Prescribing cascades in the elderly in sub-Saharan Africa occur when adverse effects from a medication are misinterpreted as new health issues, leading to additional prescriptions. This phenomenon is exacerbated by the high prevalence of chronic diseases and inadequate healthcare infrastructure, resulting in fragmented care and insufficient monitoring. For instance, an elderly patient treated with non-steroidal anti-inflammatory drugs (NSAIDs) for pain may develop gastrointestinal symptoms, prompting a prescription for proton pump inhibitors instead of reassessing the initial treatment. Limited access to healthcare professionals and a lack of medication management strategies increase the risk of these cascades, which can lead to serious health complications. To mitigate prescribing cascades, there is a need for better training of healthcare providers and improved patient education on the potential risks associated with polypharmacy.

Fig 1: Prescribing Cascades

Table: Example of Prescribing Cascades

In sub-Saharan African settings, prescribing cascades in the elderly present unique challenges due to limited healthcare resources, varying access to medications, and the high prevalence of comorbidities. A careful and culturally sensitive approach is crucial to avoid inappropriate medication use and prevent adverse drug reactions, which are particularly common in aging populations. Tailoring interventions to local healthcare infrastructures, enhancing healthcare provider training, and promoting patient education can mitigate the risks associated with prescribing cascades. Prioritizing regular medication reviews and fostering multidisciplinary collaboration will be essential to improving elderly care in this region.