Prescription cascade
Prescription cascade is the process whereby the side effects of
Theory
Over the past 20 years, spending on prescription drugs has increased drastically. This can be attributed to several different situations: There is the increased diagnosis of
The most frequent medical intervention performed by a doctor is the writing of a prescription. Because chronic illness increases with advancing age, older people are more likely to have conditions that require drug treatment, and they are more likely to suffer the effects of a prescription cascade.[2]
A prescriber can do little to modify age-related physiological changes when trying to minimize the likelihood that an older person will develop an adverse drug reaction. However, when assessing a patient who is already taking drugs, a doctor should always consider the development of any new signs and symptoms as a possible consequence of the patient's drug treatment.
Polypharmacy
Polypharmacy is the use of numerous medications at the same time (from the root "multiple pharmacies"). As people age, various health conditions may arise and must be treated. Suffering a range of issues from short-term medical conditions to chronic conditions like diabetes or high blood pressure, the older patient may be medicated by a variety of drugs at one time. A review in 2010 found that the average 81-year-old is taking an average of 15 different medications at the same time, ranging from 6 to 28 medications. It also found approximately 8.9 drug-related problems per patient in the study, ranging from 3 to 19 problems.[3] The review found that patients were commonly taking medications that they did not need anymore. More specifically, work from Australia has identified that 16% of older people use medicines that are part of a prescribing cascade.[4]
References
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Hunt, L.M.; Kreiner, M.; Brody, H. (2012). "The changing face of chronic illness management in primary care: a qualitative study of underlying influences and unintended outcomes". Annals of Family Medicine. 10 (5): 1–4. PMID 22966109.
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Farrell, Barbara; Szeto, WaiSum; Shamji, Salima (2011). "Drug-related problems in the frail elderly". Can Fam Physician. 57 (2): 168–9. PMID 21321164.
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Rochon, P.A; Gurwitz, J.H. (2007). "Optimising drug treatment for elderly people: the prescribing cascade". BMJ. 315 (7115): 1096–1099. PMID 9366745.
- S2CID 253363170.