Daunt Ruth, McGettigan Siobhán, Kelly Lorna, Curtin Denis, O'Mahony Denis
Department of Medicine, University College Cork, College Road, Cork, Ireland.
Department of Geriatric and Stroke Medicine, Cork University Hospital, Wilton, T12DC4A, Cork, Ireland.
Drugs Aging. 2025 Apr 4. doi: 10.1007/s40266-025-01201-9.
Prescribing cascades occur when a new drug is prescribed to treat an adverse drug event caused by an existing medication, resulting in unnecessary, or potentially hazardous additional drugs. To date, there are no published studies assessing the prevalence of prescribing cascades in older hospitalised adults.
To investigate the prevalence of prescribing cascades in hospitalised older adults.
We conducted a prospective observational study of adults aged ≥ 65 years with multimorbidity and polypharmacy presenting to hospital with acute unselected medical or surgical illness. Prescribing cascades were identified using two predefined validated explicit cascade lists, i.e. ThinkCascades, and a list derived from a recently published systematic review of prescribing cascades in community-dwelling adults, referred to here as the 'Doherty list'. Potential prescribing cascades were classified as 'definite', 'probable', 'possible', 'uncertain' or 'indeterminate' according to pre-specified criteria.
The study included 385 consecutive patients (55.1% female, mean age 80.2 years, standard deviation 7.3 years). A total of 281 potential prescribing cascades (drug A → drug B) were identified in 152 patients (39.4%). Probable or possible prescribing cascades were identified in 48 patients (12.4%) using the Doherty list and in 44 patients (11.4%) using ThinkCascades. Patients exposed to potential prescribing cascades experienced greater levels of polypharmacy than patients not exposed to prescribing cascades (median interquartile range [IQR] of 12 [9-14] daily drugs versus 9 [IQR 7-11], p < 0.001).
Potential prescribing cascades were highly prevalent in older hospitalised adults. Practical tools are needed to assist prescribers in prevention, recognition and management of inappropriate prescribing cascades.
当开具新药以治疗现有药物引起的药物不良事件时，就会出现处方级联反应，从而导致不必要的或潜在危险的额外药物。迄今为止，尚无已发表的研究评估老年住院患者中处方级联反应的发生率。
调查住院老年患者中处方级联反应的发生率。
我们对年龄≥65岁、患有多种疾病且使用多种药物的成年人进行了一项前瞻性观察性研究，这些患者因急性非选择性内科或外科疾病入院。使用两个预先定义的经过验证的明确级联列表来识别处方级联反应，即ThinkCascades，以及一个源自最近发表的关于社区居住成年人处方级联反应系统评价的列表，在此称为“多尔蒂列表”。根据预先指定的标准，潜在的处方级联反应被分类为“确定”、“很可能”、“可能”、“不确定”或“无法确定”。
该研究纳入了385例连续患者（女性占55.1%，平均年龄80.2岁，标准差7.3岁）。在152例患者（39.4%）中总共识别出281个潜在的处方级联反应（药物A→药物B）。使用多尔蒂列表在48例患者（12.4%）中识别出很可能或可能的处方级联反应，使用ThinkCascades在44例患者（11.4%）中识别出。暴露于潜在处方级联反应的患者比未暴露于处方级联反应的患者经历了更高水平的多药治疗（每日药物的中位数四分位间距[IQR]为12[9 - 14]种，而未暴露者为9[IQR 7 - 11]种，p < 0.001）。
潜在的处方级联反应在老年住院患者中非常普遍。需要实用工具来帮助开处方者预防、识别和管理不适当的处方级联反应。
