Twenty-four high-priority prescribing cascades prioritized in older adults

This study gives geriatric pharmacists a data-driven, population-ranked list of the potentially inappropriate prescribing cascades most worth targeting during medication review and deprescribing.

prescribing cascadesdeprescribingpolypharmacygeriatricsolder adultspotentially inappropriate prescribingprescription sequence symmetry analysisSTOPP/STARTcalcium channel blockerdiureticstatincholinesterase inhibitorcorticosteroidantipsychoticretrospective cohortdrug safety Geriatrics / Geriatric Pharmacy

Background Information

Prioritised prescribing cascades highlight risks in older adults.

Identifying inappropriate prescribing cascades in older adults can help reduce medication-related harm and improve drug safety in this vulnerable population. The study identified 24 high-priority prescribing cascades, with cardiovascular drugs frequently initiating cascades. Notably, iron supplements leading to laxative use had the highest incidence at 11.9%. This list can guide initiatives for deprescribing and policy improvements, targeting high-risk cascades for better medication safety among older adults. Understanding prescribing cascades helps target interventions improving medication safety in older adults.

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Authors: Rochon PA, Austin PC, Gurwitz JH, Wu W, Matai L, Zhang T, Li Z, Savage RD, Gruneir A, Li J, O'Mahony D, Petrovic M, Cherubini A, Onder G, Sternberg SA, McCarthy LM, Dalton K, Reppas-Rindlisbacher CE, Stall NM, Normand ST, Giannakeas V

Citation: Rochon PA, Austin PC, Gurwitz JH, et al. Exploring high priority potentially inappropriate prescribing cascades in older adults: population level retrospective cohort study. BMJ (Clinical research ed.). 2026;394:e100499. doi:10.1136/bmj-2026-100499

Article Links: PubMed · Journal / DOI

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Executive Summary

Study Design

Patient Population

Primary Outcomes

Secondary Outcomes & Safety Profile

Pharmacist Implications

Clinical Pearls

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