A dangerous and often unrecognized domino effect in healthcare, known as the prescribing cascade, is disproportionately impacting older women across Canada, leading to overtreatment and unnecessary health risks.
The Domino Effect of Inappropriate Prescribing
Imagine this common scenario: your doctor prescribes a medication for high blood pressure. Weeks later, you develop swollen ankles. Instead of recognizing this as a potential side effect of the first drug, a healthcare provider diagnoses it as a new condition and prescribes a diuretic. This new medication then causes dizziness, leading to a prescription for a third drug. Before you know it, you are taking multiple medications for what may have started as a single, manageable issue.
This is the essence of a prescribing cascade. Over two decades ago, Dr. Paula Rochon and Dr. Jerry Gurwitz developed this framework to highlight a critical flaw in medical care. While some combinations of drugs are necessary, a potentially inappropriate prescribing cascade occurs when subsequent medications are prescribed to treat the side effects of an initial drug, rather than addressing the root cause.
Why Women Are More Vulnerable
The consequences of this cascade extend far beyond the simple inconvenience of taking numerous pills. Each additional medication increases the risk of harmful drug interactions, new adverse effects, and complications. This burden is particularly heavy for mature women, who are more frequently caught in these cascades than men.
Potentially inappropriate prescribing disproportionately impacts older women. This group generally experiences more chronic health conditions than men and is more likely to be managing polypharmacy, the use of multiple medications. The problem is compounded by biological differences and a long history of systemic neglect in medical research.
For decades, until the 1990s, clinical studies were not required to include female participants. This has created a significant knowledge gap regarding how women's bodies, especially as they age, process and react to medications. For example, the optimal dose for certain drugs is often lower for women compared to men, a fact not always reflected in standard prescribing practices.
A Systemic Problem with Real Consequences
The lack of evidence-based guidelines tailored specifically to women's physiology means drugs are more likely to be inappropriately dosed. This can lead to adverse effects being mistaken for entirely new medical conditions, perpetuating the dangerous cycle of the prescribing cascade.
What began with the identification of three specific prescribing cascades has now grown to include approximately 200 documented instances from around the world. For women navigating the complex health changes associated with menopause and aging, the added risk from inappropriate medications presents a serious challenge to their well-being and quality of life.
The solution requires increased awareness among both patients and prescribers, alongside a dedicated push for more research focused on women's health across the lifespan to close the persistent gender gap in medical knowledge.
