Ontario study identifies harmful medication prescribing cascades in older adults

An Ontario-wide study published in the BMJ has identified that common medications, including statins and iron supplements, are triggering ‘potentially inappropriate prescribing cascades’ (PIPC) in older adults. These cascades occur when a side effect from one medication is misdiagnosed as a new medical condition, resulting in an unnecessary secondary prescription.

Led by Dr. Paula Rochon of Sinai Health, the research utilized population-level prescription data from ICES to identify 24 high-risk prescribing cascades out of an initial 65. One noted example involves non-steroidal anti-inflammatory drugs (NSAIDs) used for pain management; these can cause increased blood pressure, which clinicians may mistakenly treat with a new hypertension medication rather than re-evaluating the original drug.

Older adults, particularly women, face higher risks due to managing multiple chronic conditions and taking various therapies simultaneously. The study suggests these unrecognized sequences contribute to population-level drug-related harm and place unnecessary financial strain on the healthcare system.