Uso de medicamentos potencialmente inapropriados por idosos do Município de São Paulo, Brasil: Estudo SABE

Factors Associated With PIM use in the Frail Elderly: A Cross-sectional Study

Background: The use of potentially inappropriate medications (PIM) by the elderly is commonly studied, but studies evaluating the use of PIM by frail elderly covered by prepaid health plans are still lacking. Objective: To identify the prevalence of use and the factors associated with the use of PIM by the elderly patients with high and moderate risk of clinical-functional vulnerability, according to the Beers criteria 2019. Methods: A cross-sectional study was developed with elderly people from a private health plan in Vitória-ES, Brazil. Socioeconomic, demographic and clinical data were collected through a digital platform and a structured questionnaire through an interview, from October 2018 to June 2019. The association between the use of PIM and independent variables was verified by univariate logistic regression with their respective confidence intervals (CI) 95%. The Multiple Model included the variables with P ≤ .20. Results: 332 elderly patients were interviewed (mean age 81.5 years, gender 237 female, 95 male). A 65% prevalence of PIM use was identified. In the multiple logistic regression model, the variables associated with the use of PIM were self-medication (P = .004), high risk of clinical-functional vulnerability (P = .022), use of psychotropic medications (P = .000001), musculoskeletal medications (P = .04) and alimentary tract medications (P = .03). Physical exercises were considered a protection factor (P = .02). Conclusion: The high prevalence of PIM use indicates the need for improvement in elderly private health care, to increase pharmacotherapy safety for this population.

Risk factors for potentially inappropriate medication use in older adults: a cohort study

BACKGROUND

Much of the knowledge on the use of potentially inappropriate medications (PIM) in older adults is derived from cross-sectional studies, with little known about the risk factors over time.

AIM

Longitudinal analysis was applied to estimate the occurrence and risk factors of PIM use among older adults in a 10-year follow-up.

METHOD

Longitudinal study with 418 older adult residents of a capital city of Central-West Brazil. The PIM were classified according to the Beers criteria 2019. The usage rate was calculated at baseline (2008) and at the 10-year follow-up moment (2018). Analysis of predictors (sociodemographic, self-rated health, hospitalization, number of comorbidities, polypharmacy, diabetes, hypertension, hypercholesterolemia and nutritional status) was performed using Generalized Estimating Equation (GEE) models.

RESULTS

Mean age at baseline was 70.6 years (SD 7.1) and 76% were women; 221 older adults took part in the follow up. The rate of PIM use was 50.4% at baseline and 57.5% at the 10-year follow-up. Multiple analysis showed that PIM use in the cohort was statistically higher in the older adults with a history of hospitalization (RR_adj 1.20; 95% CI 1.01-1.40), with three or more diseases (RR_adj 1.41; 95% CI 1.14-1.74), with polypharmacy (RR_adj 1.81; 95% CI 1.47-2.24) and with diabetes mellitus (RR_adj 1.24; 95% CI 1.05-1.47).

CONCLUSION

A high level of potentially inappropriate medication use was observed, reaching 50% of the older adults, with a 7% increase in the prevalence over the 10-year follow-up period. Hospitalization, multimorbidities, polypharmacy and diabetes mellitus were associated with the use of these medications. Interventions for surveillance of the deprescribing process need to be encouraged to avoid potential harm caused by the use of medications.

Use of potentially inappropriate medications and adverse events in older outpatients with acute conditions

Objective

To examine associations between potentially inappropriate medication, use and the risk of falls, unplanned hospitalization and death in older patients receiving initial care in a geriatric day hospital due to acute conditions.

Methods

Cohort study with older adults referred to a geriatric day hospital from 2014 to 2017 due to acute conditions. Patients were submitted to comprehensive geriatric assessment. Use of medications was analyzed according to Beers Criteria 2019. Outcome assessment was based on monthly follow-up telephone calls made over the course of one year.

Results

In this sample, 40.6% of patients had been prescribed at least one potentially inappropriate medication, particularly proton pump inhibitors (66.5%). Over the course of follow-up, 44.7% of patients receiving potentially inappropriate medications sustained at least one fall (p=0.0043) and 70% visited the emergency department (p=0.0452). These outcomes were more common among patients using two or more of drugs. Use of potentially inappropriate medication was associated with a 64% increase in the odds of unplanned hospitalization and a two-fold increase in risk of death.

