Warning over “prescribing cascade”

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New guidelines have highlighted the risks of the “prescribing cascade” in older adults


New Choosing Wisely guidelines have highlighted the risks of the “prescribing cascade” in older adults, and focused on the need to reduce ongoing use of multiple medications

To avoid adverse outcomes for people on five to 20 medications, the Royal Australian College of Physicians advises against prescribing new drugs without a drug review.

Medications should also be ceased when no further benefit would be achieved, particularly for older patients with a limited life expectancy where the treatments were unlikely to prevent disease, they wrote.

The guidelines warn patients of a prescribing cascade – where new drugs are prescribed to counteract the side effects of current medications.

Patients have been urged to check with their doctor or pharmacist to see whether they could discontinue any medicines, and check on potential interactions.

The Australian and New Zealand Society for Geriatric Medicine also issued advice around psychiatric management of older patients. “One of our recommendations is to not use antipsychotics as the first choice in treating behavioural and psychological symptoms of dementia, including aggression, resistance to care and disruptive behaviour,” geriatrician Dr Catherine Yelland said.

“The use of antipsychotics is of dubious benefit and can lead to serious side effects that can be life-threatening. We recommend trying non-drug interventions first.”

Benzodiazepines or other sedative-hypnotics should not be the first choice for insomnia, agitation or delirium, the guidelines say.

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