Evidence map›Paper›PMID 39699297›Full record

ArticleJournal of the American Geriatrics Society2025

The impact of age, sex, and gender on polypharmacy and potential prescribing cascades: Lessons from five databases.

Paula A Rochon, Joyce Li, Denis O'Mahony, Graziano Onder, Mirko Petrovic, Shelley A Sternberg, Jerry H Gurwitz, Rachel D Savage, Wei Wu, Vasily Giannakeas and 7 more

Abstract read
In one paragraph

Article in Journal of the American Geriatrics Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Real-World Complexity of Prescribing Cascades.Basic & clinical pharmacology & toxicology · 2025
    Review
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Paula A RochonWomen's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.ORCID 0000-0002-5973-4151
Joyce LiWomen's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.ORCID 0000-0001-8112-2701
Denis O'MahonyDepartment of Medicine (Geriatrics), University College Cork, Cork, Ireland.
Graziano OnderDepartment of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy.
Mirko PetrovicDepartment of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.ORCID 0000-0002-7506-8646
Shelley A SternbergDepartment of Medicine, Division of Geriatrics, Maccabi Healthcare Services, Tel Aviv, Israel.
Jerry H GurwitzDivision of Geriatric Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA.
Rachel D SavageWomen's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.ORCID 0000-0002-2746-373X
Wei WuWomen's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
Vasily GiannakeasWomen's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
Altea KthupiWomen's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
Kieran DaltonPharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.ORCID 0000-0003-1209-8079
Lisa M McCarthyLeslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.ORCID 0000-0001-9087-1077
Robin MasonWomen's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
Amanda GiancolaWomen's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
Parya BorhaniWomen's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
Antonio CherubiniDepartment of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.

Funding

Canadian Institutes of Health Research - Institute of AgingCanadian Institutes of Health Research - Institute of Gender and HealthGENDER-NET Plus ERA-Net GNP-1782Irish Research CouncilMinistero della Salute (Italy) RRC-2019-2366768Ministry of Science and Technology (Israel)
6 · The paper itself

Abstract

backgroundFew studies describe how gender-related factors may contribute to polypharmacy and prescribing cascades. Describing these patterns using cross-national comparisons can improve the robustness of findings and provide lessons on the importance of considering age, sex, and gender in pharmacological research. The aim of the study was to explore the intersection of age, sex, and gender with polypharmacy and co-prescribing suggesting a potential prescribing cascade.

methodsIn this cross-sectional descriptive study, we assessed polypharmacy and calcium channel blocker and diuretic co-prescribing suggesting a prescribing cascade in patients aged ≥65 years from five international secondary databases: population-level community and nursing home (ICES, Maccabi Healthcare Services), clinical trial (SENATOR), and patient registry (Report-AGE, SHELTER). The intersection of age, sex, and gender was explored.

resultsAll databases provided age and sex; none included gender-identity data. Gender-related sociocultural factors, socioeconomic status (SES) measured as income and educational attainment, and marital status were not uniformly collected. Compared with males, females had lower income, has less educational attainment, and were more frequently widowed. Polypharmacy was more common in men. Co-prescribing suggesting a prescribing cascade was more frequent in females in four databases and was also more frequent in lower SES and unmarried groups (significant in ICES (community and nursing home) and Maccabi (community), with a nonsignificant trend in Maccabi (nursing home) and three remaining databases). Using two population-level databases, the prevalence of co-prescribing suggesting a prescribing cascade was highest among females 85 years and older who were also in the lower SES group (11.0% ICES and 14.6% Maccabi). Gender disparity was highest in this group (ICES Differential Prevalence = 3.0%, Maccabi Differential Prevalence = 3.8%).

conclusionOlder adults with lower SES experienced polypharmacy or co-prescribing suggesting a prescribing cascade more frequently than those with higher SES. Within the lower SES groups, females more frequently than males had evidence of co-prescribing suggesting a prescribing cascade. Considering the role of sex and gender-related sociocultural factors may help to better understand some contributors to polypharmacy and prescribing cascades. The research applications are highlighted in our five lessons learned.

Indexed as

Drug PrescriptionsPolypharmacyPractice Patterns, Physicians'AgedAged, 80 and overAge FactorsCross-Sectional StudiesDatabases, FactualFemaleHumansMaleSex FactorsSocioeconomic Factorsagegenderpolypharmacyprescribing cascadessex

Identifiers

PMID39699297
PMCPMC11825996

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.