Conclusion

Associations between potentially inappropriate medication use and unfavorable outcomes such as falls and unplanned hospitalizations within one year of admission to a geriatric day hospital support the application of Beers Criteria and emphasize the importance of periodic prescription review, deprescription and rational use of these drugs whenever possible.

[Prescription of potentially inappropriate medications for the elderly: a study in Primary Health Care]

The elderly population is vulnerable to the risks of the use of medications, especially those considered potentially inappropriate medications (PIMs), in which the risks outweigh the benefits. The study sought to evaluate the PIMs prescribed in Primary Health Care (PHC) and associated factors. A cross-sectional, analytical study was carried out from March to December 2019 in PHC in Campina Grande, Paraíba, through interviews with 458 elderly individuals. The independent variables included socioeconomic characteristics, health status and the use of medications, and the outcome was classified as PIM by the Brazilian Consensus on Potentially Inappropriate Medications. There was a prescription of at least one PIM for 44.8% of the elderly and the majority affecting the Central Nervous System (54.4%). In the adjusted model, depression (PR=2.01; 95%CI 1.59-2.55), using other medications in addition to those prescribed (PR=1.36; 95%CI 1.08-1.72) and polypharmacy (PR=1.80; 95%CI 1.40-2.33) remained an associated factor, and self-reporting systemic arterial hypertension became a protective factor (PR=0.65; 95%CI 0.49-0.87). This reveals the need for actions to monitor closely the use of PIMs by the elderly to ensure access in conjunction with safety.

Evidence of association between the use of drugs and community-dwelling older people frailty: a cross-sectional study

BACKGROUND

The scientific literature has shown that an association between polypharmacy and frailty exists. However, few studies have also considered drug interactions and the use of potentially inappropriate medications.

OBJECTIVE

To evaluate the association between the use of drugs and frailty among community-dwelling older people.

DESIGN AND SETTING

Cross-sectional study carried out among 580 older people in Uberaba (MG).

METHODS

Data were collected at these older people's homes using instruments validated in Brazil. Descriptive, bivariate and binary logistic regression analyses were performed (P < 0.05).

RESULTS

Most of these individuals were classified as pre-frail (55.7%), while 13.1% were frail. It was found that 31.7% of them presented polypharmacy, 41.7% had drug interactions and 43.8% were using potentially inappropriate medications. In the initial model, polypharmacy (odds ratio, OR = 1.91; confidence interval, CI = 1.27-2.86) and use of potentially inappropriate medications (OR = 2.45; CI = 1.68-3.57) increased the chance that these older people would be pre-frail or frail. In the final adjusted model, use of potentially inappropriate drugs remained associated with the outcome (OR = 2.26; CI = 1.43-3.57).

CONCLUSION

Use of potentially inappropriate medications was the independent variable that explained the occurrence of frailty in a representative sample of community-dwelling older adults.

Potentially inappropriate medications for the elderly: Incidence and impact on mortality in a cohort ten-year follow-up

INTRODUCTION

Pharmacological therapy plays an important role in disease control in the elderly; unfortunately, this comes with a high prevalence in the use of medications classified as potentially inappropriate.

OBJECTIVE

To analyze the incidence, risk factors, and survival of elderly people using potentially inappropriate medications (PIM).

METHOD

A ten-year follow-up assessment of elderly participants residing in a capital of Central Brazil was conducted. The initial assessment (baseline) included 418 elderly people. Data were collected through home interviews guided by a questionnaire covering socioeconomic, demographic, living conditions, and health variables. The medication information obtained comprised active ingredient, dosage, route, and regimen for the medications. The PIMs were classified according to 2019 Beers Criteria. The analyses were performed using STATA 15.0. For survival analysis, a Cox Regression was performed with the respective Kaplan Meier curve.

RESULTS

The incidence of PIM was 44.1 cases (95% CI: 35.2-54.7) per 1,000 people a year. The most used PIMs were nifedipine, glibenclamide, and sodium diclofenac. The risk factors were polypharmacy (aRR: 3.00; 95% CI: 1.31-6.88) and diabetes mellitus (aRR: 1.57; 95% CI: 1.03-2.39). We identified no statistically significant association between survival and the use of PIM.

