Assessing incidence of clinically significantly prescribing cascades in older adults: a nationwide retrospective cohort study using the French National Health Data System.

Authors

Frédéric Gervais, Clémence Vieille, Elsa Reallon, Thomas Morel, Christelle Mouchoux, Teddy Novais

Published in

Age and ageing. Volume 55. Issue 8. Aug 03, 2026.

Abstract

Prescribing cascades occur when an adverse drug event is misinterpreted as a new medical condition, leading to the prescription of additional medications. They represent an important and preventable source of potentially inappropriate prescribing in older adults, yet their population-level incidence remains poorly documented in France.
We conducted a nationwide retrospective cohort study in 2022 using the French National Health Data System, including all individuals aged ≥65 years in 2022. Clinically important prescribing cascades were identified using a consensus-based list (ThinkCascades). Two complementary approaches were applied: a conservative longitudinal analysis and prescription sequence symmetry analysis. Incidence ranges were estimated, and subgroup analyses were performed to identify factors associated with cascade initiation.
Among 16.6 million older adults, four of seven predefined potential prescribing cascades showed significant positive signals. The strongest associations were observed for benzodiazepine-antipsychotic (adjusted sequence ratio [aSR] 2.48, 99% CI 2.44-2.51) and antipsychotic-antiparkinsonian cascades (aSR 2.01, 99% CI 1.91-2.11). Incidence estimates ranged from 0.69% to 3.29%. Female sex, advanced age (≥85 years), hospital initiation of the index drug and lack of prescriber continuity were associated with higher risks for specific cascades.
Clinically important potential prescribing cascades are common among older adults in France. These findings suggest potential prescribing cascades as a persistent and preventable contributor to medication-related harm and underscore the importance of systematic medication review, particularly during transitions of care and when new prescriptions shortly follow treatment initiation, as potential signals of prescribing cascades.

PMID:
42647768
Bibliographic data and abstract were imported from PubMed on 27 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.