Prescribing cascades are increasingly recognized since they were described in the mid-1990s. Cascades are more likely in older people with multimorbidity and associated polypharmacy where multiple medications can induce a variety of side effects that manifest with various non-specific symptoms that may be misidentified as new geriatric syndromes such as falls, dizziness and new-onset incontinence. Geriatricians encounter medication side effects frequently and will usually consider if an older patient presenting with new symptoms could be experiencing an adverse drug reaction or event. However, most medications prescribed to multimorbid older patients are initiated and continued by prescribers without specialist geriatric training who may not detect medication-induced morbidity. Therefore, novel approaches to the detection and management of prescribing cascades in older people are needed. Currently, the knowledge base surrounding prescribing cascades in older people is evolving towards better methods for cascade detection and secondary prevention. However, the large number of cascades described in the literature, the wide-ranging symptomatology of cascades and the rapidly increasing number of multimorbid older people at risk of cascades represent major challenges for prescribers. Furthermore, prospective prevalence studies of prescribing cascades in older people are lacking. To detect and correct prescribing cascades during routine medication review in multimorbid older people, awareness of cascades is essential. Prescribing cascade awareness in turn requires novel explicit ways of defining cascades to facilitate their rapid detection and correction during medication review. Given that prescribing cascades represent another aspect of inappropriate prescribing (IP), explicit cascades criteria should be integrated with other explicit IP criteria.

中文翻译：

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规定级联：我们只看到我们寻找的东西，我们只寻找我们知道的东西

自从在 1990 年代中期描述了处方级联后，越来越多地认识到它们。在患有多种疾病和相关的多种药物治疗的老年人中更容易出现级联反应，其中多种药物会引起各种副作用，表现为各种非特异性症状，这些症状可能被误认为是新的老年综合征，如跌倒、头晕和新发尿失禁。老年科医生经常遇到药物副作用，通常会考虑出现新症状的老年患者是否可能正在经历药物不良反应或事件。然而，大多数为多发性老年患者开具的药物都是由没有经过专业老年病学培训的处方者开始和继续使用的，他们可能无法检测到药物引起的发病率。所以，需要新的方法来检测和管理老年人的处方级联反应。目前，围绕老年人级联处方的知识库正在朝着更好的级联检测和二级预防方法发展。然而，文献中描述的大量级联反应、级联反应的广泛症状以及面临级联风险的多病老年人数量的迅速增加是处方者面临的主要挑战。此外，缺乏对老年人处方级联的前瞻性研究。为了在多病老年人的常规药物审查过程中发现和纠正处方级联反应，对级联反应的认识至关重要。反过来，规定级联意识需要新的明确定义级联的方法，以促进在药物审查期间快速检测和纠正。鉴于处方级联代表了不当处方 (IP) 的另一方面，明确的级联标准应与其他明确的 IP 标准相结合。