Proton Pump Inhibitors and the Prescribing Cascade

Area of Science:

• Geriatric Pharmacology
• Medication Safety
• Clinical Pharmacy

Background:

• Proton pump inhibitors (PPIs) are widely prescribed in nursing home residents.
• Long-term PPI use is common and often exceeds recommended durations.
• The prescribing cascade, where drug-induced symptoms lead to new prescriptions, may contribute to PPI overuse.

Purpose of the Study:

• To describe the prescribing cascade of PPIs in nursing home residents.
• To identify factors associated with PPI and H2 receptor blocker use in this population.

Main Methods:

• Retrospective analysis of 248 nursing home residents' medication data.
• Logistic regression modeling to identify significant predictors of PPI use.

Main Results:

• Ninety-three percent of residents on PPIs had prescriptions exceeding recommended durations.
• Higher anticholinergic burden (p=0.031) and increased number of oral products (polypharmacy) (p=0.04) were significant predictors of PPI use.
• These factors may be linked to polypharmacy-associated dyspepsia and anticholinergic effects on esophageal pressure.

Conclusions:

• High PPI utilization in nursing homes may indicate a prescribing cascade.
• Strategies to mitigate polypharmacy and anticholinergic burden could reduce inappropriate PPI use.