Potentially inappropriate medications used by the elderly: prevalence and risk factors in Brazilian care homes

Abstract

BackgroundThe use of potentially inappropriate medications (PIM) among the elderly is a serious public health problem because it is intrinsically linked to increased morbidity and mortality, causing high costs to public health systems. This study’s objective was to verify the prevalence of and the factors associated with the use of PIMs by elderly Brazilians in institutional settings.MethodsWe performed a transversal study, by consulting the case files of elderly people living in Long Term Care for the Elderly (LTC) in towns in the State of São Paulo, Brazil, as well as structured interviews with the nurses responsible for them.We identified PIMs using the list of recently updated Beers criteria developed by a group of specialists from the American Geriatrics Society (AGS), who reviewed the criteria based on studies with high scientific evidence levels. We defined the factors studied to evaluate the association with PIM use prior to the statistical analyses, which were the chi-square test and multiple logistic regression.ResultsAmong the elderly who used drugs daily, 82.6% were taking at least one PIM, with antipsychotics (26.5%) and analgesics (15.1%) being the most commonly used. Out of all the medications used, 32.4% were PIMs, with 29.7% of these being PIMs that the elderly should avoid independent of their condition, 1.1% being inappropriate medication for older adults with certain illnesses or syndromes, and 1.6% being medications that older adults should use with caution. In the multivariate analysis, the factors associated with PIM use were: polypharmacy (p = 0.0187), cerebrovascular disease (p = 0.0036), psychiatric disorders (p < 0.0001) and dependency (p = 0.0404).ConclusionsThe results of this study showed a high prevalence of PIM use in institutionalized elderly Brazilian patients. and the associated factors were polypharmacy, psychiatric disorders, cerebrovascular diseases and dependency.

Assessment of prescribing potentially inappropriate medications listed in Beers criteria and its association with the unplanned hospitalization: a cross-sectional study in Lahore, Pakistan

“…Findings suggested that advanced age and exposure of patient with large number of medicines were the strong determinants of prescribing PIMs, while unplanned hospitalization was only significantly associated with polypharmacy. The correlation is in line with the study conducted in Brazil and Switzerland where elderly patients receiving polypharmacy are at higher risk of unplanned hospitalization 44,45. Based on a significant causal association, evidence suggested that the risk of unplanned hospitalization can be reduced up to 6% if PIMs are avoided among geriatric patients 46.…”

Exposure to potentially inappropriate medications in Brazilian elderly outpatients with metabolic diseases

“…Studies conducted in health primary care centers, outpatient clinics and long term care settings have also reported a strong association between polypharmacy and risk of PIMs in Brazil (Oliveira et al, 2012;Faustino, Passarelli, Jacob-Filho, 2013;Santos et al, 2013;Vieira de Lima et al, 2013;Cassoni et al, 2014).…”

Reações adversas a medicamentos entre idosos institucionalizados: prevalência e fatores associados.

“…Já a risperidona deve ser evitada pois aumenta o risco de acidente cerebrovascular e pode levar a óbito pessoas com demência 24 . Outro fator ligado à ocorrência de RAM foi o sedentarismo, associação que pode ser explicada pelo fato de que pessoas sedentárias estão mais predispostas a doenças crônicas, principalmente as cardiovasculares, necessitando de um alto consumo de medicamentos, e consequentemente, aumentando os riscos da ocorrência de RAM 40 . Uma detalhe importante que não pode ser descartado é o fato de que, apesar do emprego de métodos estatísticos (análise multivariada) que supostamente eliminem possíveis confundimentos, a condução da análise pode levar a essa ocorrência.…”