An unintentional prescribing cascade occurs when a medication side effect is misinterpreted as a new symptom resulting in the initiation of a new medication. Interviews were conducted with patients, caregivers, physicians, pharmacists, and other experts for their perspectives on prescribing cascades in older adults. Adverse drug events, and therefore prescribing cascades, were accepted as unavoidable for older adults taking multiple medications. Clinicians felt challenged when balancing risks and benefits of further prescribing. None of the stakeholder groups felt like they had adequate information for a safe medication reconciliation which presents a missed opportunity to identify and stop prescribing cascades.