Use of potentially inappropriate medication by older adults in a southern municipality of Minas Gerais: prevalence study
DOI:
https://doi.org/10.30968/rbfhss.2023.142.0827Abstract
Objectives: to analyze the frequency of use of potentially inappropriate medications by the older adults in primary care in a municipality in the south of Minas Gerais and to determine the associated factors. Methods: cross-sectional observational study carried out in primary health care units in a city in the south of Minas Gerais. Potentially inappropriate medications for the older adults were classified according to the American Geriatric Society/ Beers 2019 Criteria. Descriptive analysis was performed with determination of absolute and relative frequency and dispersion measures. The association between the use of potentially inappropriate medications by the older adults and the independent variables was verified using Pearson’s chi-square test. Variables that were associated with the use of potentially inappropriate medications by the older adults with p<0.20 were included in the initial multiple logistic regression model. The selection of variables to be included in the final model was defined by the Backward method The magnitude of the association was estimated by the Odds Ratio. The adequacy of the final models was evaluated using the Hosmer-Lemeshow test. Results: A total of 436 elderly patients aged 60 years and over were included in the study. The frequency of potentially inappropriate medications by the older adults use was 47.7%. The most use potentially inappropriate medications by the older adults classes were proton pump inhibitors; long-acting benzodiazepines, including clonazepam and diazepam; and the antidepressants amitriptyline, clomipramine, imipramine and nortriptyline. Logistic regression showed a positive association of potentially inappropriate medications by the older adults use with polypharmacy, absence of a partner, presence in two or more consultations in the last six months. Regarding the presence of potentially inappropriate drugs for the older adults in the Municipal List of Drugs in the city of this study, 48 drugs were identified, which corresponds to 43.6% of the total number of standardized drugs in the city. Conclusions: The frequency of potentially inappropriate medications by the older adults use in primary care in the city investigated was high. This study can help health professionals that work in primary care in decision-making, helping to ensure the medication safety for the older adults.
Downloads
References
Correr JC, Pontarolo R, Ferreira LC, et al. Riscos de problemas relacionados com medicamentos em pacientes de uma instituição geriátrica. Rev Bras Cienc Farm. 2007;43(1):55-62. DOI: 10.1590/S1516-93322007000100007.
IBGE. Indicadores Sociodemográficos e de Saúde no Brasil. Brasília, DF, 2009. Available in: http://www.ibge.gov.br/english/estatistica/populacao/indic_sociosaude/2009/indicsaude.pdf. Accessed on: 5 Jul 2020.
Gorzoni ML, Fabbri RMA, Pires SL. Medicamentos Potencialmente Inapropriados para Idosos. Rev Assoc Med Bras. 2012;58(4):442-446. DOI: 10.1590/S0104-42302012000400014.
Salazar JA, Poon I, Nair M. Clinical consequences of polypharmacy in elderly: expect the unexpected, think the unthinkable. Expert Opnion Drug Safety. 2007; 6(6):695-704. DOI: 10.1517/14740338.6.6.695.
Medeiro SP, Neto SLL, Kusano ETL, et al. Diagnosis and control of polypharmacy in the elderly. Revista de Saúde Pública. 2007;41(6):1049-1053. DOI: 10.1590/S0034-89102006005000050.
Rozenfeld S. Prevalência, fatores associados a mau uso de medicamentos entre idosos: uma revisão. Cadernos de Saúde Pública. 2003;19(3):717-724. DOI: 10.1590/S0102-311X2003000300004.
Cojutti P, Arnoldo L, Cattani G, et al. Polytherapy and the risk of potentially inappropriate prescriptions (PIPs) among elderly and very elderly patients in three different settings (hospital, community, long-term care facilities) of the Friuli Venezia Giulia region, Italy: are the very elderly at higher risk of PIPs?. Pharmacoepidemiol Drug Saf. 2016; 25:1070-1078. DOI: 10.1002/pds.4026.
Laroche ML, Charmes JP, Nouaille Y, et al. Is inappropriate medication use a major cause of adverse drug reactions in the elderly? Br J Clin Pharmacol. 2007; 63: 177-186. DOI: 10.1111/j.1365-125.2006.02831.x.
Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly: an update. Arch Intern Med. 1997;157(14):1531-6.
