Análisis de las cascadas de prescripción en tratamientos farmacológicos en población mayor de 65 años en la ciudad de Machala

Abstract

This research focuses on the analysis of prescription cascades in pharmacological treatments in adults over 65 years of age in the city of Machala, Ecuador. This phenomenon refers to the unnecessary use of medicines resulting from the prescription of drugs to treat adverse effects caused by other medicines, which is particularly relevant in the geriatric population. With increasing life expectancy and the consequent ageing of the population, it is crucial to address the rational use of medicines in this population to avoid severe complications. The initial aim of the study was to characterise the predominant pathophysiological conditions in elderly patients, as well as the quantification of prescription cascades. To this end, a survey was carried out in the General Hospital of Machala IESS and in the nursing home ‘Esteban Quirola’. The results revealed that diseases such as hypertension and diabetes are common in this population, which increases the possibility of polypharmacy and associated complications. One of the most worrying findings is the high incidence of adverse events related to the use of medicines, which not only compromise patient safety but also negatively affect their quality of life. The research identified multiple cases of patients who, after experiencing side effects from a medication, received new prescriptions instead of making an adjustment to their initial treatment. This cycle perpetuates polypharmacy and leads to increased unnecessary medication burden. In response to these findings, strategies to improve pharmacotherapeutic management in older adults are proposed. The collaboration of pharmacists in health care teams is considered essential, as their expertise can contribute to the prevention and appropriate management of prescription cascades. Education and awareness are essential to empower health professionals and patients, enabling the clinical team to work together to optimise treatments. To measure the effectiveness of the strategies implemented, it is recommended to conduct an outcome evaluation that includes monitoring the incidence of prescription cascades before and after the application of an intervention protocol. Indicators such as the reduction of adverse effects and improved adherence should be analysed to adjust future actions. In addition, it is suggested that communication between physicians and pharmacists be encouraged to ensure that medication management is consistent and patient-centred. The research concludes that pharmaceutical care is key to mitigating prescribing cascades in older adults. However, it is important to recognise that the implementation of these strategies faces challenges, such as the resistance of some professionals to integrate the pharmacist into the healthcare team. Therefore, ongoing training and awareness of the pharmacist's role are essential to overcome these barriers.