CONCLUSION

The study highlights the high consumption of PIM among the elderly causing polypharmacy risks. Health professionals working in drug treatment need to be alert to polypharmacy risks to ensure the rational use of medications to prevent adverse reactions and other health problems.

Avaliação farmacológica de medicamentos usados por idosos frequentadores de uma drogaria privada

Objetivo: realizar a avaliação da farmacoterapia de idosos frequentadores de uma drogaria privada.Método: a pesquisa abrangeu um estudo transversal realizado no período de junho a setembro de 2019, em uma drogaria privada, conveniada ao Programa Farmácia Popular do Brasil, localizada no município de Nova Bréscia/RS. Para a coleta de dados foi aplicado um questionário, a fim de analisar a farmacoterapia e os hábitos de vida dos idosos participantes da pesquisa na drogaria selecionada.Resultados: a população pesquisada envolveu 81 idosos, sendo a maioria composta por mulheres (69,1%) e a idade média dos participantes foi de 69,4 anos, predominando aqueles na faixa de 60 a 69 anos (53,1%). A grande maioria dos entrevistados (66,7%) se automedica; 36 (44,4%) pessoas foram classificadas com o nível de polifarmácia maior e uma média de 4,64 medicamentos por pessoas. No total, foram 45 pessoas (55,6%) que tiveram algum tipo de interação medicamentosa, variando uma média de 2,72 interações por pessoa. Na pesquisa, foram encontrados 59 medicamentos que são considerados inapropriados para os idosos de acordo com os Critérios de Beers.Conclusão: o envelhecimento predispõe os idosos a um aumento do uso de medicamentos, aumentando o nível de polifarmácia e as chances de ter interações medicamentosas. Assim, destaca-se a importância do profissional farmacêutico em orientá-los sobre os medicamentos, sobre a não utilização de alguns fármacos, o uso de doses adequadas, acompanhamento da terapia farmacológica, como a sua eficácia e, dessa forma, contribuir para uma qualidade de vida melhor.

Use of potentially inappropriate medications in institutionalized elderly: prevalence and associated factors

This study aimed to verify the prevalence of the use of Potentially Inappropriate Medications (PIM) for elderly living in Long-Term Care Institutions for the Elderly (LTCIE), as well as the types of medications and their associated factors. This is a cross-sectional study carried out in 10 LTCIEs in the city of Natal in the period October-December 2013. Potentially inappropriate medications were classified according to the 2015 American Geriatric Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults - 2015. Sociodemographic, LTCIE-related and health-related variables were considered. Univariate and multivariate analyses were performed between the primary variable (PIM use) and the independent variables using Poisson regression. The sample consisted of 321 older people, of whom 304 used medications. The prevalence of PIM use was 54.6% (95% CI: 48.9-60.2) and was associated with polypharmacy and dementia in the final model. The most common PIMs were antipsychotics and benzodiazepines. The study revealed a high prevalence of PIM use among the elderly of the LTCIEs, evidencing the need to adopt indicators on the use of these drugs and the implementation of strategies that make drug therapy safer and more adequate for older adults.

Use of medicines by adults in primary care: Survey on health services in Minas Gerais, Brazil

INTRODUCTION

Inappropriate use and increase of health care spending reinforce the need to extend our knowledge about the quality of medication use.

OBJECTIVES

To describe and evaluate the profile of medication use in a representative sample of adult users of primary care services in the Unified Health System (SUS) of Minas Gerais.

METHOD

Cross-sectional study, with 1,159 interviewees in 104 municipalities and 253 health care services. Data on sociodemographic characteristics, health conditions and use of medicines were collected, and these variables were stratified by age group. Univariate and multivariate analyses, using logistic regression, were conducted to identify predictors of self-medication. We set a significance level of 5% for all tests.

RESULTS

The prevalence of medication use was 81.8%, with an average of 2.67 medicines per user, which increased with age. The most used drugs were losartan, hydrochlorothiazide and simvastatin, which differed between age groups. Significant self-medication was observed not only in young adults but also in the elderly. The predictors of self-medication were: being a young adult, having a higher level of education, not having chronic diseases, having worse self-perception of health and not adhering to prescription drugs. Young and elderly adults showed characteristics that made them more vulnerable in relation to the rational use of medicines.

CONCLUSION

This study can contribute to improving primary care, where it identified problems related to the extent of medication use, especially among young adults and the elderly in Minas Gerais.

