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Background and Importance Older adults frequently present to emergency departments (EDs) with polypharmacy and high-risk or unnecessary medications, increasing their risk of adverse drug events, falls, and unplanned healthcare utilisation. Deprescribing (the supervised dose reduction or discontinuation of medications) has been addressed in the literature as a means of optimising medication safety in the ED.Aim and Objectives To evaluate and synthesize the available evidence on deprescribing activities among older adults (≥65 years) in the ED, focusing on the characteristics, processes, and outcomes of such interventions.Material and Methods A systematic search following PRISMA guidelines of PubMed, EBSCOhost (CINAHL, Medline, International Pharmaceutical Abstracts), ProQuest, ScienceDirect, and Google Scholar was conducted for studies published from 2015 to date. Eligible articles were peer-reviewed primary research (qualitative or quantitative) addressing deprescribing in EDs for older adults. Data extraction captured study design, intervention characteristics, specialties involved, tools/frameworks used, outcomes, and implementation determinants. Study quality was appraised according to design.Results Seven studies met inclusion criteria. Studies were cohort (n=2), qualitative (n=2), before-after observational (n=2) and randomised controlled trial (n=1). Clinical pharmacists were central in nearly all interventions, with few studies describing physician and nurse involvement. Common deprescribing tolls included the Screening Tool of Older Persons’ Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) and the American Geriatrics Society Beers Criteria. Reported benefits included substantial reductions in potentially inappropriate medications (PIMs), decreased medication burden after hospital discharge, improved post-ED primary care follow-up, and targeted deprescribing of high-risk fall-related drugs. Evidence for clinical outcomes–such as fewer ED revisits, readmissions, mortality, or recurrent falls–was inconsistent or statistically non-significant across most studies. Qualitative analyses highlighted time pressures, incomplete medication histories, fragmented transitions, and patient resistance as barriers, whereas pharmacist expertise, structured tools, interprofessional rounds, and clear post-discharge communication emerged as facilitators.Conclusion and Relevance ED-based deprescribing is feasible and consistently reduces exposure to PIMs, yet robust evidence for improving clinical outcomes is limited. Described activities were mainly led by pharmacists, supported by validated screening tools, and integrated with primary-care follow-up. There is a need for Large multicentre studies to determine effects on re-admissions, adverse events, and patient-centred outcomes.Conflict of Interest No conflict of interest