RESUMO:Os idosos constituem o grupo populacional que mais cresce de forma acelerada e descontrolada no Brasil, representando 14,3% da população geral. Associado a isto e ao aumento da expectativa de vida, mudança do padrão de adoecimento do pais e a medicalização no idoso, temas como a farmacologia do indivíduo idoso tornam-se essenciais na formação de um profissional da área da saúde. O processo normal do envelhecimento possui particularidades capazes de modificar as etapas da farmacocinética e a farmacodinâmica de um medicamento, predispondo o idoso às Reações Adversas a Medicamentos (RAM), cascata iatrogênica, uso de Medicamentos Potencialmente Inapropriados (MPI) e polifarmácia, processo do adoecimento, quedas e fraturas, delirium, hospitalização, institucionalização e até à morte. Baseado nisso, instrumentos ou listas de medicamentos considerados inadequados para uso em idosos foram criadas, cada uma com particularidades da comercialização de seu país. Visto isso, entende-se que o assunto é de extrema relevância na pratica clínica, e, quando utilizado de forma interdisciplinar, melhora a qualidade de serviços, formação de profissionais da área da saúde e permite a prevenção de eventos iatrogênicos.Descritores: Idoso; Farmacologia. Envelhecimento; Lista de medicamentos potencialmente inapropriados/utilização; Efeitos colataterais e reações adversas à medicamentos; Serviços de saúde para idosos. ABSTRACT:The elderly are the fastest growing population group in Brazil, accounting for 14.3% of the population. Associated with this and with the increase in life expectancy, changes in the country's pattern of illness and the medicalization of aging, issues such as pharmacology in elderly have become essential topics in the health professionals' training. The normal aging process has particularities that can modify the pharmacokinetic and pharmacodynamic properties of drugs, predisposing elderly to Adverse Drug Reactions (ADRs), iatrogenesis, use of Potentially Inappropriate Medications (PIM), polypharmacy, illness processes, falls and fractures, delirium, hospitalization, institutionalization and even death. Based on this, instruments or lists of medications considered inappropriate for elderly were created, each with particularities of the medication market of each country. Therefore, this subject is extremely relevant in clinical practice and when it is used in an interdisciplinary way, it improves the quality of services and the training of health professionals and allows the prevention of iatrogenic events.

A senescência é um processo natural do envelhecimento que altera a farmacocinética e a farmacodinâmica dos medicamentos, sendo particularmente importante quando se trata de um país de idosos como o Brasil. Associado à idade, há um aumento das doenças crônicas não transmissíveis (DCNTs) e consequentemente do uso de diversos medicamentos. A polifarmácia aumenta o risco de reações adversas, especialmente quando associado à prescrição de medicamentos potencialmente inapropriados (MPIs) para idosos. O presente estudo tem como objetivo avaliar a prescrição de MPIs por meio dos critérios de Beers de 2015 em um grupo de idosos portadores de doenças crônicas vinculados a um plano de saúde em São Paulo, Brasil. Trata-se de um estudo exploratório e descritivo, realizado mediante a análise de 5.995 prescrições médicas, de setembro a dezembro de 2015. Os medicamentos foram examinados segundo os critérios de Beers revisados em 2015. Observou-se que, das 5.995 prescrições médicas feitas a 1.428 idosos, 20,3% foram consideradas inapropriadas. Os MPIs mais prescritos foram: inibidores de bomba de prótons (IBP), 39,4% (481); antidiabéticos, 13,3% (162); benzodiazepínicos (BZP) de ação curta, intermediária e longa, 10,8% (132); anti-inflamatórios não hormonais (AINEs), 10,3% (127); e anti-histamínicos de primeira geração, 6,8% (83). O grupo estudado apresentou um alto índice de prescrição inadequada de medicamentos em uso contínuo. Trata-se de um grupo populacional de risco, devido às suas próprias particularidades clínicas, predispondo a desfechos biopsicossociais desfavoráveis.Palavras-chave: Assistência à saúde do idoso. Lista de medicamentos potencialmente inapropriados. Planos de saúde. Prescrições de medicamentos.

