Aged care move tied to higher medication cascade risk in Australia

Older Australians were more likely to face potentially harmful medication patterns after moving into residential aged care, according to a new study in Age and Ageing. The findings matter because the shift into long-term care is often accompanied by changes in health, frailty and prescriptions, raising the risk that side effects may be treated as new illnesses.

The study was led by the Registry of Senior Australians Research Centre at the South Australian Health and Medical Research Institute and Flinders University. Researchers examined medication records for more than 167,000 people aged 65 and older who entered long-term care facilities across Australia.

According to the research team, 16.7% of residents had at least one prescribing cascade before entering care. After admission, that share rose to 25.1%.

The researchers described a prescribing cascade as a chain of treatment in which a drug side effect is interpreted as a separate medical problem, leading to another prescription. The team said that pattern can increase the number of medicines a person takes and may add further side effects or medication-related harm.

Professor Gill Caughey, the lead researcher, said the findings show a safety issue that has not received enough attention in care for older Australians. Caughey said entry into residential aged care is a particularly vulnerable period for medication safety, and many residents may be exposed to prescribing patterns that unintentionally increase harm.

The study found that cascades were more common after admission to aged care. The researchers said this is a time when medication plans often change and residents may be dealing with worsening health or greater frailty.

According to the study, many of the cascades involved commonly used medicines. The researchers reported that several were connected to medicines already considered high risk for older people, including antipsychotics, benzodiazepines and opioids.

Caughey said some prescribing cascades may be clinically appropriate. However, she said the study identified many cascades involving medications that international guidelines regard as inappropriate for older populations.

The researchers said the pattern reflects the difficulty of medication care among older people with multiple health conditions and multiple prescriptions. Caughey said treatment decisions can accumulate over time, especially in patients with complex needs.

The study also reported additional prescribing cascades among people living with dementia. According to the researchers, many of those cascades were linked to sleep disturbance and sedation, pointing to the need for care approaches tailored to dementia.

Caughey said the risks for people with dementia can be more complicated than for other residents. The research team said clinicians and care teams need to pay closer attention to whether a symptom may be a drug side effect before adding another medicine.

The researchers called for routine medication reviews, closer monitoring of side effects and deprescribing strategies where appropriate. Caughey said better awareness of prescribing cascades could help clinicians treat the underlying cause of symptoms rather than adding to the medication burden for older residents.

The paper, “Prescribing cascades potentially associated with harms before and after transition to long-term care facilities,” was authored by Craig Hansen and colleagues and published in Age and Ageing. The study was reported by the South Australian Health and Medical Research Institute.

This story draws on original reporting from Medical Xpress.