Patient safety in primary health care and polypharmacy: cross-sectional survey among patients with chronic diseases

OBJECTIVE

to characterize and determine the polypharmacy prevalence in patients with chronic diseases and to identify the factors associated, in order to improvement of pharmaceutical care focused on patient safety.

METHODS

cross-sectional study included 558 patients, covered by primary health care, using a household and structured questionnaire. We analyzed the data on polypharmacy and its clinical and socioeconomic factors. Poisson regression analysis with robust variance was applied, with results expressed in prevalence ratio.

RESULTS

the results showed that polypharmacy (consumption of four or more drugs) was of 37.6%. The prevalence ratio analyses identified independent variables associated with polypharmacy: age (3.05), economic strata (0.33), way of medication acquisition through a combination of out-of-pocket and Brazilian public health system (1.44), diabetes and hypertension (2.11), comorbidities (coronary artery disease 2.26) and hospital admission (1.73). In the analyses, inappropriate medication use of the 278 patients (≥ 65 years) was associated with polypharmacy (prevalence ratio 4.04).

CONCLUSION

polypharmacy study becomes an opportunity to guide the strategies for the patient safety to promote the medication without harm in chronic diseases.

Potentially inappropriate medication use and frailty phenotype among community-dwelling older adults: A population-based study

AIMS AND OBJECTIVES

To investigate the association between potentially inappropriate medication use and frailty phenotype among community-dwelling older adults and to identify factors associated with the use of these drugs according to frailty condition.

BACKGROUND

There is insufficient evidence about the association between inappropriate medication use and the condition of frailty, particularly among community-dwelling older adults. Therefore, data obtained from population surveys should be made available in order to support the development of clinical guidelines about the prevention of frailty.

DESIGN

This was a cross-sectional study conducted according to the STROBE Checklist.

METHODS

This population-based study was conducted on 1,607 older adults. Potentially inappropriate medication use was assessed according to Beers criteria and frailty syndrome was determined according to the phenotype proposed by Fried and colleagues. Data were analysed statistically using multinomial or binary logistic regression models.

RESULTS

About 13.6% of the subjects were frail, and 36.8% used at least one inappropriate medication. The adjusted model indicated that, the more potentially inappropriate medication use, the higher the prevalence of frailty, prefrailty and the walking slowness component. Female gender, one or more years of schooling, five or more reported morbidities, and instrumental dependence regarding daily life activities were factors associated with potentially inappropriate medication use in the nonfrail group.

CONCLUSION

Inappropriate medication use was prevalent among community-living older adults, and its presence was associated with the occurrence of frailty.

RELEVANCE TO CLINICAL PRACTICE

Primary care nurses are the professionals with the greatest contact with the older adults in the community. Thus, the results support the inclusion of the assessment of potentially inappropriate medication use in the routine of nursing consultation. In case of a positive screening, the older person should be referred to geriatric evaluation in order to optimise drug treatment for the prevention of frailty.

Potentially inappropriate medications in older kidney transplant recipients: a Brazilian prevalence study

Background Older kidney transplant recipients take a larger number of medications than younger patients, but there is currently no evidence that this affects health outcomes or that is it associated with potentia medicine-related problems. Objective To evaluate the prevalence and number of potentially inappropriate medications in older kidney transplant recipients and also the possible associated factors (sex, age, comorbidities, number of medications, etc.). Setting A renal post-transplant ambulatory outpatient clinic of a university hospital in Fortaleza, Brazil. Method PIMs were defined according to the Beers criteria, version 2015. Medications were classified following the Anatomical Therapeutic Chemical Classification System. Chi squared tests and analysis of variance were used for the analyses. Main outcome measure Prevalence of potentially inappropriate medications and medication groups with higher prevalence rates of PIMs, including associated factors. Results Among 143 kidney transplant recipients, 77.6% had at least one potentially inappropriate medication as part of their prescription regime. Medication groups that were most implicated in PIM are medicines that act on the alimentary tract and metabolism (55.9%), cardiovascular system (32.2%) and nervous system (21.7%). We detected a high prevalence (63.6%) of self-medication (use of OTC medicines without indication of a healthcare professional) among the population studied. There was a statistically significant association between the number of prescribed medications and the presence of potentially inappropriate medication in the prescription regime (P < 0.01). Conclusion Our data draw attention to the need of medicine therapy management by clinical pharmacists and clinicians in this group of patients and also assessing the real clinical impacts of these medications in the prescription regimes of elderly renal transplant patients.

