Study warns of medication cascades among older people
A Canadian analysis highlights common combinations in which a side effect from one medicine can lead to a new prescription.
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An analysis of prescribing data in Ontario has identified 24 potential medication cascades that are common at population level and may cause harm. The study does not concern individual treatments, but the risk that a side effect is mistaken for a new condition.
A medication cascade occurs when a side effect of a medicine is interpreted as a new health problem. The person is then given a second medicine, when reassessing the first might have been more appropriate. The risk increases when people have multiple conditions and therefore take several medicines.
Researchers affiliated with the University of Toronto used prescribing data from Ontario. They began with a list of 65 potentially inappropriate cascades, drawn up previously by an international panel of experts. They then examined, among other things, how often the first medicine was used, how often a second medicine was prescribed afterwards and how strong the statistical association was.
The analysis identified 24 combinations that are relatively common and potentially harmful. One example involves anti-inflammatory painkillers that can raise blood pressure. If that increase is treated with a new blood-pressure medicine without reviewing the original medication, the second prescription can mask the side effect of the first.
The researchers stress that such combinations are not always wrong. A doctor may consciously decide to treat a side effect because the original medicine is necessary or because its benefits outweigh the risks. The problem arises mainly when the link between medicines is not recognised and the medication list consequently continues to grow.
A separate systematic review in Drugs & Aging collected 165 earlier studies on prescribing cascades. The review confirms that the phenomenon has been described in several healthcare systems, but also that definitions and measurement methods vary. As a result, there is no reliable, universal percentage for how often cascades occur among older people.
The results are particularly relevant to researchers and healthcare organisations. The authors cite electronic alerts and a greater role for pharmacists as possible next steps. For individual patients, this provides no reason to stop or change medicines themselves; a medication review should take place in consultation with a doctor or pharmacist.
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The study design, the number of potential cascades identified and the limitations can be found in the University of Toronto publication and the systematic review. The text provides no individual medical advice and makes clear that not every combination is wrong.
- confirmed The Ontario analysis identified 24 common potential medication cascades. — The University of Toronto describes this result. source
- confirmed The researchers worked with an earlier list of 65 potential cascades. — This is stated in the University of Toronto research report. source
- confirmed A systematic review covered 165 primary studies. — The review states this in its summary. source
- incorrect A medication cascade is always a mistake. — The sources stress that some combinations may be clinically justified; the text therefore explicitly says that this is not always the case. source
1 correction(s) applied
- Was: Older people are too often given a pill for the side effects of a pill.Now: In some older people, a side effect may be mistaken for a new condition, after which an additional medicine is prescribed. (The original wording was too general; not every additional medicine is unnecessary or wrong.)
Editor's note
According to the University of Toronto, the Ontario study was peer-reviewed and identifies potential risks at population level. The prevalence of medication cascades among individual patients remains uncertain.Sources
More on this in Dutch media
- de Volkskrant — „medicijnen ouderen”
- RTL Nieuws — „medicijnen ouderen”
- NOS — „medicijnen ouderen”