ObjectivesTo assess the effect of sex and spouse condition on symptoms of anxiety, depression and posttraumatic stress symptoms in patients and their spouses.MethodsA prospective study conducted in a 22-bed adult mixed intensive care unit in a tertiary hospital in São Paulo, Brazil. Patients and their spouses were enrolled 2 days after intensive care unit admission. They were interviewed while in the intensive care unit using the Hospital Anxiety and Depression Scale. At 30 and 90 days after intensive care unit discharge, they completed the Impact of Event Scale and Hospital Anxiety and Depression Scale by phone.ResultsFrom March 2011 to March 2013, we analyzed 118 patients and their spouses. We observed that female sex was associated with higher scores than male sex was in terms of the anxiety Hospital Anxiety and Depression Scale - subscale (p = 0.032) and depression (p = 0.034). There was no association between sex and posttraumatic stress disorder symptoms. However, spouses had higher Impact of Event Scale points compared with patients (p = 0.001).ConclusionsFemale sex was associated with anxiety and depression, and spouses were more vulnerable to post-traumatic stress symptoms than the patients were. Increasing age and a later time of assessment were also associated with lower scores on the Impact of Event Scale.

SUMMARY OBJECTIVE To identify the use of Potentially Inappropriate Medications with imminent risk of Cardiovascular and Cerebrovascular Adverse Events (PIM-CCVAE), in addition to the factors associated with a group of elderly individuals undergoing therapeutic care in a Brazilian public service. METHODS A cross-sectional retrospective study conducted at a secondary level service located in Carapicuíba, SP, Brasil. Only elderly individuals (≥60 years) who were treated in one of the outpatient departments were included. The use of PIM-CCVAE was defined based on the PIM-CCVAEs list. In this research, we used descriptive statistics and logistic regression to identify and track possible predictors of MPI use. All statistical analyses were performed using Stata software version 15.1 (Stata Corporation). RESULTS The sample included 233 elderly individuals, with a mean age of 74.9 (± 9.4) years. Of these, 74.2% used at least one PIM-CCVAE, with an average daily intake of 1.3 (± 1) PIM/elderly. The presence of comorbidities, diseases of the circulatory system, polypharmacy, and low to moderate scores in morbidity and mortality were important factors associated with an increased odds ratio for the consumption of PIM-CCVAE. It is also emphasized that the presence of neurological symptoms proved to be a protective factor for this outcome. CONCLUSION Given the clinical severity and imminent risk of CCVAE in the researched group, preventive measures should be instituted to minimize health problems related to medication in the public network.

Objective To analyze the satisfaction, medical situation understanding and symptoms of anxiety and depression in family members of patients admitted to the intensive care unit. Methods The family members of patients who were hospitalized for ≥ 72 hours were invited to participate in the study, which was performed in a public hospital. Questionnaires were answered to assess the understanding of the diagnosis, treatment and prognosis, and the support received in the intensive care unit. The family needs were also evaluated using a modified version of the Critical Care Family Needs Inventory (CCFNI). The Hospital Anxiety and Depression Scale (HADS) was used to assess the symptoms of anxiety and depression. Results A total of 35 family members were interviewed within the patients' first week of stay in the intensive care unit. Most patients (57.1%) were male, aged 54 ± 19 years. Sepsis was the main reason for admission to the intensive care unit (40%); the median of the Simplified Acute Physiology Score (SAPS) 3 was 68 (48 - 77), and 51.4% of the patients died in the intensive care unit. The majority of the family members were female (74.3%) and were sons or daughters of patients (54.3%), with a mean age of 43.2 ± 14 years. Overall, 77.1% of the family members were satisfied with the intensive care unit. A total of 37.1% of the family members did not understand the prognosis. Receiving clear and complete information in the intensive care unit and the doctor being accessible were factors that were significantly correlated with the overall family satisfaction. The prevalence of symptoms of anxiety (60%) and depression (54.3%) in the family members was high. Conclusion The emotional distress of family members is high during a patient's hospitalization in the intensive care unit, although satisfaction is also high. Clear and complete information provided by the intensivist and the support received in the intensive care unit are significantly correlated with the satisfaction of family members in a public hospital.

