Polypharmacy and Polymorbidity in Older Adults in Brazil: a public health challenge

Abstract

OBJECTIVE To analyze variations in the prevalence of chronic use of medicines by older adults in Brazil according to its possible association with the most prevalent chronic diseases and demographic and health factors, and to identify risk factors for polypharmacy.METHODS A study based on data from the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM), a cross-sectional, population-based survey with probability sampling in Brazilian urban areas. The independent variable was the number of chronic-use medicines taken by older adults, linked to eight chronic diseases investigated. The intervening variables were gender, age group, marital status, level of education, socioeconomic status, Brazilian region, body mass index, smoking, self-perceived health, hospitalization in the previous year and having health insurance, besides the investigated chronic diseases. A multivariable analysis identified risk factors for polypharmacy.RESULTS Prevalence of at least one chronic-use medicines among older adults was 93.0%. Of the total number of older adults, 18.0% used at least five medications (polypharmacy). Polypharmacy was higher among the oldest individuals (20.0%), in the South region (25.0%), in those with poor self-perceived health (35.0%), in obese individuals (26.0%), in those with reported health insurance (23.0%) or hospitalization in the previous year (31.0%), and among those who reported any of the investigated diseases, particularly diabetes (36.0%) and heart diseases (43.0%). The variables remaining in the final risk model for polypharmacy were age, region, perceived health, health insurance, hospitalization in the previous year and all investigated diseases except stroke.CONCLUSIONS Older adults with specific diseases have risk factors for polypharmacy modifiable by actions aimed at the rational use of medicines. With the current population aging and successful drug access policy, the trend is an increase in drug use by older adults, which should feature as a priority in the planning agenda of the Brazilian Unified Health System (SUS).

Geriatrics: Medicine of the 21st Century ?

“…Sabendo-se que o risco de interações medicamentosas e de efeitos colaterais é proporcional ao número de fármacos em uso, 37 a literatura médica brasileira apresenta tendência a considerar como polifarmácia o uso concomitante de cinco ou mais medicamentos. [38][39][40][41][42][43] 2. Cascata medicamentosa ou prescrição em cascata -expressão criada por Rochon e Gurwitz 44,45 (the prescribing cascade) conceitua situações na qual um medicamento em uso gera efeitos colaterais que provocam sintomas e sinais com potencial de provocar diagnósticos equivocados econsequentemente -a prescrição de outro fár-maco para minimizá-los.…”

New Insights for the Polypharmacy Use in Elderly with Diabetes-An Update about Effect of Education Level

“…This alarming situation reflects what exists in Brazil, where 20% of the oldest individuals use at least five medicines [4]. Since diabetic polypharmacy significantly increased treatment costs, it is in the public health interest to identify the factors driving up the necessity of multiple pharmaceutical prescriptions [5].…”

“…This absence in the literature is an open door to explore others factors that may influencing multi-drug use among those who have negligible knowledge about their prescription drugs. Lack of knowledge about their medication among diabetics inhibits compliance, increases the risk adverse multi-drug interaction, and increases, both, DC and PC [1,[2][3][4][5][6][7][8].…”

Validation and standardization of the Brazilian version of the Medication Regimen Complexity Index for older adults in primary care

“…The study, National Survey of Access, Use and Promotion of Rational Use of Medicines in Brazil, found that 75.7% of older adults used two or more chronic medications. In addition, polypharmacy is found in 60% of older adults with four or more diseases in Brazil . This setting favors the use of complex regimens, which are common among older adults …”