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ABSTRACT Objective To examine associations between potentially inappropriate medication, use and the risk of falls, unplanned hospitalization and death in older patients receiving initial care in a geriatric day hospital due to acute conditions. Methods Cohort study with older adults referred to a geriatric day hospital from 2014 to 2017 due to acute conditions. Patients were submitted to comprehensive geriatric assessment. Use of medications was analyzed according to Beers Criteria 2019. Outcome assessment was based on monthly follow-up telephone calls made over the course of one year. Results In this sample, 40.6% of patients had been prescribed at least one potentially inappropriate medication, particularly proton pump inhibitors (66.5%). Over the course of follow-up, 44.7% of patients receiving potentially inappropriate medications sustained at least one fall (p=0.0043) and 70% visited the emergency department (p=0.0452). These outcomes were more common among patients using two or more of drugs. Use of potentially inappropriate medication was associated with a 64% increase in the odds of unplanned hospitalization and a two-fold increase in risk of death. Conclusion Associations between potentially inappropriate medication use and unfavorable outcomes such as falls and unplanned hospitalizations within one year of admission to a geriatric day hospital support the application of Beers Criteria and emphasize the importance of periodic prescription review, deprescription and rational use of these drugs whenever possible.
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ABSTRACT Objective To discuss the role of the clinical pharmacist in hospital care of critical elderly patients. Methods Critical patients aged 60 years and over admitted by the clinical staff to an Intermediate Care Unit were followed-up for 4 months regarding their drug therapies. Medical prescriptions were reviewed daily on the basis of patients' clinical conditions, with the view to identify opportunities for optimization of drug therapies, contributing to safer prescribing, reduced discomfort and correct and rational use of drugs. Results A total of 386 prescriptions were reviewed and 212 pharmaceutical interventions performed; 64.3% of prescriptions were classified as accepted with changes, 28.5% not accepted and 7.2% verbally accepted with no changes. Interventions included drug therapy indications, directions for dose adjustment, reduction of the use of potentially inappropriate medications for older patients, prescription adjustments, discontinuing unnecessary drugs, among others. Conclusion The significant number of interventions accepted by the healthcare staff supports the relevance of the clinical pharmacist as a member of the multiprofessional team, especially in care of the elderly.
RESUMO Objetivo Discutir o papel do farmacêutico clínico no cuidado hospitalar de pacientes críticos, idosos. Métodos Ao longo do período de 4 meses, foi realizado o acompanhamento farmacoterapêutico de pacientes críticos com 60 anos ou mais, admitidos pela equipe de Clínica Médica em uma Unidade de Cuidados Intermediários. Diariamente, foram realizadas avaliações das prescrições médicas, frente ao quadro clínico, a fim de encontrar oportunidades de otimização da farmacoterapia prescrita, contribuindo para a maior segurança da prescrição, a redução de desconfortos, e o uso correto e racional de medicamentos. Resultados Foram avaliadas 386 prescrições e realizadas 212 intervenções farmacêuticas, sendo 64,3% destas classificadas como aceitas com alteração na prescrição, 28,5% não aceitas e 7,2% aceitas verbalmente, porém sem alteração na prescrição. As intervenções envolviam indicações farmacoterapêuticas, orientações para ajustes de dose, redução do uso de medicamentos potencialmente inapropriados para idosos, ajustes de prescrição, suspensão de medicamentos desnecessários, entre outras. Conclusão O significativo número de intervenções aceitas pela equipe da saúde reforça o papel que o farmacêutico clínico tem a desempenhar na equipe multiprofissional, sobretudo quando direcionados ao cuidado de idosos.