Estudio de salud de las personas mayores en Extremadura: consumo de fármacos y patologías crónicas más frecuentes  <span class="so-article-trans-title" dir="auto"> Translated title: Study on the health of the elderly in Extremadura: medication and most frequent chronic diseases </span>

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Abstract

Fundamento: Determinar el consumo de fármacos en el anciano no institucionalizado, los factores asociados a la polifarmacia e identificar su relación con las patologías crónicas. Métodos: Estudio epidemiológico transversal mediante entrevista directa domiciliaria. La población seleccionada sistemáticamente es de 960 sujetos entre 65 y 93 años. El cuestionario incluía datos demográficos, salud autopercibida, aspectos cualitativos y cuantitativos del consumo de fármacos patologías crónicas, y valoración de capacidad funcional. Resultados: El 91,62% de las personas entrevistadas declaró consumir medicamentos, siendo superior en la mujer (p<0.002). Los más consumidos son los hipotensores (42,4%), analgésicos (38,7%) y cardioterápicos (24,8%). El consumo de fármacos fue superior en el grupo de edad más avanzada (p<0,0001), con nivel de instrucción inferior (p<0,001), con déficit visual y auditivo (p<0,0001), peor situación social (p<0,001), más contactos con los servicios sanitarios (p<0,0001), peor salud autopercibida (p<0,0001), mayor número de enfermedades crónicas (p<0,0001) y con trastornos depresivos (p=0,004). El análisis de regresión lineal mostró una relación positiva entre el número de fármacos consumidos y el número de enfermedades crónicas (r=0,518; p<0,0001). Las mujeres refieren un peor estado de salud (p<0,05). Las variables asociadas a la polifarmacia estudiadas mediante regresión logística son la edad (mayores de 75 años; OR=1,1478), tres o más enfermedades crónicas (OR=1,83) y mala salud autopercibida (OR=1,22). Conclusiones: Es necesario incluir en los exámenes de salud del anciano una revisión del consumo de fármacos, particularmente en mayores de 75 años con peor salud autopercibida con más enfermedades crónicas.

Translated abstract

Background: To ascertain the use of drugs among the non-institutionalised elderly population, the factors related to polypharmacy and pinpointing the relationship thereof with chronic diseases. Methods: Cross-sectional epidemiological study by means of door-to-door survey. The population systematically selected totalled 960 individuals age 65-93. The questionnaire included demographic data, self-asessed health condition, quantitative and qualitative aspects of the use of medications, chronic diseases and assesment of functional ability. Results: 91.62% of those surveyed were taking medication, a greater number of females (p<0.002) than males. The medications taken to the greatest extent were blood pressure drugs (42.4%), analgesics (38.7%) and heart drugs (24.8%). Drugs were used to a greater extent among the oldest age group (p<0.0001), those having the lowest educational level (p<0.001), those with impaired eyesight and hearing(p<0001), those having the lowest social status (p<001), more contacts with the health care services (p<0.0001), worse self-assessed health condition (p<0001), a greater number of chronic diseases (p<0.0001) and depressive disorders (p=0.004). The linear regression analysis revealed a positive relationship between the number of medications taken and the number of chronic diseases (r=0.518; p<0.0001). Females report worse health conditions (p<0.05). The variables analyzed with regard to polypharmacy by means of logistic regression are age (over age 75; OR=1.1478), three or more chronic diseases (OR=1.83) and poor self-assessed health condition (OR=1.22). Conclusions: Physical checkups on the elderly must include a review of the medications being taken, especially among those over age 75 who have a worse self-assessed health condition and a larger number of chronic diseases.

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A summated score for the medication appropriateness index: development and assessment of clinimetric properties including content validity.

G Samsa, J Hanlon, K E Schmader … (1994)

Inappropriate medication prescribing is an important problem in the elderly, but is difficult to measure. As part of a randomized controlled trial to evaluate the effectiveness of a pharmacist intervention among elderly veterans using many medications, we developed the Medication Appropriateness Index (MAI), which uses implicit criteria to measure elements of appropriate prescribing. This paper describes the development and validation of a weighting scheme used to produce a single summated MAI score per medication. Using this weighting scheme, two clinical pharmacists rated 105 medications prescribed to 10 elderly veterans from a general medicine clinic. The summated score demonstrated acceptable reliability (intraclass correlation co-efficient = 0.74). In addition, the summated MAI adequately reflected the putative heterogeneity in prescribing appropriateness among 1644 medications prescribed to 208 elderly veterans in the same general medicine clinic. These data support the content validity of the summated MAI. The MAI appears to be a relatively reliable, valid measure of prescribing appropriateness and may be useful for research studies, quality improvement programs, and patient care.

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Inappropriate drug prescribing for the community-dwelling elderly.

S M Willcox, D U Himmelstein, S Woolhandler (1994)

To examine the amount of inappropriate drug prescribing for Americans aged 65 years or older living in the community. Cross-sectional survey of a national probability sample of older adults. The 1987 National Medical Expenditure Survey, a national probability sample of the US civilian noninstitutionalized population, with oversampling of some population groups, including the elderly. The 6171 people aged 65 years or older in the National Medical Expenditure Survey sample, using appropriate weighting procedures to produce national estimates. Incidence of prescribing 20 potentially inappropriate drugs, using explicit criteria previously developed by 13 United States and Canadian geriatrics experts through a modified Delphi consensus technique. Three cardiovascular drugs identified as potentially inappropriate were analyzed separately since they may be considered appropriate for some noninstitutionalized elderly patients. A total of 23.5% (95% confidence interval [CI], 22.4% to 24.6%) of people aged 65 years or older living in the community, or 6.64 million Americans (95% CI, 6.28 million to 7.00 million), received at least one of the 20 contraindicated drugs. While 79.6% (95% CI, 77.2% to 82.0%) of people receiving potentially inappropriate medications received only one such drug, 20.4% received two or more. The most commonly prescribed of these drugs were dipyridamole, propoxyphene, amitriptyline, chlorpropamide, diazepam, indomethacin, and chlordiazepoxide, each used by at least half a million people aged 65 years or older. Including the three controversial cardiovascular agents (propranolol, methyldopa, and reserpine) in the list of contraindicated drugs increased the incidence of probably inappropriate medication use to 32% (95% CI, 30.7% to 33.3%), or 9.04 million people (95% CI, 8.64 million to 9.44 million). Physicians prescribe potentially inappropriate medications for nearly a quarter of all older people living in the community, placing them at risk of drug adverse effects such as cognitive impairment and sedation. Although most previous strategies for improving drug prescribing for the elderly have focused on nursing homes, broader educational and regulatory initiatives are needed.