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Identifying key prescribing cascades in older people (iKASCADE): a transnational initiative on drug safety through a sex and gender lens—rationale and design

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Key Summary Points

AbstractSection Aim

To describe the objectives and expected impact of an international consortium (iKASCADE) whose purpose is to improve drug safety for older adults by addressing prescribing cascades through a sex and gender lens.

AbstractSection Findings

The consortium proposes to (a) develop an inventory of clinically relevant prescribing cascades; (b) provide a detailed understanding of sex-specific prescribing cascades in hospital, long-term care, and community settings; (c) foster a greater understanding of similarities or differences regarding prescribing cascades internationally; (d) and provide a nascent understanding of the ways in which gender dimensions may influence the development or treatment of prescribing cascades.

AbstractSection Message

It is critically important to examine sex and gender within geriatric pharmacology to better inform recommendations and treatment decisions tailored for older women and men.

Abstract

Purpose

To describe the objectives, methods and expected impact of an international consortium (iKASCADE) whose purpose is to improve drug safety for older adults by addressing prescribing cascades through a sex and gender lens.

Methods

To create a comprehensive, internationally relevant inventory of prescribing cascades affecting older adults, the consortium has created a modified Delphi procedure where international experts in prescribing and managing pharmacotherapy for older adults will rank a list of prescribing cascades as to their clinical importance. We will use administrative and clinical data on older adults to evaluate the frequency of prescribing cascades by sex internationally, in the hospital, long-term care and community settings. Finally, we will use semi-structured interviews and realistic, country-specific vignettes, each incorporating a prescribing cascade with identified sex differences, to explore how socially constructed gender roles contribute to the experience, presentation and management of prescribing cascades.

Results

The consortium will synthesize the quantitative and qualitative results to produce a position paper and products—aimed at knowledge users within and outside of academia—designed to elevate the importance of integrating a gender dimension in the identification and prevention of prescribing cascades.

Conclusion

Findings will improve our understanding of how adverse drug events are different between older women and men and inform the development and dissemination of tailored knowledge translation products to reduce the frequency and impact of prescribing cascades.

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Availability of data and material

Additional information about the iKASCADE Team and project is available from the corresponding author.

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Acknowledgements

The authors would like to express their appreciation and thanks to Peter Anderson for the preparation of the manuscript. We also thank iKASCADE team members Prof. Stephen Byrne, Dr. Barbara Carrieri Ph.D., Dr. Kieran Dalton, Vasily Giannakeas MPH (PhD candidate), Dr. Rachel Savage Ph.D., and Dr. Nathan Stall for their ongoing input and support. Furthermore, the authors would like to thank Dr. Amy Hoang-Kim Ph.D., Nousin Hussain, and Camilla Parpia for their support in the development of the protocol.

Funding

The iKascade project is funded by “Identifying Key Prescribing CASCADes in the Elderly: A Transnational Initiative on Drug Safety” (GNP-1782), GENDER-NET Plus ERA-Net Cofund: “Promoting gender equality in H2020 and the ERA, in Partnership with: the Canadian Institues of Health Research-Institutes of Gender & Health and Institute of Aging; Irish Research Council; Ministerodella Salute (Italy); Ministry of Science and Technology (Israel). Dr. Paula Rochon holds the RTOERO Chair in Geriatric Medicine at the University of Toronto.

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Authors and Affiliations

  1. Department of Geriatric Medicine, Maccabi Healthcare Services, Modiin, Israel

    Shelley A. Sternberg

  2. Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium

    Mirko Petrovic

  3. Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, IstitutoSuperiore di Sanità, Rome, Italy

    Graziano Onder

  4. Geriatria, Accettazione geriatrica e Centro di ricerca per l’invecchiamento. IRCCS INRCA, Ancona, Italy

    Antonio Cherubini

  5. Department of Medicine (Geriatrics), School of Medicine, University College Cork, Cork, Ireland

    Denis O’Mahony

  6. Division of Geriatric Medicine and Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA

    Jerry H. Gurwitz

  7. Department for Life Quality Studies, University of Bologna, Bologna, Italy

    Francesco Pegreffi

  8. Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada

    Robin Mason, Jennifer Akerman, Lisa McCarthy, Andrea Lawson, Joyce Li, Wei Wu & Paula A. Rochon

  9. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Robin Mason

  10. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada

    Lisa McCarthy

  11. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Paula A. Rochon

  12. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Paula A. Rochon

  13. ICES, Toronto, ON, Canada

    Paula A. Rochon

Authors
  1. Shelley A. Sternberg
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  2. Mirko Petrovic
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  3. Graziano Onder
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  4. Antonio Cherubini
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  5. Denis O’Mahony
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  6. Jerry H. Gurwitz
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  7. Francesco Pegreffi
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  8. Robin Mason
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  9. Jennifer Akerman
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  10. Lisa McCarthy
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  11. Andrea Lawson
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  12. Joyce Li
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  13. Wei Wu
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  14. Paula A. Rochon
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by all members of the iKASCADE Team. The first draft of the manuscript was written by Shelley Sternberg, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Paula A. Rochon.

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Conflict of interest

The author(s) declare no competing interests.

Ethical approval

Research Ethics Board review and approval was provided by the Women’s College Hospital Research Ethics Board in Toronto, Ontario, Canada.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Sternberg, S.A., Petrovic, M., Onder, G. et al. Identifying key prescribing cascades in older people (iKASCADE): a transnational initiative on drug safety through a sex and gender lens—rationale and design. Eur Geriatr Med 12, 475–483 (2021). https://doi.org/10.1007/s41999-021-00480-w

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