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

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          Abstract

          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.

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          Most cited references59

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          What is polypharmacy? A systematic review of definitions

          Background Multimorbidity and the associated use of multiple medicines (polypharmacy), is common in the older population. Despite this, there is no consensus definition for polypharmacy. A systematic review was conducted to identify and summarise polypharmacy definitions in existing literature. Methods The reporting of this systematic review conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. MEDLINE (Ovid), EMBASE and Cochrane were systematically searched, as well as grey literature, to identify articles which defined the term polypharmacy (without any limits on the types of definitions) and were in English, published between 1st January 2000 and 30th May 2016. Definitions were categorised as i. numerical only (using the number of medications to define polypharmacy), ii. numerical with an associated duration of therapy or healthcare setting (such as during hospital stay) or iii. Descriptive (using a brief description to define polypharmacy). Results A total of 1156 articles were identified and 110 articles met the inclusion criteria. Articles not only defined polypharmacy but associated terms such as minor and major polypharmacy. As a result, a total of 138 definitions of polypharmacy and associated terms were obtained. There were 111 numerical only definitions (80.4% of all definitions), 15 numerical definitions which incorporated a duration of therapy or healthcare setting (10.9%) and 12 descriptive definitions (8.7%). The most commonly reported definition of polypharmacy was the numerical definition of five or more medications daily (n = 51, 46.4% of articles), with definitions ranging from two or more to 11 or more medicines. Only 6.4% of articles classified the distinction between appropriate and inappropriate polypharmacy, using descriptive definitions to make this distinction. Conclusions Polypharmacy definitions were variable. Numerical definitions of polypharmacy did not account for specific comorbidities present and make it difficult to assess safety and appropriateness of therapy in the clinical setting.
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            Screening for nutritional status in the elderly.

            A comprehensive assessment of nutritional status is a critically important component of any patient evaluation. Based upon clinical information, anthropometric data, and a small number of laboratory investigations, an accurate appraisal of nutritional status should be possible and an appropriate intervention plan can be developed. The actual approach depends on the particular problem discovered. These are discussed in detail elsewhere in this issue.
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              7ª Diretriz Brasileira de Hiper-tensão Arterial

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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Writing – original draft
                Role: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draft
                Role: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                28 October 2020
                2020
                : 15
                : 10
                : e0240104
                Affiliations
                [1 ] Faculty of Nursing, Postgraduate Program in Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil
                [2 ] Faculty of Medicine, Postgraduate Program in Health Sciences, Federal University of Goiás, Goiânia, Goiás, Brazil
                [3 ] Faculty of Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil
                Hong Kong Polytechnic University, HONG KONG
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-5590-2453
                Article
                PONE-D-20-04702
                10.1371/journal.pone.0240104
                7592782
                33112864
                48115abc-b642-433a-b282-0267529960e1
                © 2020 de Araújo et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 18 February 2020
                : 19 September 2020
                Page count
                Figures: 1, Tables: 6, Pages: 18
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100003593, Conselho Nacional de Desenvolvimento Científico e Tecnológico;
                Award ID: Edital Universal 01/2016 – CNPQ – Process number: 428635/2016-4
                Award Recipient :
                This study was partially funded by the Goiás State Research Support Foundation (Fundação de Amparo à Pesquisa do Estado de Goiás- FAPEG) as well by by National Council for Scientific and Technological Development of Brazil (CNPq). VP received the award.
                Categories
                Research Article
                Medicine and Health Sciences
                Health Care
                Geriatric Care
                Medicine and Health Sciences
                Endocrinology
                Endocrine Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Medical Conditions
                Metabolic Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Medicine and Health Sciences
                Geriatrics
                Medicine and Health Sciences
                Epidemiology
                Social Sciences
                Economics
                Health Economics
                Medicine and Health Sciences
                Health Care
                Health Economics
                People and Places
                Population Groupings
                Age Groups
                People and Places
                Population Groupings
                Age Groups
                Adults
                Elderly
                Custom metadata
                All relevant data are within the manuscript and its Supporting Information files.

                Uncategorized
                Uncategorized

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