Prescription of potentially inappropriate medication for the elderly: comparing health service providers

Abstract Objective: to compare the prescription of medications to elderly users of the SUS with users of a Supplementary Health Plan in the context of the Beers criteria. Method: a quantitative documental analysis using two databases, obtained from surveys conducted in the same municipal region, was performed. In the first database, the sample included 532 people aged 60 years or older, of both genders, who were users of the SUS. In the second, the sample was 239 people aged 60 years or older, irrespective of gender, who were users of the principal supplementary health plan. Statistical analyses to compare the data of the two databases were performed using Pearson’s Chi-squared Test and the extension of Fisher’s Exact test, with a significance level α equal to 5%. Results: The results showed significant differences in the use of medications and polypharmacy among the users of the two service providers. Moreover, there were statistically significant differences between the service providers, with SUS users using more non-steroidal anti-inflammatory drugs (p=0.01), long-lasting sulfonylureas (p=0.02) and Nifedipine (p=0.01), and the users of the Supplementary Health Care plan using more musculoskeletal relaxants (p=0.01), estrogen (p=0.01), amiodarone (p=0.01) and Doxazosin (p=0.01), which are potentially inappropriate for the elderly. Conclusion: there are differences between having health insurance or not in terms of the profile of drug use, including in medications which are potentially inappropriate for use among the elderly. The use of information technology that centralizes the data of the elderly, both in the SUS and in Supplementary Health, could reduce inappropriate or unnecessary prescriptions.

Drug therapy, potential interactions and iatrogenesis as factors related to frailty in the elderly

Abstract Objective: to investigate the use of drugs, potential drug interactions and iatrogenesis, as factors associated with frailty. Method: an observational, cross-sectional, population-based study of elderly persons registered with the Family Health Strategies of the urban area of a municipal region in the south of Brazil was carried out. The sample was probabilistic and involved 554 elderly persons; and the proportional stratified sampling technique by FHS and gender was used. Data collection was performed in the home, with the gathering of information regarding sociodemographic characteristics and pharmacotherapeutic profile and the evaluation of frailty based on Fried et al. (2001). Results: medications were taken by 86.3% of the elderly and there was a prevalence of frailty of 63.0%. A total of 39.4% of the elderly were exposed to polypharmacy, 49.1% used potentially inappropriate medications and 52.2% were exposed to potential drug interactions, the most frequent being enalapril and metformin. An association between increased risk of frailty and the variables: polypharmacy; use of potentially inappropriate medications; potential drug interactions; more than two potential drug interactions with the presence or absence of potentially inappropriate medication was identified. Conclusion: an association was found between frailty and polypharmacy, the use of potentially inappropriate medication and the presence of drug interactions. The findings underscore the importance of the monitoring of drug therapy in this population group with a view to the early detection, prevention and resolution of iatrogenesis arising from the use of medicines.

Profile of elderly persons with metabolic syndrome and factors associated with possible drug interactions

Abstract Objectives: To describe the sociodemographic, clinical and pharmacotherapy characteristics of elderly persons with metabolic syndrome and to identify factors associated with drug interactions among these individuals. Method: A quantitative, analytical and transversal study was carried out among 263 elderly people with metabolic syndrome in the urban area of Uberaba, Minas Gerais, Brazil. Possible drug interactions were identified and classified according to the Micromedex® DrugReax System. The chi-squared test and the multiple logistic regression model were used for analysis (p<0.05). Results: The majority of the individuals were female (70.7%); aged 60 to 74 years (72.3%); lived with a spouse/partner (63.9%); had some schooling (74.1%); an individual monthly income of ≤ one minimum wage (77.1%); lived with others (88.2%); had five or more morbidities (89.7%) and exhibited polypharmacy (73.0%); used potentially inappropriate medications (54.4%) and had possible drug interactions (75.3%). Associated with the possible presence of drug interactions were: age range (p=0.005), polypharmacy (p<0.001) and use of potentially inappropriate medications (p=0.006). Conclusion: Possible drug interactions were associated with increased age, polypharmacy and the use of potentially inappropriate medications. This study contributes to knowledge of these possible interactions among elderly people with metabolic syndrome, and as such can be considered an important tool for planning actions to ensure the safety of these individuals who, due to the complexity of their treatment, use multiple medications.

