ABSTRACT
Introducción: las prescripciones potencialmente inapropiadas en ancianos es un hecho común, tanto en el ámbito comunitario como hospitalario, dada su frecuencia elevada de comorbilidad grave y polifarmacia, y conlleva importantes repercusiones clínicas y económicas. Objetivo: determinar la prevalencia de polifarmacia y de prescripción de medicamentos potencialmente no apropiados en adultos mayores. Métodos: se realizó un estudio analítico transversal, de series de casos, en adultos mayores hospitalizados en el hogar de ancianos "Lidia Doce Sánchez" de Bayamo entre 1ro de septiembre de 2018 al 1ro de septiembre de 2019. La información se obtuvo del análisis de las historias clínicas y la aplicación de los criterios de STOPP/START. El análisis de los datos se realizó mediante estadística descriptiva, se utilizaron pruebas de contrastación de hipótesis y se determinó la razón de prevalencia para determinar los factores asociados. Resultados: fueron frecuentes los pacientes con edades iguales o superiores a 75 años; del sexo masculino; con grado de instrucción primaria; con estado civil soltero y desnutrido. El promedio de comorbilidades por paciente fue de 4,2 ± 2,5; encontrándose como las principales afecciones las enfermedades cardiovasculares. La polifarmacia fue frecuente. La relación de riesgo frente a las potenciales prescripciones inadecuadas de medicamentos es con la edad avanzada, nivel de instrucción baja, comorbilidad, malnutrición y polimedicación. Las potenciales omisiones en la prescripción relacionan con la edad avanzada. Las potenciales interacciones medicamentosas aumentan su probabilidad de presentación con edad avanzada, un nivel bajo de instrucción, la desnutrición, la comorbilidad y la polimedicación. Conclusiones: se constató elevada polifarmacia y prescripción de medicamentos potencialmente no apropiados en los adultos mayores.
Introduction: potentially inappropriate prescription in the elderly is a common occurrence, both in the community and hospital settings, given its high frequency of severe comorbidity and polypharmacy, and has significant clinical and economic repercussions. Objective: to determine the prevalence of polypharmacy and the prescription of potentially inappropriate medications in older adults. Methods: a cross-sectional analytical study of case series was carried out in older adults hospitalized in the "Lidia Doce Sánchez" nursing home in Bayamo between September 1, 2018 and September 1, 2019. The information was obtained from the analysis of clinical records and the application of the STOPP/START criteria. The analysis of the data was carried out through descriptive statistics, hypothesis contrast tests were used and the prevalence ratio was determined to determine the associated factors. Results: patients with ages equal to or greater than 75 years were frequent; of the male sex; with a primary education degree; with single marital status and malnourished. The average number of comorbidities per patient was 4.2 ± 2.5; being found as the main affections cardiovascular diseases. Polypharmacy was frequent. The risk relationship against potential inappropriate drug prescriptions is with advanced age, low level of education, comorbidity, malnutrition and polypharmacy. The potential omissions in the prescription are related to advanced age. Potential drug interactions increase the probability of presentation with advanced age, low level of education, malnutrition, comorbidity and polypharmacy. Conclusions: high polypharmacy and prescription of potentially inappropriate medications were found in older adults.
Introdução: prescrições potencialmente inadequadas em idosos é uma ocorrência comum, tanto na comunidade quanto no hospital, dada a sua alta frequência de comorbidades graves e polifarmácia, e acarreta importantes repercussões clínicas e econômicas. Objetivo: determinar a prevalência de polifarmácia e prescrição de medicamentos potencialmente inapropriados em idosos. Métodos: foi realizado um estudo transversal analítico de série de casos em idosos hospitalizados no lar de idosos "Lidia Doce Sánchez", em Bayamo, entre 1º de setembro de 2018 e 1º de setembro de 2019. As informações foram obtidas a partir da análise dos prontuários e da aplicação dos critérios STOPP/START. A análise dos dados foi realizada por meio de estatística descritiva, teste de hipóteses e razão de prevalência foi determinada para determinar os fatores associados. Resultados: pacientes com 75 anos ou mais foram frequentes; macho; com o ensino fundamental; com estado civil solteiro e desnutrido. O número médio de comorbidades por paciente foi de 4,2 ± 2,5; sendo encontradas como principais afecções as doenças cardiovasculares. A polifarmácia era frequente. A razão de risco para potenciais prescrições inadequadas de medicamentos é com idade avançada, baixa escolaridade, comorbidade, desnutrição e polimedicação. As possíveis omissões na prescrição referem-se à idade avançada. Potenciais interações medicamentosas aumentam sua probabilidade de se apresentar com idade avançada, baixo nível de escolaridade, desnutrição, comorbidade e polimedicação. Conclusões: alta polifarmácia e prescrição de medicamentos potencialmente inapropriados foram encontrados em idosos.
ABSTRACT
OBJECTIVE:To improve rational drug use and reduce potentially inappropriate medication (PIM). METHODS:PIM of 700 elderly inpatients in internal medicine department of our hospital was evaluated by Beers criteria(2012 edition)and STOPP/START criteria. RESULTS:700 inpatients whose mean ages were (76.3 ± 7.2) years old took (12.1 ± 4.9) kinds of drugs per patient. 144 cases involved PIM(20.6%). The number of PIM was 220 in total,among which there were 117 cases/times relat-ed to drugs and 22 cases/times related to disease in according to Beers criteria,9 cases/times of STOPP and 72 cases/times of START. Drug with most frequency of PIM in accordance with Beers was benzodiazepines and most frequency in STOPP was thia-zides that used by patients with gout histonry. The most omission frequency of START prescription were absence of metformin thera-py for type 2 diabetes and absence of antiplatelet therapy for diabetes complicated with cardiovascular risk. CONCLUSIONS:A high prevalence of PIM in elderly inpatients in our hospital requires various measures to prevent its occurrence.
ABSTRACT
BACKGROUND: Prescribing potentially harmful drugs and omitting essential drugs to older patients is a common problem because they take so many medications. In this study, our goal was to identify potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) using Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to the Right Treatment (START) criteria to improve proper prescription and reduce improper prescription. METHODS: Enrolled in this study were 117 patients older than 65 years old who were hospitalized at Inha University Hospital in Incheon due to pneumonia from January 2012 to March 2012. Patient data, including medical histories, current diagnoses, current medications, and biochemical data were recorded from electronic records. STOPP and START were applied to their clinical datasheets. RESULTS: STOPP criteria identified 24 patients who had 29 PIMs. Most potential inappropriate prescribing was of cardiovascular medications, followed by drugs whose primary effect is on the urogenital system and gastrointestinal system. START criteria identified 31 patients who had 46 PPOs. The cardiovascular system drugs comprised most of the PPOs. No PPOs were identified under the central nervous system criteria. CONCLUSION: Given the current Korean medical system conditions and considering the many clinically important situations when prescribing drugs, STOPP/START criteria are not absolute criteria to prevent improper prescription, but sagacious usage of these standards can help physicians to prescribe properly in clinical practice.