Imagine the distress of an 87-year-old North Carolina woman in a whirlwind of hospital visits and prescriptions.
It all started with a simple fall.
She visited the emergency room for lingering back pain, was diagnosed with sciatica, and was prescribed prednisone and a muscle relaxant. Little did she know that this was the beginning of a medical maze.
Later, she experienced delirium, stomach pain, severe diarrhea, and more hospital visits within days. Each symptom was treated with a new medication, which led to new side effects.
The Prescribing Cascade Unveiled
This story is a classic example of what is known as the “prescribing cascade.” It’s like a domino effect – one medication causes side effects, which are mistaken for a new ailment, leading to more prescriptions and, you guessed it, more side effects. It’s a vicious cycle, and the elderly are particularly vulnerable.
The Missing Link: Communication
One of the main issues here is the lack of communication and consultation. The doctors who prescribed the medications to the elderly lady did not consult the Beers Criteria, a guideline by the American Geriatrics Society that lists drugs that are often unsafe for older adults. This lack of consultation and the tendency to view each symptom in isolation can lead to a cascade of prescriptions.
Rethinking the Approach
Doctors are trained to diagnose and treat, but sometimes this mindset needs tweaking. Dr. Timothy Anderson, an internist at Beth Israel Deaconess Medical Center in Boston, states that doctors must consider whether a patient’s medication could be the problem.
This shift in thinking is crucial in avoiding the prescribing cascade.
Patients and their caregivers have a significant role in avoiding this cascade. Before accepting a prescription, it’s essential to ask questions:
- Could this symptom be a side effect of a medication I’m already taking?
- Is this new medication safe for me?
- Is there an alternative to this medication?
- Can I take a lower dose?
- Do I even need this medication?
Sometimes, the best medicine is no medicine at all. For conditions like high blood pressure, lifestyle changes can be beneficial. Shedding pounds, reducing salt, and eating potassium-rich foods can work wonders.
With the plethora of medications available, it’s easy to lose track. Patients must maintain an up-to-date list of all medications, including over-the-counter drugs and supplements.
This list should be shared with every healthcare provider they consult. It’s a simple step but can be a game-changer in preventing the prescribing cascade.
Wrapping It Up
The prescribing cascade is a real and daunting phenomenon, especially for the elderly. However, it can be avoided with a shift in thinking among healthcare providers, empowered and informed patients, and open communication.
It’s time to break the cycle and ensure that medications heal, not harm.