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Jamanetwork. Older adults frequently take many medications, with two-fifths taking 5 or more.
While most older adults are exposed to polypharmacy as part of evidence-based treatment of 1 or more chronic conditions, with a rising tide of medications comes higher risk of adverse drug events. One strategy to prevent harms associated with polypharmacy is to identify medications that are unnecessary or inappropriate and proactively deprescribe them. The American Geriatric Society Beers Criteria1 and similar lists have provided a starting point for identifying medications that are most often inappropriate in older adults. However, the appropriateness of many other medications is highly dependent on the clinical context of the individual patient. One potentially valuable strategy for deprescribing efforts is to identify common prescribing cascades, instances in which a second (potentially avoidable) medication is administered in response to an adverse effect or drug reaction caused by another medication.
Jamanetwork. Key Points Question Are older adults who begin taking a calcium channel blocker more likely to be subsequently prescribed a diuretic, leading to a prescribing cascade, than those who began taking other medications?
Findings In a population-based cohort study of 41 086 older adults with hypertension, being newly dispensed a calcium channel blocker was associated with a statistically significantly higher rate of being subsequently dispensed a loop diuretic within 90 days compared with 2 groups (n = 66 494 and n = 231 439) who began taking other medications. Meaning Many older adults who begin taking a calcium channel blocker may subsequently experience a prescribing cascade; steps can be taken to avoid prescribing unnecessary medications that can cause harm and are costly.
Importance Calcium channel blockers (CCBs) are commonly prescribed agents for hypertension that can cause peripheral edema.
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About SENATOR. Tinetti2019 caring for patients with multiple chronic conditions ann intern med .pdf. Polypharmacy: new guidance available. News Polypharmacy: new guidance available More medicine reviews needed The Royal Pharmaceutical Society has today published guidance on polypharmacy for pharmacists and all healthcare organisations involved with medicines.
Polypharmacy: Getting our medicines right provides a summary of the scale and complexity of the issue of polypharmacy. It outlines how healthcare professionals, patients and carers can find solutions when polypharmacy causes problems for patients and points to useful resources that can help. The guidance recommends that all healthcare organisations have systems in place to ensure people taking 10 or more medicines can be identified and highlighted as requiring a comprehensive medication review with a pharmacist. The benefits of such reviews include: • A reduction in problematic polypharmacy • Improved health • Patients more likely to take their medicines • Fewer wasted medicines RPS President Ash Soni said: A shorter version is available for pharmacy teams.
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