Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Now is a good time to reassess your medications with your clinician

Paula Rochon, MD, Jerry Gurwitz, MD, and Lisa McCarthy, PharmD
Meds
February 12, 2024
Share
Tweet
Share

Now that we are embarking on a new year, many of us take on annual resolutions with a focus on diet and exercise.  Overlooked is another important way to improve our health: increasing awareness of our medications.

Nearly 4 in 10 adults over the age of 65 living in the United States are prescribed five or more medications. Sometimes these medications are necessary.  But sometimes, they may need adjusting or they may even be unnecessary – medications we no longer need or that may have more possible harms than benefits.

We need to check regularly with our health care provider that the medications we are on are necessary and at the right dosage.

Polypharmacy is known as the use of five or more medications.  Polypharmacy is particularly relevant to older adults, especially women, because drug use increases with age, often to manage chronic conditions.

Polypharmacy poses risks such as unwanted and sometimes harmful side effects, as well as possible interactions with other drug therapies and problems with adhering to complex medication regimens. Women are more at risk for drug-related injuries than men.

Do individuals need to be on so many medications? The answer might be yes.

But one way polypharmacy happens is because of something called “prescribing cascades.” Prescribing cascades occur when a drug therapy is started and an adverse effect develops.  These new symptoms are often misinterpreted as a new medical condition which leads to the inappropriate beginning of a new drug therapy to treat the new symptoms.

Take, for example, an individual experiencing mild knee pain.  They may be prescribed a non-steroidal anti-inflammatory drug (NSAID) to manage the pain.  Subsequently, they develop stomach upset, and an anti-ulcer medication is prescribed to treat this new symptom.

By recognizing that this is a prescribing cascade, the health care provider can make choices.  They can decide whether the initial drug therapy, the NSAID, is required or whether a non-pharmacologic approach, such as physiotherapy, could manage the knee pain.

Alternatively, if the initial drug therapy is required, the provider could decrease the dose or select an alternative medication with a lower risk of adverse effects to manage the knee pain.  In so doing, the need for additional medication may be eliminated, and a prescribing cascade could be avoided.

In our research into prescribing cascades, we initially described three common prescribing cascades. Now more than 160 prescribing cascades have been identified.  Highlighting the impact of prescribing cascades is essential because it demonstrates how potentially inappropriate medications could be avoided.

Our recent study, published in the Journal of the American Geriatrics Society also raises another concern about prescribing cascades: the impact of a common prescribing cascade on health care use, including emergency room visits and hospital admissions.

Few things are absolute in medicine. When making prescribing decisions, it is always important for health care providers to consider individual circumstances and what matters most to a patient.

ADVERTISEMENT

In some cases, the use of the medication that starts the prescribing cascade is absolutely necessary, the new symptoms are recognized as adverse effects of the drug, and the decision is made that it is best to continue with the drug therapy and treat the side effects as best possible.

The important point is that prescribing cascades are recognized, and the options are considered as part of the drug prescribing or the medication review process.

Here is what you can do as a patient or caregiver to increase awareness of your medications and the potential prescribing cascades that may contribute to polypharmacy:

  • Keep a list of all your medications.
  • Write down the date they were started,
    • the clinician who started them,
    • why they were started.
  • Review your medications regularly with your health care provider.

This information is important as medications may have been started years ago and the provider reviewing the medications may not have this information.  Understanding the sequence of events can help to identify prescribing cascades and to decide if action is needed.

By keeping track of this information and regularly reviewing your medications with your health care provider, you may reduce the use of medications that you don’t need and the risk of drug-related adverse effects and polypharmacy.

Paula Rochon and Jerry Gurwitz are geriatricians. Lisa McCarthy is a pharmacist.

Prev

Nursing in crisis: How administrative tasks are taking a toll [PODCAST]

February 11, 2024 Kevin 0
…
Next

Exploring neurodivergence: a specialist psychiatrist's journey

February 12, 2024 Kevin 0
…

Tagged as: Geriatrics

Post navigation

< Previous Post
Nursing in crisis: How administrative tasks are taking a toll [PODCAST]
Next Post >
Exploring neurodivergence: a specialist psychiatrist's journey

ADVERTISEMENT

Related Posts

  • Think twice before prescribing opioids as a first-line treatment for pain

    Gary Call, MD
  • Merging the wisdom of pain medicine and addiction medicine to optimize outcomes

    Julie Craig, MD
  • Euphoria-free pain relief: A gabapentin alternative you’ve been waiting for?

    L. Joseph Parker, MD
  • 5 hidden consequences of chronic pain

    Toni Bernhard, JD
  • Gene therapies for chronic pain?

    L. Joseph Parker, MD
  • 5 things I wish I had known earlier about chronic pain

    Tom Bowen

More in Meds

  • A psychiatrist’s 20-year journey with ketamine

    Muhamad Aly Rifai, MD
  • How drug companies profit by inventing diseases

    Martha Rosenberg
  • Every medication error is a system failure, not a personal flaw

    Muhammad Abdullah Khan
  • Why kratom addiction is the next public health crisis

    Muhamad Aly Rifai, MD
  • FDA delays could end vital treatment for rare disease patients

    GJ van Londen, MD
  • Pharmacists are key to expanding Medicaid access to digital therapeutics

    Amanda Matter
  • Most Popular

  • Past Week

    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
    • How community and buses saved my retirement

      Raymond Abbott | Conditions
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • Why U.S. universities should adopt a standard pre-med major [PODCAST]

      The Podcast by KevinMD | Podcast
    • Ancient health secrets for modern life

      Larry Kaskel, MD | Conditions
    • How the internet broke the doctor-parent trust

      Wendy L. Hunter, MD | Conditions
    • Why don’t women in medicine support each other?

      Jessie Mahoney, MD | Physician
    • Why doctors need emotional literacy training

      Vineet Vishwanath | Education
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
    • How community and buses saved my retirement

      Raymond Abbott | Conditions
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • Why U.S. universities should adopt a standard pre-med major [PODCAST]

      The Podcast by KevinMD | Podcast
    • Ancient health secrets for modern life

      Larry Kaskel, MD | Conditions
    • How the internet broke the doctor-parent trust

      Wendy L. Hunter, MD | Conditions
    • Why don’t women in medicine support each other?

      Jessie Mahoney, MD | Physician
    • Why doctors need emotional literacy training

      Vineet Vishwanath | Education
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Now is a good time to reassess your medications with your clinician
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...