Polypharmacy and the Prescribing Cascade


January 26, 2023

Polypharmacy and the Prescribing Cascade

Many older adults cope with more than one medical condition at the same time. Managing multiple conditions often results in taking many different medications which are meant to help, not harm. But sometimes taking too many drugs can be dangerous, especially for older adults.

What is Polypharmacy?

Polypharmacy, an umbrella term, is defined as “the simultaneous use of multiple drugs by a single patient, for one or more conditions.” Most commonly it is defined as regularly taking five or more medications.

With polypharmacy, the medicines may interact with each other and with your body in harmful ways. For example, the medications can increase negative side effects or decrease benefits. Polypharmacy also increases the possibility of a “prescribing cascade.”

What is a Prescribing Cascade?

A prescribing cascade is when a side effect of one medication is mistaken for a new medical condition and is then treated with another medication. This can lead to being prescribed more medications than you need and also further increases your risk of having more side effects and continuing the cascade. Therefore, ask your healthcare provider to review all of your medicines with you. And before you get a new medicine, ask if one of the medicines you are already taking might be causing the problem the new medicine is meant to treat.

How do I avoid polypharmacy and the prescribing cascade? 

Since medications are often prescribed by different doctors it is important to provide a list of your current medications, including any OTC medicines, vitamins, supplements, or herbal products you use, to each provider so they can update their records. You can also discuss all the medications with either your primary care physician or your pharmacist. This practice, often called a Medication Review, can help prevent harmful side effects and decrease unnecessary medications and interactions.

Also, if you have experienced an unwanted symptom (such as having had a fall or having memory problems), be sure to tell your healthcare provider – and ask if this could be caused by one of your medicines.

The roll Pharmacist have on Polypharmacy

Pharmacists also have a role to play in reducing the risks of polypharmacy. Alternating between pharmacies can make communication more difficult between patients, pharmacists, and health care providers, thereby increasing the possibility of inappropriate medication use and subsequent adverse consequences. Thus, where possible, elderly patients should use only one pharmacy.

Pharmacists can help elderly individuals avoid added risk by engaging in thorough communication with patients and providers. Pharmacist counseling should occur at every patient encounter, as educated patients are more likely to adhere to a medication regimen and take an active role in their own care.

Moreover, pharmacists should be cognizant of alerts generated by their computer systems pointing to a potential drug interaction or medication duplication, including any patient-specific information available to the pharmacist through the prescription drug monitoring program.

Effects of Food and Beverages on Medications

Also be aware that medications may be affected by food and beverages. For example, some antibiotics are not absorbed well when taken with foods, beverages, or medicines that contain calcium, magnesium, or iron (such as antacids, vitamins, or dairy products). Certain foods, such as grapefruit juice, can also change the metabolism of certain medications. This may cause the medicine to build up in the body. You can ask your pharmacist about what foods, beverages or supplements to avoid when you pick up your medications.

Other factors that can Effect Medications

Your age, sex, and even race can influence how long drugs take to work their way out of your body; women and men process and metabolize drugs differently as well. 

  • Aging – Due to the physiological changes that occur as humans age, including a reduction in kidney and liver function, the way the body processes medications changes.
  • Rapid weight loss – For example, If an individual is taking medications for diabetes or high blood pressure, fast weight loss can lead to these medications becoming too strong, which may result in these unsavory symptoms. Also rapid weight loss has been associated with decreased metabolism which may affect how you process medication and how quickly it leaves your system. 
  • Medication Non-adherence – failure to take medications consistently as prescribed can increase health complications.
Polypharmacy Fact Sheet

Sources: Health in Aging.org article, Medications work differently in older adults; Polypharmacy and the Elderly: Reducing the Risk of Adverse Events Through Monitoring and Communication

We hope this information is helpful to you in the important work you do as a family caregiver.
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