Prescription cascade

Prescription cascade refers to the process whereby the side effects of drugs are misdiagnosed as symptoms of another problem resulting in further prescriptions and further side effects and unanticipated drug interactions. This may lead to further misdiagnoses and further symptoms. This is a pharmacological example of a feedback loop. Such cascades can be reversed through Deprescribing.

Theory

Over the past 20 years, spending on prescription drugs has increased drastically. This can be attributed to a couple of different things: the increased diagnosis of chronic conditions and the use of numerous medications by the older population. Increases in obesity has obviously affected the increase of chronic conditions such as diabetes and hypertension, but another factor has been noted. While each drug treats a specific condition, a correlating side-effect comes with its treatment. Where the prescribing cascade comes into play is when a doctor fails to acknowledge the drugs that a patient is currently taking. When an adverse drug reaction is misinterpreted as a new medical condition, a prescription cascade can rise. A drug is prescribed and an adverse drug side-effect occurs that is mistakenly diagnosed as a new medical condition. A new drug is prescribed, and the patient is placed at risk of developing additional adverse effects relating to this potentially unnecessary treatment. ^[1] 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.^[2] This can result in a cascade of unnecessary prescriptions to treat side-effects of other drugs, known as the prescription cascade.

A prescriber can do little to modify age related physiological changes in trying to minimise 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

As described in theory, polypharmacy is a term used to describe the use of numerous medications at the same time (from the root "multiple pharmacies"). As people age, numerous health conditions can arise and thus, must be treated. From chronic conditions like diabetes or high blood pressure to short-term medical conditions, the older population is medicated by a number of different drugs at the same time. A review in 2010 demonstrates that the average 81 year old is taking an average of 15 different medications at the same time, ranging from 6 to 28. It was also found that there was approximately 8.9 drug-related problems per identified patient in the study with a range of 3 to 19 problems.^[3] With a staggering number like that, it is obvious why prescription cascades are majorly based on the theory of polypharmacy.

One problem that was found in the aforementioned review was that patients in the study were commonly taking medication that they did not need anymore. Adverse effects from the drugs were seen as symptoms of a new condition and led to a prescription cascade in many cases.

References

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