Cascade iatrogenesis: factors leading to the development of adverse events in hospitalized older adults.


Journal Article (Review)

Older adults are at particular risk for injuries associated with hospitalization and the rate of adverse events increases significantly with age. The purpose of this paper is to review factors associated with the development of adverse events in hospitalized older adults, especially those factors that contribute to cascade iatrogenesis. Cascade iatrogenesis is the serial development of multiple medical complications that can be set in motion by a seemingly innocuous first event [Rothschild, J.M., Bates, D.W., Leape, L.L., 2000. Preventable medical injuries in older patients. Archieves of Internal Medicine 160 (October), 2717-2728]. Research has examined how patient characteristics may lead to cascade iatrogenesis, but existing conceptual models and research have not considered the role of nursing care. Using the outcome postoperative respiratory failure as an example, we expand on existing knowledge about factors associated with older adults' risk for developing this complication by presenting a conceptual model of events that may trigger the initial cascade and the nursing care variables that may prevent or mitigate these risks. We believe that this model will help guide research in this area and enable clinicians to identify systemic failures and develop targeted interventions to prevent their occurrence.

Full Text

Duke Authors

Cited Authors

  • Thornlow, DK; Anderson, R; Oddone, E

Published Date

  • November 2009

Published In

Volume / Issue

  • 46 / 11

Start / End Page

  • 1528 - 1535

PubMed ID

  • 19643409

Pubmed Central ID

  • 19643409

Electronic International Standard Serial Number (EISSN)

  • 1873-491X

Digital Object Identifier (DOI)

  • 10.1016/j.ijnurstu.2009.06.015


  • eng

Conference Location

  • England