer Medication Practices into Epic 

But education alone isn’t enough to implement safer medication practices consistently or at scale. That’s why O’Mara has been spearheading the Accelerator’s transformational updates to the electronic medical record, Epic, so it’s easier for clinicians to protect their aging patients and make safer decisions right from the start.  

The Accelerator’s first Epic build, which went live in November 2025, adjusted PIM default doses and improved high-risk medication safety precautions for patients aged 65 and older. “It’s really important we ‘start-low, go-slow’,” O’Mara says, referring to a best practice for safe medication management in older adults that informs her approach. Early results are encouraging. “If you take a highly complex individual and make it easier for their care team to do the right thing, it can only impact people in a positive way,” she says.  

Setting a New Standard for Medication Safety 

As the work continues, the West Health Champions will develop unit-level quality improvement projects that will build on these results and help establish a new baseline for inpatient medication use that keeps older adults safer throughout their hospital stay. O’Mara has also built standardized, age-friendly discharge instructions directly into Epic for every older adult patient. These automated educational materials will go live in January 2026 and will help patients and families make safer medication choices at home.  

Through this coordinated work, the West Health Accelerator at Mass General Brigham is setting a new standard for inpatient care — one where medications are used thoughtfully, safely and in service of what matters most to older adults.