Antidepressant use and the components of the frailty syndrome

Abstract Objective: to evaluate the effects of antidepressant use on components of frailty. Methods: a cross-sectional and analytical study comparing groups of users and non-users of antidepressants was carried out in a municipal region in the south of Brazil. The research was linked to the matrix study "Health of Elderly Persons in Primary Care". The sample was selected through access to the database of the matrix study from which two groups were extracted: users (n=87) and non-users (n=114) of antidepressants. After selection of the groups, data collection was carried out between June and September 2016 in the homes of the elderly, and included information on sociodemographic characteristics, use of medications and the evaluation of frailty. Pearson's Chi-square hypothesis test was used to verify the association between the groups and the Odds Ratio (OR) was used to calculate risk. Results: The prevalence of frailty was 62.7% and was associated with the group that used antidepressants. Among the components of frailty an association between the user group and fatigue, low gait speed and unintentional weight loss was found. A greater risk of frailty among elderly persons using tricyclic antidepressants and antidepressants potentially inappropriate for the elderly was identified. Conclusions: an association between frailty and antidepressant use was found. These results indicate the need for the clinical evaluation of the risks and benefits of prescribing antidepressants for the elderly; and reveal that when treatment begins, the monitoring and assessment of geriatric characteristics are required to ensure the safety and quality of life of the elderly.

Potentially inappropriate medications among older adults in Pelotas, Southern Brazil

OBJECTIVE

To assess the use of potentially inappropriate medications among older adults.

METHODS

This is a population-based cross-sectional study with 1,451 older individuals aged 60 years or more in the city of Pelotas, State of Rio Grande do Sul, Brazil, in 2014. We have investigated the use of medications in the last 15 days. Using the Beers criteria (2012), we have verified the use of potentially inappropriate medications and their relationship with socioeconomic and demographic variables, polypharmacy, self-medication, and burden of disease.

RESULTS

Among the 5,700 medications used, 5,651 could be assessed as to being inappropriate. Of these, 937 were potentially inappropriate for the older adults according to the 2012 Beers criteria (16.6%). Approximately 42.4% of the older adults studied used at least one medication considered as potentially inappropriate. The group of medications for the nervous system accounted for 48.9% of the total of the potentially inappropriate medications. In the adjusted analysis, the variables female, advanced age, white race, low educational level, polypharmacy, self-medication, and burden of disease were associated with the use of potentially inappropriate medications.

CONCLUSIONS

It is important to known the possible consequences of the use of medication among older adults. Special attention should be given to the older adults who use polypharmacy. Specific lists should be created with more appropriate medications for the older population in the National Essential Medicine List.

OBJETIVO

Avaliar o uso de medicamentos potencialmente inadequados entre idosos.

MÉTODOS

Estudo transversal de base populacional com 1.451 idosos com 60 anos ou mais em Pelotas, RS, em 2014. Investigou-se o uso de medicamentos nos últimos 15 dias. Utilizando os critérios de Beers (2012), verificou-se a potencial inadequação dos medicamentos e sua relação com variáveis socioeconômicas e demográficas, polifarmácia, automedicação e carga de doença.

RESULTADOS

Dentre os 5.700 medicamentos utilizados, 5.651 puderam ser avaliados quanto à inadequação. Destes, 937 eram potencialmente inadequados para idosos segundo os critérios de Beers de 2012 (16,6%). Cerca de 42,4% dos idosos usaram no mínimo um medicamento considerado potencialmente inapropriado. O grupo de medicamentos para o sistema nervoso correspondeu a 48,9% do total de medicamentos potencialmente inadequados. Na análise ajustada, as variáveis sexo feminino, idade avançada, cor da pele branca, baixa escolaridade, polifarmácia, automedicação e carga de doença mostraram-se associadas ao uso de medicamentos potencialmente inadequados.

CONCLUSÕES

É importante que sejam bem conhecidas as possíveis consequências do uso de medicamentos entre idosos. Atenção especial deve ser dada aos idosos que fazem uso de polifarmácia. É necessário existir listas específicas com medicamentos mais adequados para uso em idosos na Relação Nacional de Medicamentos Essenciais.

