Prescribing cascade in an elderly woman

Nguyen, Patrick Viet-Quoc; Spinelli, Caroline

doi:10.1177/1715163516640811

Cited by 25 publications

(24 citation statements)

References 9 publications

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“…This patient eventually lost her balance and fell, leading to a prolonged hospital stay in which the Bprescribing cascadeŵ as identified and corrected. 27 Misinterpreting medicationrelated adverse effects as new conditions can lead to unnecessary increases in both polypharmacy and symptom burden.…”

Section: Discussionmentioning

confidence: 99%

Associations Between Polypharmacy, Symptom Burden, and Quality of Life in Patients with Advanced, Life-Limiting Illness

et al. 2019

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BACKGROUND: Polypharmacy may be particularly burdensome near the end of life, as patients Baccumulatem edications to treat and prevent multiple diseases. OBJECTIVE: To evaluate associations between polypharmacy, symptom burden, and quality of life (QOL) in patients with advanced, life-limiting illness (clinician-estimated, 1 month-1 year). DESIGN: Secondary analysis of baseline data from a trial of statin discontinuation. PARTICIPANTS: Adults with advanced, life-limiting illness. MAIN MEASURES: Polypharmacy was assessed by summing the number of non-statin medications taken regularly or as needed. Symptom burden was assessed using the Edmonton Symptom Assessment Scale (range 0-90; higher scores indicating greater symptom burden) and QOL was assessed using the McGill QOL Questionnaire (range 0-10; higher scores indicating better QOL). Linear regression models assessed associations between polypharmacy, symptom burden, and QOL. KEY RESULTS: Among 372 participants, 47% were age 75 or older and 35% were enrolled in hospice. The mean symptom score was 27.0 (standard deviation (SD) 16.1) and the mean QOL score was 7.0 (SD 1.3). The average number of non-statin medications was 11.6 (SD 5.0); onethird of participants took ≥ 14 medications. In adjusted models, higher polypharmacy was associated with higher symptom burden (coefficient 0.81; p < .001) and lower QOL (coefficient − .06; p = .001). Adjusting for symptom burden weakened the association between polypharmacy and QOL (coefficient − .03; p = .045) without a significant interaction, suggesting that worse quality of life associated with polypharmacy may be related to medicationassociated symptoms. CONCLUSIONS: Among adults with advanced illness, taking more medications is associated with higher symptom burden and lower QOL. Attention to medicationrelated symptoms and shared decision-making regarding deprescribing are warranted in this setting. NIH TRIAL REGISTRY NUMBER: ClinicalTrials.gov Identifier for Parent Study -NCT01415934 KEY WORDS: pharmaceutical care; quality of life; end-of-life care; geriatrics.

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Section: Discussionmentioning

confidence: 99%

Associations Between Polypharmacy, Symptom Burden, and Quality of Life in Patients with Advanced, Life-Limiting Illness

et al. 2019

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“…A prescribing cascade occurs when a drug‐induced adverse event (DIAE) is misinterpreted as a new medical condition resulting in the prescription of a new, potentially unnecessary medication . Case reports have previously described the negative impacts of prescribing cascades in older adults . Currently, there are a limited number of case reports that have described a successful intervention to mitigate a prescribing cascade by discontinuing the medication contributing to the DIAE .…”

Section: What Is Known and Objectivementioning

confidence: 99%

“…1 Case reports have previously described the negative impacts of prescribing cascades in older adults. [2][3][4][5][6][7][8][9] Currently, there are a limited number of case reports that have described a successful intervention to mitigate a prescribing cascade by discontinuing the medication contributing to the DIAE. [2][3][4][5] However, the initial medication may not be able to be discontinued depending on the patient and medication in question.…”

Section: What Is Known and Objectivementioning

confidence: 99%

“…[2][3][4][5][6][7][8][9] Currently, there are a limited number of case reports that have described a successful intervention to mitigate a prescribing cascade by discontinuing the medication contributing to the DIAE. [2][3][4][5] However, the initial medication may not be able to be discontinued depending on the patient and medication in question. We describe a case of acetylcholinesterase inhibitor-induced rhinorrhea, subsequent self-medication using an over-the-counter (OTC) product, and the intervention to reduce these symptoms without negatively impacting cognition or function in a patient with dementia.…”

Section: What Is Known and Objectivementioning

confidence: 99%

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Successful intervention to mitigate an acetylcholinesterase inhibitor-induced rhinorrhea prescribing cascade: a case report

2017

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SUMMARY What is known and objective A prescribing cascade if often treated by discontinuing both medications. We describe an intervention to mitigate a prescribing cascade while continuing a clinically necessary medication without negatively impacting the patient. Case Summary A 77 year-old women experienced probable acetylcholinesterase inhibitor-induced rhinorrhea and subsequently self-medicated with diphenhydramine which lead to worsening cognitive function. We reduced the dose of the acetylcholinesterase inhibitor and discontinued the diphenhydramine. The symptoms of rhinorrhea was subsequently reduced without negatively impacting cognition. What is new and conclusion This was the first prescribing cascade intervention that did not require discontinuation of both medications, which may be emulated in future cases of a prescribing cascade.

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“…We as patients are thereby treated in parts; and the adage -"Treat the patient and not the disease" is not being adhered to. Can this sort of treatment modality not lead to polypharmacy and prescription cascade, which is known to be relatively common in the elderly patients on multiple medications 1,2 ? Is patient safety a prime concern or is the aim just to keep the disease symptoms at bay 3 .…”

Section: Dixit Smmentioning

confidence: 99%

Patient’s dilemma for doctors to ponder over

Dixit¹

2017

J. Kathmandu Med. Coll.

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Prescribing cascade in an elderly woman

Abstract: translated, reviewed and revised the article. Both authors approved the final version of the article.

Cited by 25 publications

References 9 publications

Associations Between Polypharmacy, Symptom Burden, and Quality of Life in Patients with Advanced, Life-Limiting Illness

Associations Between Polypharmacy, Symptom Burden, and Quality of Life in Patients with Advanced, Life-Limiting Illness

Successful intervention to mitigate an acetylcholinesterase inhibitor-induced rhinorrhea prescribing cascade: a case report

Patient’s dilemma for doctors to ponder over

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