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Little is known about which older adults are at highest risk of experiencing prescribing cascades. We explored which older veterans are at highest risk of the gabapentinoid (including gabapentin and pregabalin)\u2013loop diuretic (LD) cascade, given the dramatic increase in gabapentinoid prescribing in recent years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using Veterans Affairs and Medicare claims data (2010\u20132019), we performed a prescription sequence symmetry analysis (PSSA) to assess loop diuretic initiation before and after gabapentinoid initiation among older veterans (\u226566\u2009years). To identify the cascade, we calculated the adjusted sequence ratio (aSR), which assesses the temporality of LD relative to gabapentinoid initiation. To explore high\u2010risk groups, we used multivariable logistic regression with prescribing order modeled as a binary dependent variable. We calculated adjusted odds ratios (aORs), measuring the extent to which factors are associated with one prescribing order versus another.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 151,442 veterans who initiated a gabapentinoid, there were 1,981 patients who initiated a LD within 6\u2009months after initiating a gabapentinoid compared to 1,599 patients who initiated a LD within 6\u2009months before initiating a gabapentinoid. In the gabapentinoid\u2013LD group, the mean age was 73\u2009years, 98% were male, 13% were Black, 5% were Hispanic, and 80% were White. Patients in each group were similar across patient and health utilization factors (standardized mean difference &lt;0.10 for all comparisons). The aSR was 1.23 (95% CI: 1.13, 1.34), strongly suggesting the cascade's presence. People age \u226585\u2009years were less likely to have the cascade (compared to 66\u201374\u2009years; aOR 0.74, 95% CI: 0.56\u20130.96), and people taking \u226510 medications were more likely to have the cascade (compared to 0\u20134 drugs; aOR 1.39, 95% CI: 1.07\u20131.82).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among older adults, those who are younger and taking many medications may be at higher risk of the gabapentinoid\u2013LD cascade, contributing to worsening polypharmacy and potential drug\u2010related harms. We did not identify strong predictors of this cascade, suggesting that prescribing cascade prevention efforts should be widespread rather than focused on specific subgroups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.18892","type":"journal-article","created":{"date-parts":[[2024,3,28]],"date-time":"2024-03-28T14:37:17Z","timestamp":1711636637000},"page":"1728-1740","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Which older adults are at highest risk of prescribing cascades? A national study of the gabapentinoid\u2013loop diuretic cascade"],"prefix":"10.1111","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5997-4406","authenticated-orcid":false,"given":"Matthew E.","family":"Growdon","sequence":"first","affiliation":[{"name":"Division of Geriatrics University of California, San Francisco  San Francisco California USA"},{"name":"San Francisco Veterans Affairs Medical Center  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bocheng","family":"Jing","sequence":"additional","affiliation":[{"name":"Division of Geriatrics University of California, San Francisco  San Francisco California USA"},{"name":"San Francisco Veterans Affairs Medical Center  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6092-8906","authenticated-orcid":false,"given":"Earl J.","family":"Morris","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes &amp; Policy University of Florida College of Pharmacy  Gainesville Florida USA"},{"name":"Center for Drug Evaluation and Safety University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7947-3008","authenticated-orcid":false,"given":"W. James","family":"Deardorff","sequence":"additional","affiliation":[{"name":"Division of Geriatrics University of California, San Francisco  San Francisco California USA"},{"name":"San Francisco Veterans Affairs Medical Center  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. John","family":"Boscardin","sequence":"additional","affiliation":[{"name":"Division of Geriatrics University of California, San Francisco  San Francisco California USA"},{"name":"San Francisco Veterans Affairs Medical Center  San Francisco California USA"},{"name":"Department of Epidemiology and Biostatistics University of California, San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy L.","family":"Byers","sequence":"additional","affiliation":[{"name":"Division of Geriatrics University of California, San Francisco  San Francisco California USA"},{"name":"San Francisco Veterans Affairs Medical Center  San Francisco California USA"},{"name":"Department of Psychiatry, Weill Institute for Neurosciences University of California, San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1165-5558","authenticated-orcid":false,"given":"Kenneth S.","family":"Boockvar","sequence":"additional","affiliation":[{"name":"Division of Gerontology, Geriatrics, and Palliative Care University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9564-9480","authenticated-orcid":false,"given":"Michael A.","family":"Steinman","sequence":"additional","affiliation":[{"name":"Division of Geriatrics University of California, San Francisco  San Francisco California USA"},{"name":"San Francisco Veterans Affairs Medical Center  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,28]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(17)31188\u20101"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15800"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18683"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40266\u2010021\u201000868\u20100"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15543"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sapharm.2021.08.003"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afac138"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.17312"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.7087"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.18425"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.15447"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjopharm.2004.09.004"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102296\u201011\u201085"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.7856"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.0086"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.14408"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010023\u201008250\u2010z"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1704633"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/jep.12223"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40266\u2010023\u201001066\u2010w"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654\u2010017\u20100281\u20108"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-199609000-00005"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874\u2010017\u20100457\u20107"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopha.2022.112807"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.9740\/mhc.2020.07.250"},{"key":"e_1_2_13_28_1","unstructured":"Identifying Medicare Managed Care Beneficiaries from the Master Beneficiary Summary or Denominator Files | ResDAC.2021. 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