Stockl KM, Le L, Zhang S, et al. Clinical and economic outcomes associated with potentially inappropriate prescribing in the elderly. Am J Manag Care. 2010;16(1): e1-10.
By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674-694. DOI: 10.1111/jgs.15767.
Santana DM, Bueno FG, Silva LL. Prescrição de medicamentos potencialmente inapropriados para idosos em um hospital público. J Assist Farmac Farmacoecon. 2016;1(2):320-330.
Koyama A, Steinman M, Ensrud K, et al. Long-term cognitive and cunctional effects of potentially inappropriate medications in older women. J Gerontol A Biol Sci Med Sci. 2014;69(4):423-9. DOI: 10.1093/gerona/glt192.
Price SD, Holman CD, Sanfilippo FM, et al. Association between potentially inappropriate medications from the beers criteria and the risk of unplanned hospitalization in elderly patients. Ann Pharmacother. 2014;48(1):6-16. DOI: 10.1177/1060028013504904.
Nascimento MMG, Mambrini JVM, Lima-Costa MF, et al. Potentially inappropriate medications: predictor for mortality in a cohort of community-dwelling older adults. Eur J Clin Pharmacol. 2017;73(5):615-621. DOI: 10.1007/s00228-017-2202-x.
Amorim WW, Passos LC, Gama RS, et al. Physician and patient-related factors associated with inappropriate prescribing to older patients within primary care: a cross-sectional study in Brazil. São Paulo Med J. 2021;139(2):107-116. DOI: 10.1590/1516-3180.2020.0411.R1.18112020
Farias AD, Lima KC, Oliveira YMDC, et al. Prescription of potentially inappropriate medications for the elderly: a study in Primary Health Care. Cien Saude Colet. 2021;26(5):1781-1792. DOI: 10.1590/1413-81232021265.04532021.
Almeida TA, Reis AE, Pinto LVI, et al. Factors associated with the use of potentially inappropriate medications by older adults in primary health care: An analysis comparing AGS Beers, EU(7)-PIM List , and Brazilian Consensus PIM criteria. Res Social Adm Pharm. 2019;15(4):370-377. DOI: 10.1016/j.sapharm.2018.06.002.
Resende ACGD, Costa FBC, Gomes IR, et al. Evaluation of drug use in the elderly according to Beers criteria. Revista Médica de Minas Gerais. 2017;27:30-36. doi: 10.5935/2238-3182.20170006.
Oliveira MG, Amorim WW, Jesus SR, et al. Factors associated with potentially inappropriate medication use by the elderly in the Brazilian primary care setting. International Journal of Clinical Pharmacy. 2012;34: 626-632. DOI:10.1007/s11096-012-9656-9.
Oliveira MG, Amorim WW, Jesus SR, et al. A comparison of the Beers and STOPP criteria for identifying the use of potentially inappropriate medications among elderly patients in primary care. Journal of Evaluation In Clinical Practice. 2015;21: 320-325. DOI: 10.1111/jep.12319.
IBGE. Alfenas-MG - Último censo. Available in: https://cidades.ibge.gov.br/brasil/mg/alfenas/panorama. Accessed on: 5 Apr 2021.
Elm VE, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): diretrizes para relatar estudos observacionais. Ann Intern Med. 2007;147(8):573-577. DOI: 10.7326/0003-4819-147-8-200710160-00010.
Targownik LE, Pescadora D, Saini SD. AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review. Gastroenterology. 2022;162(4):1334-1342. DOI: 10.1053/j.gastro.2021.12.24.
Cadogan CA, Ryan C, Hughes CM. Appropriate polypharmacy and medicine safety: When many is not too many. Drug Saf. 2016;39(2):109-116. DOI: 10.1007/s40264-015-0378-5.
Molokhia M, Majeed A. Current and future perspectives on the management of polypharmacy. BMC Fam Prac. 2017; 18(1):7 DOI: 10.1186/s12875-017-0642-0.
Clyne B, Fitzgerald C, Quinlan A, et al. Interventions to address potentially inappropriate prescribing in community-dwelling older adults: a systematic review of randomized controlled trials. J Am Geriatr Soc. 2016;64:1210–1222. DOI: 10.1111/jgs.14133.
