Evidence map›Paper›PMID 40742670›Full record

ArticleEuropean geriatric medicine2025

International expert panel's potentially inappropriate prescribing cascades (PIPC) list.

Paula A Rochon, Denis O'Mahony, Antonio Cherubini, Graziano Onder, Mirko Petrovic, Kieran Dalton, Lisa M McCarthy, Shelley A Sternberg, Donna R Zwas, Nathan M Stall and 7 more

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In one paragraph

Article in European geriatric medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 10 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing 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

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

  1. Pooled it
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4 · The record

Corrections and comments

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, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. paula.rochon@wchospital.ca.ORCID http://orcid.org/0000-0002-5973-4151
Denis O'MahonyDepartment of Medicine (Geriatrics), School of Medicine, University College Cork, Cork, Ireland.
Antonio CherubiniDepartment of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy.
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.
Kieran DaltonPharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
Lisa M McCarthyLeslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
Shelley A SternbergDepartment of Medicine, Division of Geriatrics, Maccabi Healthcare Services, Tel Aviv, Israel.
Donna R ZwasHadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Nathan M StallWomen's Age Lab and Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
Christina E Reppas-RindlisbacherWomen's Age Lab and Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
Nathalie van der VeldeInternal Medicine, Section of Geriatric Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Sarah N HilmerDepartment of Clinical Pharmacology, Royal North Shore Hospital, Sydney, Australia.
Wei WuWomen's Age Lab and Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
Joyce LiWomen's Age Lab and Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
Amy LyWomen's Age Lab and Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
Jerry H GurwitzDivision of Geriatric Medicine, UMass Chan Medical School, Worcester, MA, USA.

Funding

CIHR grant PCS-197247CIHR PJT-180408GENDER-NET Plus ERA-Net Cofund GNP-1782Ministero della Salute RRC-2019-2366768
6 · The paper itself

Abstract

purposePrescribing cascades contribute to potentially inappropriate prescribing, especially among older adults. With the prescribing cascade framework maturation, it is important to distinguish potentially inappropriate from potentially appropriate prescribing cascades. The objective was to create a comprehensive consensus list of Potentially Inappropriate Prescribing Cascades (PIPCs).

methodsA prescribing cascade inventory was compiled using published lists. An international panel of 12 experts in geriatric medicine and pharmacology was selected. Panelists participated in a Delphi consensus process completing two questionnaire rounds and one discussion round.

resultsA total of 107 proposed prescribing cascades were identified. After Questionnaire Round 1, 56 prescribing cascades achieved a rating of agree or strongly agree by ≥ 75% of the panelists and were included in the PIPC list. For 32 of the 107 proposed cascades, 50-74% of panelists provided a rating of agree or strongly agree, and were moved to Round 2. In Questionnaire Round 2, 9 of 32 proposed cascades achieved a rating of agree or strongly agree by ≥ 75% of panelists and were included in the final PIPC list. For 14 prescribing cascades, 50-74% of panelists provided a rating of agree or strongly agree, and were included in the Discussion Round. After discussion, no additional prescribing cascades were included.

conclusionAn explicit list of 65 PIPCs was created using a rigorous Delphi consensus process conducted by international experts on pharmacotherapy for older adults. The PIPC list provides a crucial tool for clinicians and researchers to detect potentially inappropriate prescribing patterns and to foster efforts to improve medication safety.

Indexed as

Inappropriate PrescribingPotentially Inappropriate Medication ListPractice Patterns, Physicians'AgedConsensusDelphi TechniqueHumansSurveys and QuestionnairesDelphi consensusOlder adultsOptimizing drug therapyPrescribing cascade

Identifiers

PMID40742670
PMCPMC12712104

What OpenQuestion holds

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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.