Analysis of medication use by elderly persons with supplemental health insurance plans

Abstract Objective: To analyze the socio-demographic and pharmacotherapeutic profiles of elderly users of a private health plan. Method: A cross-sectional and descriptive study was conducted with 239 elderly users of a private health plan in a medium-size city in the state of São Paulo, Brazil. A structured questionnaire was used for data collection and absolute and relative frequencies were obtained. The pharmacotherapeutic survey estimated the prevalence and average number of medicines used in the 15 days prior to the interview, as well as adherence to treatment. Results: Of the respondents, 79% were female, with a mean age of 73 years. The main health problems reported were: arterial hypertension, rheumatism/arthritis, dyslipidemia and diabetes. A total of 97.1% of the elderly persons used medicine, and the most frequently used classes were for the cardiovascular and digestive systems. An average of 5.9 drugs/elderly person were used and 62.8% of the sample were undergoing polymedication. A total of 11.7% of the sample used medications that were unsuitable for the elderly, 51% had average adherence to medication and 12.1% had poor adherence. Conclusions: The majority of elderly people in the sample were female, lived with relatives and had a higher-level education. Despite the use of polymedication and the presence of multiple comorbidities, the percentage of elderly persons with low adherence to treatment was lower than that found in other studies. A high level of education and purchasing power, which facilitated the access to medication of the elderly patients under study, may be important predictors of adherence to treatment. The results support maintaining a model of care for the elderly centered on the treatment of diseases and pharmacotherapy.

Utilização de medicamentos potencialmente inapropriados por idosos em domicílio

Resumo O objetivo foi avaliar a frequência de utilização em domicílio de medicamentos potencialmente inapropriados por idosos e analisar a significância clínica. Trata-se de estudo transversal retrospectivo, recorte de um estudo de utilização de medicamentos desenvolvido em um hospital público. Os medicamentos inapropriados foram classificados empregando os três grupos de critérios explícitos incluídos na Lista de Beers de 2012. Houve inclusão de 190 idosos na pesquisa e a prevalência encontrada para utilização de medicamentos inapropriados foi 44,2%. As classes terapêuticas de medicamentos inapropriados mais utilizados foram antiinflamatórios não esteroidais, agentes cardiovasculares, benzodiazepínicos e antidepressivos. Identificou-se associação positiva entre utilização de medicamentos inapropriados e polifarmácia, polipatologia e hipertensão. Na Rename 2013 identificou-se 35(34,3%) fármacos inapropriados. O estudo demonstrou alta prevalência de utilização de medicamentos inapropriados pelos idosos. As consequências clínicas da utilização de medicamentos inapropriados são importantes para a saúde pública devido ao risco de eventos adversos e impacto negativo na funcionalidade do idoso. Na atenção ao idoso é importante desenvolver ações para promover o uso racional de medicamentos.

Diabetes em idosos: uso de medicamentos e risco de interação medicamentosa

Resumo Caracterizar o perfil sociodemográfico e de saúde dos idosos segundo diabetes referido, avaliar o conhecimento e a prática quanto às opções de tratamento, bem como descrever o uso de medicamentos e potenciais riscos de interação medicamentosa (IM) neste subgrupo. Estudo transversal com 1.517 idosos de Campinas em 2008. Estimaram-se as prevalências de diabetes e verificaram-se as associações pelo teste de Rao-Scott. As potenciais IM foram avaliadas pela base de dados Micromedex®. A prevalência de diabetes referida pelos idosos foi de 21,7% sem diferença significativa entre os sexos. Verificou-se maior percentual de idosos diabéticos com 70 anos ou mais, com menor escolaridade, renda familiar per capita inferior a 1 salário mínimo e que não realizavam atividade ocupacional. O número médio de medicamentos foi de 3,9 nos 3 dias anteriores. Identificaram-se 413 possíveis interações, sendo que 53,1%, 7,8% e 7,2% dos idosos apresentaram risco de IM moderadas, menores e graves, respectivamente. Ressalta-se a importância da adoção de dieta saudável e prática de atividade física para redução do peso, controle da doença e de complicações. Evidencia-se a necessidade de atenção ao risco potencial das IM e o uso de medicamentos inapropriados ao idoso.

