Polypharmacy among the elderly: a population-based study

Prevalence of depressive symptoms and associated factors among older adults treated at a referral center

Abstract The present study aimed to estimate the prevalence of depressive symptoms and associated factors among older adults treated at a referral center. A cross-sectional study was carried out with a sample of 360 older adults treated at a Referral Center for the Health of Older Adults in the north of Minas Gerais, Brazil. The following data were collected in 2017: demographic, socioeconomic, morbidity, hospital admission in the last year, frailty (Edmonton Frail Scale), functional capacity (Katz Index, Lawton and Brody Scale) and presence of depressive symptoms (Geriatric Depression Scale - GDS-15). Multiple analysis was performed through logistic regression. A prevalence of depressive symptoms was observed in 37.2% of the sample. The variables associated with depressive symptoms were: negative perception about one’s own health (OR=1.9, 95% CI 1.34-2.70); frailty (OR=1.94, 95% CI 1.41-2.66); having suffered falls (OR=1.24, 95% CI 1.01-1.61); having been hospitalized in the last year (OR=1.56, 95% CI, 1.11-2.27); (OR=2.56, 95% CI 1.38-4.77) and residing alone (OR=1.66, 95% CI 1.09-2.53). Thus, a high prevalence of depressive symptoms was identified among the older adults, evidencing the need for an effective and immediate approach by health professionals.

Association between number of medications used and nutritional markers among elderly persons with chronic diseases: National Health Survey (2013)

Abstract Objective: to evaluate the association between the number of medications taken and nutritional markers in Brazilian elderly persons diagnosed with chronic diseases. Method: study based on data from the National Health Survey (PNS) 2013, for the population aged 60 years or older who reported at least one chronic disease (hypertension, diabetes mellitus, heart disease, stroke, arthritis, depression, lung disease and chronic renal failure) (7,770 elderly persons). The outcome was the number of medications used for the selected diseases (0, 1 to 2 and 3 or more), and the exploratory variables were food consumption markers and anthropometric indicators (body mass index, waist circumference and waist-to-height ratio). The associations were evaluated by multinomial logistic regression, estimating the odds ratio and confidence intervals (95%) and considering potential confounding factors. Results: the use of a greater number of medications was positively associated with the consumption of fruits and vegetables, fish and milk, and negatively associated with the consumption of sweet foods, soft drinks and meat with excess fat; a greater consumption of medications was also associated with higher anthropometric indicator values. Conclusion: although a greater consumption of medications was associated with better dietary indicators, these elderly persons also had higher anthropometric indicator values, including a higher concentration of central adiposity.

Polypharmacy in community-based older adults: results of the Fibra study

Abstract Objectives : To estimate the prevalence of polypharmacy among older adults (≥65 years); to verify its association with sociodemographic variables, nutritional status and health conditions; to describe the prevalence of polypharmacy according to the presence of specific chronic diseases, and to report the method of acquiring drugs. Method : A cross-sectional study was performed with older adults (n=2,217) from seven Brazilian municipal regions. The prevalence of polypharmacy and its 95% confidence intervals were estimated. Associations were verified using Pearson’s Chi-squared test with a significance level of 5%, and the independent associations between the selected variables and polypharmacy were verified by multiple hierarchical Poisson regression. Results : The prevalence of polypharmacy was 18.4% (CI95%:16.8-20.0), and was significantly lower among non-white individuals, those who did not have a health plan, and those who assessed their health as very good/good (p<0.05). Obesity: (PR=1.36; CI95%:1.06-1.75), increased waist circumference (PR=1.54; CI95%:1.08-2.20) and presence of two (PR=2.24; CI95%:1.52-3.31) or three or more (PR=4.22; CI95%:2.96-6.02) chronic diseases were positively associated with polypharmacy. Polypharmacy was observed in about 30.0% of older adults with heart disease, diabetes mellitus and/or strokes/CVA/ischemia. The frequency of older adults who acquired drugs in Basic Health Units was 20.3% and those who obtained them via their own/family resources was 13.5%. Conclusion : Among older adults, the identification of segments with a higher prevalence of polypharmacy enables a better structuring of the provision of treatment during their care pathway, allowing special attention to be paid to problems related to the use of drugs.

Medication use by the elderly: analysis of prescribing, dispensing, and use in a medium-sized city in the state of São Paulo

Abstract Objective: To describe the prescribing, dispensing, use, adhesion, and storage of medicines to and by the elderly. Method: A descriptive cross-sectional study was performed in Estratégia Saúde da Família (Family Health Strategy) health centers (ESF), in Marília in the state of São Paulo, Brazil, based on the records of and interviews with 114 individuals seven to ten days after a medical consultation. A descriptive analysis was carried out. Results: The mean number of prescribed drugs was 4.98 per elderly patient. Of the total number of prescribed drugs, 81.5% were supplied by public services, with the nutrient (50%); antilipemic (62.1%); analgesic (30.7%); dermo-protector (66.6%); herbal (40%) and parasite and antifungal (37.5%) classes dispensed the least. A total of 83.8% of the prescribed drugs were used, while the drugs dispensed at the lowest rates were not used by the elderly, except for analgesics. A total of 40.3% of the respondents exhibited low adherence. Most stored their medicines in a suitable place. Conclusion: The prescribing, dispensing, use and storage of medications to and by the elderly can be considered effective, but adherence remains low, requiring new strategies and interventions.