Oliveira MG, Amorim WW, Oliveira CRB, et al. Consenso brasileiro de medicamentos potencialmente inapropriados para idosos. Geriatr Gerontol Aging. 2016;10:168–181. DOI:10.5327/z2447-211520161600054.
Toth JM, Jadhav S, Holmes HM, et al. Prescribing trends of proton pump inhibitors, antipsychotics and benzodiazepines of medicare part d providers. BMC Geriatr. 2022;22(1):306.
Praxedes MFS, Telles Filho PCP, Pinheiro MLP. Identificação e análise de prescrições de medicamentos potencialmente inapropriados para idosos em uma Instituição Hospitalar. Cienc Cuid Saúde. 2011;10(2):338-44. DOI: 10.4025/ciencuidsaude.v10i2.10214.
Cassoni TCJ, Corona PL, Lieber RSN, et al. Uso de medicamentos potencialmente inapropriados por idosos do Município de São Paulo, Brasil: Estudo SABE. Cad Saúde Pública. 2014;(30):1708-1720.
Fick DM, Mion CL, Beers HM, et al. Health outcomes associated with potentially Inappropriate medication use in older adults. Res Nurs Health. 2008; 31(1): 42-51. DOI: 10.1002/nr.20232.
Klarin I, Wimo A, Fastbom J. The association of inappropriate drug use with hospitalisation and mortality: A population-based study of the very old. Drugs & Aging. 2005;22:69–82. DOI: 10.2165/00002512-200522010-00005.
Varallo FR, Ambiel ISS, Nanci LO, et al. Assessment of pharmacotherapeutic safety of medical prescriptions for elderly residents in a long-term care facility. Braz J Pharm Sci. 2012;48(3):477-85. DOI: 10.1590/S1984-82502012000300015.
Passarelli MCG, Jacob-Filho W, Figueras A. Adverse drug reactions in elderly hospilised population: inappropriate prescribing is a leading cause. Drugs & Aging. 2005; 22(9):767-777. DOI: 10.2165/00002512-200522090-00005.
Lucchetti G, Lucchetti AL. Inappropriate prescribing in older persons: A systematic review of medications available in different criteria. Arch Gerontol Geriatr. 2017; 68:55-61. DOI: 10.1016/j.archger.2016.09.003.
Praxedes MFS, Pereira SCG, Lima MFC, et al. Prescrição de medicamentos potencialmente inapropriados para idosos segundo os Critérios de Beers: revisão sistemática. Ciênc Saúde Colet. 2021;26(8). DOI:10.1590/1413-81232021268.05672020.
Najjar MF, Sulaiman SAS, Al Jeraisy M, et al. The impact of a combined intervention program: an educational and clinical pharmacist’s intervention to improve prescribing pattern in hospitalized geriatric patients at King Abdulaziz Medical City in Riyadh, Saudi Arabia. Ther Clin Risk Manag. 2018;14:557-564. DOI: 10.2147/TCRM.S157469.
Lopes LM, Figueiredo TP, Costa SC, et al. Use of potentially inappropriate medications by the elderly at home. Cien Saude Colet. 2016;21(11):3429-3438. DOI: 10.1590/1413-812320152111.14302015.
Halon JT, Weinberger M, Samsa GP, et al. A Randomized, Controlled Trial of a Clinical Pharmacist Intervention to Improve Inappropriate Prescribing in Elderly Outpatients With Polypharmacy. Am J Medicine. 1996;100(4):428-437. DOI: 10.1016/S0002-9343(97)89519-8.
Brasil. Ministério da Saúde (MS). Portaria nº 2.436, de 21 de setembro de 2017. Aprova a Política Nacional de Atenção Básica, estabelecendo a revisão de diretrizes para a Organização da Atenção Básica, no âmbito do Sistema Único de Saúde (SUS). Diário Oficial da União; 2017.
Ma X, Yin X, Li M, et al. Appropriate use of essential medicines in the elderly: a comparison of the WHO essential medicines list and PIM criteria. Eur J Clin Pharmacol. 2021;77(4):509-516. DOI: 10.1007/s00228-020-03038-0.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The authors hereby transfer, assign, or otherwise convey to RBFHSS: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print republish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to RHFHSS with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Serlf-archiving policy
This journal permits and encourages authors to post and archive the final pdf of the articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.
