Irish Study Uncovers Risky Medication Prescribing Cascades for the Elderly

A recent investigation published in the Annals of Family Medicine sheds light on alarming medication prescribing cascades affecting older adults in Ireland. Conducted by researchers at University College Cork, this study analyzed extensive prescription data from over half a million community-dwelling adults aged 65 and older. The research involved prescriptions dispensed between 2017 and 2020, aiming to identify how unnoticed drug side effects can lead to further prescriptions and potential health risks in primary care settings.

Prescribing cascades are situations where a new medication is prescribed to counteract side effects from another drug. These unintended sequences can result in patients experiencing additional complications rather than preventing health issues. The study highlights five significant prescribing cascades that pose particular concerns.

The Key Findings: An Overview

1. Calcium Channel Blockers and Diuretics
This cascade emerged as the most prominent one identified. Approximately 2.6% of patients who began using calcium channel blockers, frequently prescribed for high blood pressure treatment, also received diuretics within a year. The study authors estimate that there is one additional diuretic prescription for every 78 patients starting calcium channel blockers.

2. Alpha-1-Receptor Blockers and Vestibular Sedatives
About 3% of those prescribed alpha-1 receptor blockers, typically used to relieve the symptoms of enlarged prostates, subsequently received vestibular sedatives (for vertigo relief) within a year. This indicates that one extra vestibular sedative is prescribed for every 85 patients starting on this medication.

3. SSRIs/SNRIs and Sleep Agents
Approximately 2.5% of patients taking selective serotonin reuptake inhibitors (SSRIs) or selective norepinephrine reuptake inhibitors (SNRIs), which are commonly used for depression, also ended up needing prescriptions for sleep agents within a year—resulting in one extra sleep agent for every 115 patients on SSRIs/SNRIs.

4. Benzodiazepines and Antipsychotics
This cascade involved 3.2% of individuals beginning treatment with benzodiazepines, usually prescribed for anxiety disorders, who later received antipsychotic prescriptions. The estimate indicates one additional antipsychotic for every 242 benzodiazepine initiators.

5. Antipsychotics and Antiparkinsonian Agents
Lastly, about 0.4% of antipsychotic users were found to also require prescriptions for antiparkinsonian medications within a year, resulting in one extra prescription for every 1,644 antipsychotic users.

The study revealed that three additional pairs of medication combinations - diuretics to overactive bladder drugs, benzodiazepines to antidementia agents, and NSAIDs to antihypertensive medications - showed significant negative associations, suggesting that clinicians might be proactively avoiding these potential cascades.

Implications of the Study

The authors emphasize that a growing number of medications in older individuals correlates with an increased risk of adverse drug reactions and interactions. They raise awareness among clinicians to consider adverse drug reactions when new symptoms arise in older patients. Identifying and addressing prescribing cascades, along with deprescribing when suitable, could be pivotal in minimizing the range of medications patients are taking and alleviating their treatment burden.

This research highlights an urgent need for healthcare professionals to revisit prescribing practices, ensuring that the benefits of each medication are maximized while minimizing the risks of polypharmacy. The authors conclude by stressing that being vigilant about potential adverse drug reactions must be a standard practice in primary care for older adults.

The full article detailing these impactful findings can be found in the Annals of Family Medicine, a journal committed to providing crucial evidence-based information that affects patient care and decision-making in the primary healthcare sector.