Objective: To measure the Quality of Life (QoL) and associated factors in a group of elderly persons receiving care through a health plan operator in the city of São Paulo, Brazil. Method: A cross-sectional study was carried out with 169 elderly persons enrolled in a health plan and who were participants in a program to promote health and prevent risks and diseases. The Bref and Old versions of the World Health Organization Quality of Life (WHOQOL) instruments were adopted for the evaluation of the QoL of the elderly. After descriptive analysis, a comparative analysis was performed through the Student’s t-tests and ANOVA. The Brown-Forsythe test was applied for situations in which no homogeneity was found and the Tukey test for multiple comparisons was applied. Results: The highest mean QoL values were found in the Psychological [72.1 (±14.3)] and Environment [68 (±15.4)] and Intimacy [72.5 (±20.8)] domains, while the worst results were found in the Physical [64.3 (±18)] domain and in the Death and Dying facet [61.2 (±23.2)]. In this group, factors such as obesity, neoplasia and previous hospitalizations were negatively associated with QoL, whereas young elderly, female, widows, carriers of chronic non-communicable diseases and those limited to two morbidities, who practiced physical activity and had clinical care provided by a reference physician had a positive influence. Conclusion: The findings of this research showed high levels of satisfaction with health and QoL, in addition to raising relevant discussions about predictors that influence the QoL of the elderly receiving care from the supplementary sector. It also emphasizes the need for new strategies of action to ensure improvements in the health care of the elderly.

Objective: to study the main elements of the iatrogenic triad in a group of elderly women with a Chronic Non-Communicable Disease (CNCD) contracted to a health plan. Method: A cross-sectional and descriptive epidemiological study was carried out by analyzing 3,501 medical prescriptions of 725 elderly women aged ≥65 years. The medications were determined to be Potentially Inappropriate Medications (PIM) based on four instruments (AGS Beers 2015, PRISCUS List, EU(7)-PIM, Brazilian Consensus of PIM - CBPIM). In addition, the most prescribed drugs were assessed for possible Drug Interactions (DI) and classified according to degree of severity. Results: the present study revealed that 89.3% of the studied group used at least one element of the iatrogenic triad, and 44.9% of the sample were associated with the use of polypharmacy and PIM. A total of 48.0% were taking at least five continuous use medications. The main DI were omeprazole, simvastatin and levothyroxine, all of which are of significant severity and have potential drug-food interactions. A total of 35.1% of PIM were identified through the four criteria used, 26.6% were identified by the CBPIM, 25.8% by the EU(7)-PIM, and 24.6% and 6.6% by AGS Beers and PRISCUS, respectively. Conclusion: a high index of continuous use medications, PIM and potential DI were identified, mainly enzymatic inhibitors in a group of elderly women at risk due to their clinical characteristics. Old age was associated with the presence of all the elements of the iatrogenic triad. It was also noted that there were no significant differences between the criteria applied, except for the PRISCUS list.

Chronic critical illness (CCI) is a relevant clinical, social and financial health issue. The aim of this study was to compare the mental outcomes (symptoms of anxiety and depression) and quality of life outcomes of the family members of patients with CCI from different socioeconomic backgrounds who were admitted to one of the intensive care units (ICUs) in two Brazilian hospitals, one private and one public. It is a prospective study involving a public hospital that serves a low-income population and a tertiary private hospital that serves a high-income population. Family members of patients with CCI answered the Hospital Anxiety and Depression Scale (HADS) and The World Health Organization Quality of Life–WHOQOL-bref questionnaires. They responded to the European Quality of life Five Dimension three Level (EuroQol-5D-3L) and the Activities of Daily Living (ADL) questionnaires on behalf of the patients at three time points: during the ICU stay, 30 and 90 days after the patient was discharged. We used logistic regression models to evaluate the main predictors of a binary outcome regarding symptoms of anxiety and depression. We enrolled 186 patients with CCI. Many patients from public hospitals who were independent became dependent for their ADLs at 90 days (41.7% versus 14.3%, p = 0.03). At 30 days, family members from public hospital had worse impact on all domains of WHOQOL-bref compared with families from private hospital. At 90-days, the difference persists in the physical domain, worse for families from public hospital (p = 0.006). The symptoms of depression at 30-days (p = 0.008) and at 90-days (p = 0.013) were worse in the public hospital. CCIs affected quality of life and the emotional condition of family members, especially in families with fewer resources when the patients became more dependent. Family members with higher education were more likely to experience depression, while depression was associated with cohabiting with the patient in low-income families.