Identification of commonly observed prescribing cascades in geriatric outpatient clinic

Prescribing cascades occur when patients are prescribed a new medication to treat the adverse drug events of previously prescribed medication. This situation might lead undesirable series of events, especially for older adults. This study aimed to determine prescribing cascade frequency and associated factors in the geriatric outpatient clinic. Prescribing cascades in medical records covering entire previous outpatient clinic visit(s) of patients aged ≥60 years, who applied to the geriatric outpatient clinic of a university hospital between November 15, 2015, and November 15, 2020, were using at least two medications were evaluated retrospectively by a clinical pharmacist. A total of 435 patients (64.4% female) included had a high Charlson-Comorbidity Index (CCI) (≥2 scores) and median age (range) of 79 (63-99) years. The median (range) of the total number of drugs was determined as 8 (6-9) in patients without prescribing cascade and 10 (8-12) in patients with prescribing cascade. A cascade-related condition was detected in 208 (47.8%) patients. Most-common medication groups associated with cascades were anti-dementia agents (9.6%), calcium-channel blockers (9.0%), and lipid-modifying agents (8.7%). According to multivariate logistic regression analysis, total medication number (p=0.001, OR=1.18), CCI (p=0.03, OR=0.81), medication-related admission to the geriatric clinic (p<0.001, OR:11.20) medication-related admission to another clinic (p<0.001, OR=7.72) and Katz index of independence in activities of daily living (p=0.003, OR=3.41) were significantly associated with prescribing cascades. In this study, it was concluded that elderly patients are at risk for the prescribing cascade, there are various factors associated with the prescribing cascade, and it is essential for clinical pharmacists to take part in a multidisciplinary team in terms of detecting prescribing cascades.