Aim: To identify prescribing cascades potentially associated with transition to residential aged care homes (RACHs) in older people.
Methods: A population‑based cohort study was conducted using the Registry of Senior Australians National Historical Cohort. Individuals aged ≥65 years who received home care between 2018-2020 were included. Prescription sequence symmetry analysis examined 143 prescribing cascades of newly initiated medicines in a 12‑month exposure window, reporting adjusted sequence ratios (aSR) and 95%CIs. Associations of identified significant prescribing cascades with transition to RACHs were then examined in the 12 months following the index date of the prescribing cascade.
Results: Of 325,016 individuals, 11.5% had at least one significant prescribing cascade. Of the 39 significant prescribing cascades identified, two were associated with an increased risk of transition to RACH. Initiation of systemic corticosteroids were associated with a 10% increased risk of prescribing a benzodiazepine (n=5472, aSR 1.10, 95%CI 1.04-1.16), which was associated with a 28% increased risk of transition to RACH (aOR 1.28, 95%CI 1.07-1.52). Initiation of a tricyclic antidepressant (TCA) was associated with a 17% increased risk of prescribing a laxative (n=2667, aSR 1.08, 95%CI 1.08-1.26), which was associated with a 56% increased risk of transition to RACH (aOR 1.56, 95%CI 1.23-1.97).
Conclusion: Initiation of corticosteroids and TCAs were associated with prescribing cascades for common adverse events, that were associated with increased risk of transition to RACH. These findings highlight the impact of prescribing cascades on older people’s ability to successfully age in place and identifies clear targets for medication review and deprescribing.