Analysis of potential drug interactions and adverse reactions to nonsteroidal anti-inflammatory drugs among the elderly

Abstract Objective: The aim of the present study was to analyze potential drug interactions and adverse reactions to NSAIDs in elderly users of a private drug distribution service. Method: A prospective, exploratory and descriptive study with a quantitative approach was performed. The elderly users of NSAIDs attended by the service were interviewed and their prescriptions analyzed between May and September, 2014. Analysis of drug interactions was performed through computerized databases. The post-sales analysis of adverse reactions was performed using the Adverse Drug Reaction Probability Scale. Statistical analysis was performed with the Chi-squared and Fisher's Exact tests. Results: The study evaluated 200 elderly persons, among whom women predominated (56.5%). The average age was 65 years ±10. The NSAIDs accounted for 38.7% of prescription drugs used, and included dipyrone (26.9%), nimesulide (22.8%) and ketoprofen (16.3%). A total of 8.5% of such drugs were considered inappropriate medications for the elderly. A total of 104 potential drug interactions were identified, of which 24% were considered highly clinically significant. The NSAIDs with the greatest risk of interactions were ketoprofen 46.2%, ketorolac 14.4%, nimesulide 12.5% and diclofenac 9.6%. In post-sales monitoring 30.5% of the elderly persons reported undesirable symptoms after the use of NSAIDs, with stomach discomfort the most prevalent (17%). Conclusion: The present study confirmed the importance of monitoring the use of NSAIDs among the elderly due to the increased risk of drug interactions and adverse reactions associated with age, concomitant diseases, multi- prescriptions and polypharmacy. The choice of appropriate drugs for the elderly, the reconciliation of all the medications taken by the patient, and effective pharmaceutical care are measures that can contribute to the rational and safe use of NSAIDs.

Elderly health care in the Family Health Strategy and the prevalence of common mental disorders

The aims of the present study were to characterize the reasons for medical appointments and treatment procedures of elderly people in the Estratégia Saúde da Família ("Family Health Strategy") (ESF), with emphasis on mental health, as well as to identify the prevalence of common mental disorders, and compare this with the approaches described in medical records. A descriptive and cross-sectional study of 219 elderly persons was performed by reviewing medical records and applying a Self-Response Questionnaire (SRQ-20). For this population the average number of appointments per year was three, 42.3% of appointments were to obtain a medical prescription, and 70.9% of medical procedures involved the provision of medical prescriptions. There were eight referrals to specialized mental health services. The most prescribed psychiatric drugs were anxiolytics (55%), and antidepressants (29.7%). A total of 19.6% of the elderly persons had scores above seven in the SRQ-20. It was observed that a large proportion of mental disorders were not detected, and there was a failure in the procedures adopted. More investment in patient flow and the definition of assistance criteria for this population is required.

Prescrição inadequada de medicamentos a idosos portadores de doenças crônicas em um plano de saúde no município de São Paulo, Brasil

INTRODUÇÃO: A polifarmácia e a prescrição de medicamentos inapropriados para idosos podem causar uma série de efeitos indesejados, comprometendo sua capacidade funcional. OBJETIVO: Verificação da presença de prescrição de medicamentos inapropriados em um grupo de idosos vinculados a um plano de saúde privado com cobertura na cidade de São Paulo-SP. METODOLOGIA: Estudo realizado mediante a análise de prescrições feitas a um grupo de idosos vinculados a um plano de saúde privado, todos portadores de doenças crônico-degenerativas e acompanhados por médicos de especialidades diversas, na capital do estado de São Paulo, durante os anos de 2012 e 2013. Os medicamentos foram examinados segundo os Critérios de Beers revisados pela American Geriatrics Society em 2012. RESULTADOS: Foram observadas prescrições feitas a 2.500 idosos com um total de 8.760 medicamentos. Destes, 2.926 33,4% foram considerados inapropriados para uso em idosos. Os fármacos mais prescritos foram os anti-inflamatórios não esteroides, seguidos por medicamentos cardiovasculares e de ação central. A maioria desses idosos não possui médico de referência, sendo acompanhados, em média, por quatro médicos de especialidades diferentes. CONCLUSÃO: O grupo pesquisado apresenta um número elevado de prescrições de medicamentos inapropriados para uso em idosos, os quais, somados às características próprias, fazem com que esse grupo se torne de alto risco para o aparecimento de iatrogenias. Utilizar critérios de fácil memorização para identificação desses medicamentos e, principalmente, rever a forma como o setor de saúde suplementar brasileiro atende a este segmento etário é de suma importância, a fim de preservar a qualidade de vida desses idosos.