News release

From: South Australian Health and Medical Research Institute (SAHMRI)

New research has shown concerning patterns of medication use among older Australians transitioning into residential aged care, that may increase risks of medication-related harms, highlighting opportunities to improve medication safety at this critical point in the care journey.

Recently published in Age and Ageing, the study led by the Registry of Senior Australians (ROSA) Research Centre at SAHMRI and Flinders University, analysed the medication records of more than 167,000 people aged 65 and over who entered long-term care facilities across Australia. It found that 16.7 per cent of residents experienced at least one prescribing cascade before entering care, rising to 25.1 per cent after admission.

Prescribing cascades occur when a side effect of a medication is mistaken for a new condition, leading to prescribing of a new medication. Over time, this can increase medication burden, increase risk of further side-effects and medication-related harms, creating a cycle that adds complexity and risk to a person’s care.

The study identified many prescribing cascades involving commonly used medications, with many linked to medicines already recognised as high risk in older populations, including antipsychotics, benzodiazepines and opioids.

Lead researcher, Professor Gill Caughey says the findings point to a significant and under-recognised safety issue for older Australians.

“Transitioning into residential aged care is one of the most vulnerable periods for older people when it comes to medication safety,” Prof Caughey said.

“What we’re seeing is that many residents are exposed to patterns of prescribing that may unintentionally lead to harm.”

The research found that prescribing cascades were more likely to occur after entry into aged care, a time when medication regimens often change and residents may experience declining health or increased frailty.

Prof Caughey says treatment decisions can easily compound in complex patients.

“While some instances prescribing may be appropriate, however we found many prescribing cascades that involved medications deemed inappropriate by international guidelines for the older population” she said.

“Our findings highlight the complexity of medication-related care in the older population - prescribing decisions can build on one another, especially in older people who have multiple conditions and are prescribed multiple medications.”

The study also found additional prescribing cascades among people living with dementia, many of which were linked to sleep disturbance and sedation, underscoring the need for tailored approaches to care.

“For people living with dementia, the risks can be even more complex,” Prof Caughey said.

Researchers are calling for medication reviews and deprescribing strategies at key transition points.

“There’s a real opportunity here to intervene earlier through routine medication reviews, better monitoring of side effects and, where appropriate, deprescribing strategies,” Prof Caughey said.

“Improving awareness of prescribing cascades among clinicians and care teams can help ensure we’re treating the root cause of symptoms, rather than unintentionally adding to the burden of care and placing older people at increased risk of harm.”