Is This A New Medical Condition? Beware The “Prescribing Cascade!”
Prescription medicines may often be involved in causing new symptoms in patients. In fact, when new symptoms appear — especially in people 65 and over who have multiple chronic health conditions and, who are taking multiple medications — suspect an adverse drug effect until proven otherwise say medical experts.
According to Dr. Richard Lindsay, M.D., professor emeritus of internal medicine and family medicine at the University of Virginia (UVA), who teaches a course in “How to Be an Olympic Swimmer in the Aging Tsunami” through the Osher Lifelong Learning Institute at UVA, the problem is a complex one, complicated by the increasing number of chronic diseases that commonly occur as people live longer.
As longevity has increased, there’s been an explosion in the number of patients with multiple chronic diseases, and a correspondingly dramatic increase in the number of medications taken to treat those conditions. “This places patients at a greater risk for an adverse drug effects and triggering a prescribing cascade,” Lindsay says. More than 77% of seniors between the ages of 65 and 79 suffer from one or more chronic diseases. The number increases to 85% for those over age 80.
Often the side effect of one drug may mimic another health problem. A new medication can be prescribed to treat the new symptom. But the new drug may add yet another side effect, or interact adversely with a medication the patient was previously taking, which can then trigger prescribing another new drug — known as the “prescribing cascade.”
With multiple chronic health conditions, patients are also more likely to see multiple physicians, and the number of doctors involved exacerbates the prescribing cascade. “The average Medicare patient often sees about 4 doctors, but people with multiple health conditions may be seen by as many as 14, and that’s a lot of cooks to spoil the soup,” Lindsay notes.
The problem of prescribing for individuals with multiple chronic diseases and multiple physicians, not only presents a challenge for healthcare providers trying to prevent the prescribing cascade, but for patients trying to manage out-of-pocket spending on prescription drugs.
To cut your risk, most clinical practices ask that you take a bag with all the prescriptions, over-the-counter medications, vitamins, and herbal supplements that you currently take with you to each doctor’s appointment. You should also maintain a current list of everything that you take, be sure to spell correctly, and include the dosage and the frequency you take it. Review and update it after every doctor’s appointment or when you start or stop any medications. In addition, Dr. Lindsay recommends the following:
- Always ask your healthcare provider or pharmacist if you have questions about a medication.
- Carefully monitor (or ask someone to help you monitor) for side effects and adverse reactions, including things like checking for elevated blood pressure, rashes, or fluctuations in blood sugar.
- Be sure to report any new symptoms or possible side effects.
- Tell your healthcare provider if you have not been taking your medications regularly.
- Tell your healthcare provider if you are having any problems getting or using the medications.
For more information and free fact sheets, visit HealthinAging.org.
