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      Uso de medicamentos potencialmente inapropriados em idosos institucionalizados: prevalência e fatores associados Translated title: Use of potentially inappropriate medications in institutionalized elderly: prevalence and associated factors

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          Abstract

          Resumo Este trabalho teve como objetivo verificar a prevalência do uso de medicamento potencialmente inapropriado (MPI) para idosos residentes em Instituições de Longa Permanência para Idosos (ILPI), assim como os tipos de medicamentos e seus fatores associados. Trata-se de estudo transversal realizado em 10 ILPI da cidade do Natal, entre outubro e dezembro de 2013. Os medicamentos inapropriados foram classificados de acordo com os Critérios de Beers da American Geriatric Society 2015. Foram analisadas variáveis sociodemográficas, relacionadas à ILPI e às condições de saúde. Para as análises univariada e multivariada entre a variável principal (uso de MPI) e as demais foi utilizada a regressão de Poisson. A amostra foi composta por 321 idosos e, destes, 304 utilizavam medicamentos. A prevalência de uso de MPI foi de 54,6% (IC 95%: 48,9-60,2) e no modelo final esteve associada à polifarmácia e à demência. As classes terapêuticas de MPI mais identificadas foram antipsicóticos e benzodiazepínicos. O estudo revelou alta prevalência de MPI entre os idosos das ILPI, configurando a necessidade de adoção de indicadores do uso destes medicamentos e a implantação de estratégias que tornem a farmacoterapia mais segura e adequada aos idosos.

          Translated abstract

          Abstract 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.

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          Most cited references45

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          Envelhecimento populacional contemporâneo: demandas, desafios e inovações

          O estudo discute as conseqüências sociais e, particularmente, da saúde, decorrentes da ampliação do número de idosos no Brasil em um curto período. Foram utilizados dados da Pesquisa Nacional por Amostra de Domicílios, de 1998 e 2003, que indicam melhoria das condições de saúde dos idosos e uma distribuição de doença crônica semelhante para todos os grupos de renda. Se, por um lado, os idosos apresentam maior carga de doenças e incapacidades, e usam mais os serviços de saúde, por outro, os modelos vigentes de atenção à saúde do idoso se mostram ineficientes e de alto custo, reclamando estruturas criativas e inovadoras, como os centros de convivência com avaliação e tratamento de saúde. A agenda prioritária da política pública brasileira deveria priorizar a manutenção da capacidade funcional dos idosos, com monitoramento das condições de saúde, com ações preventivas e diferenciadas de saúde e de educação, com cuidados qualificados e atenção multidimensional e integral.
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            Antipsychotic drug use and mortality in older adults with dementia.

            Antipsychotic drugs are widely used to manage behavioral and psychological symptoms in dementia despite concerns about their safety. To examine the association between treatment with antipsychotics (both conventional and atypical) and all-cause mortality. Population-based, retrospective cohort study. Ontario, Canada. Older adults with dementia who were followed between 1 April 1997 and 31 March 2003. The risk for death was determined at 30, 60, 120, and 180 days after the initial dispensing of antipsychotic medication. Two pairwise comparisons were made: atypical versus no antipsychotic use and conventional versus atypical antipsychotic use. Groups were stratified by place of residence (community or long-term care). Propensity score matching was used to adjust for differences in baseline health status. A total of 27,259 matched pairs were identified. New use of atypical antipsychotics was associated with a statistically significant increase in the risk for death at 30 days compared with nonuse in both the community-dwelling cohort (adjusted hazard ratio, 1.31 [95% CI, 1.02 to 1.70]; absolute risk difference, 0.2 percentage point) and the long-term care cohort (adjusted hazard ratio, 1.55 [CI, 1.15 to 2.07]; absolute risk difference, 1.2 percentage points). Excess risk seemed to persist to 180 days, but unequal rates of censoring over time may have affected these results. Relative to atypical antipsychotic use, conventional antipsychotic use was associated with a higher risk for death at all time points. Sensitivity analysis revealed that unmeasured confounders that increase the risk for death could diminish or eliminate the observed associations. Information on causes of death was not available. Many patients did not continue their initial treatments after 1 month of therapy. Unmeasured confounders could affect associations. Atypical antipsychotic use is associated with an increased risk for death compared with nonuse among older adults with dementia. The risk for death may be greater with conventional antipsychotics than with atypical antipsychotics.
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              Polypharmacy, adverse drug reactions, and geriatric syndromes.

              The elderly are at risk for polypharmacy, which is associated with significant consequences such as adverse effects, medication nonadherence, drug-drug and drug-disease interactions, and increased risk of geriatric syndromes. Providers should evaluate all existing medications at each patient visit for appropriateness and weigh the risks and benefits of starting new medications to minimize polypharmacy.
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                Author and article information

                Journal
                csc
                Ciência & Saúde Coletiva
                Ciênc. saúde coletiva
                ABRASCO - Associação Brasileira de Saúde Coletiva (Rio de Janeiro, RJ, Brazil )
                1413-8123
                1678-4561
                2020
                : 25
                : 6
                : 2073-2082
                Affiliations
                [2] orgnameUniversity of Vic-Central University of Catalonia orgdiv1Centre for Health and Social Care Research orgdiv2Faculty of Health Science and Welfare Espanha
                [5] Natal RN orgnameUFRN orgdiv1Programa de Pós-Graduação em Saúde Coletiva Brazil
                [3] Natal RN orgnameUFRN orgdiv1Departamento de Cirurgia Brazil
                [4] Natal RN orgnameUFRN orgdiv1Departamento de Medicina Clínica Brazil
                [1] Natal Rio Grande do Norte orgnameUniversidade Federal do Rio Grande do Norte orgdiv1Departamento de Farmácia Brazil suelimonte@ 123456yahoo.com.br
                Article
                S1413-81232020000602073 S1413-8123(20)02500602073
                10.1590/1413-81232020256.26752018
                32520255
                2546e1d2-f362-4785-a80c-4df1ed0763f5

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 26 October 2018
                : 12 June 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 51, Pages: 10
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                SciELO Public Health

                Self URI: Texto completo somente em PDF (PT)
                Self URI: Full text available only in PDF format (EN)
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                Artigo

                List of Potentially Inappropriate Medications,Idoso,Instituição de longa permanência para idoso,Prescrição inapropriada,Lista de medicamentos potencialmente inapropriados,Elderly,Long-term care institutions for the elderly,Inadequate prescription

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