Potentially inappropriate medications with older people in intensive care and associated factors: a historic cohort study

ABSTRACT BACKGROUND: The epidemiology of potentially inappropriate medications (PIMs) in critical care units remains limited, especially in terms of the factors associated with their use. OBJECTIVE: To estimate the incidence and factors associated with PIMs use in intensive care units. DESIGN AND SETTING: Historical cohort study was conducted in a high-complexity hospital in Brazil. METHODS: A retrospective chart review was conducted on 314 patients aged ≥ 60 years who were admitted to intensive care units (ICUs) at a high-complexity hospital in Brazil. The dates were extracted from a "Patient Safety Project" database. A Chi-square test, Student's t-test, and multivariable logistic regression analyses were performed to assess which factors were associated with PIMs. The statistical significance was set at 5%. RESULTS: According to Beers' criteria, 12.8% of the identified drugs were considered inappropriate for the elderly population. The incidence rate of PIMs use was 45.8%. The most frequently used PIMs were metoclopramide, insulin, antipsychotics, non-steroidal anti-inflammatory drugs, and benzodiazepines. Factors associated with PIMs use were the number of medications (odds ratio [OR] = 1.17), length of hospital stay (OR = 1.07), and excessive potential drug interactions (OR = 2.43). CONCLUSIONS: Approximately half of the older adults in ICUs received PIM. Patients taking PIMs had a longer length of stay in the ICU, higher numbers of medications, and higher numbers of potential drug interactions. In ICUs, the use of explicit methods combined with clinical judgment can contribute to the safety and quality of medication prescriptions.

Assessment and comparison of anticholinergic exposure in older adults at a Basic Health Unit in Porto Alegre / Avaliação e comparação da exposição anticolinérgica em idosos de uma Unidade Básica de Saúde de Porto Alegre

Objectives: To estimate the anticholinergic burden in geriatric patients using two scales and to assess the degree of agreement between them. Methods: Data from an observational study conducted in a primary health care service were used. Anticholinergic burden was assessed using the Belgian Scale Muscarinic Acetylcholinergic Receptor ANTagonist Exposure Scale and the Brazilian Scale of Medicines with Anticholinergic Activity. The cumulative anticholinergic burden score was classified using a categorical approach: Brazilian scale (0: none; 1 ­ 2: low; ≥ 3: high) and Belgian scale (0: none; 0.5 ­ 1.5: low; ≥ 2: high). The degree of agreement between the two instruments was obtained through Cohen's kappa coefficient. Results: A total of 374 older people were included, most of them female and aged between 60 and 69 years. At least one potentially inappropriate drug with anticholinergic activity was used by 60.70% of patients according to the Brazilian scale and 32.89% by the Belgian scale. On average, 20.85% were under high anticholinergic exposure. Overall, on both scales, the most commonly recurrent medications were those indicated for the treatment of psychiatric disorders. Agreement between the scales was moderate (Kappa = 0.43). Conclusions: A high percentage of older adults was exposed to drugs with an anticholinergic burden, posing risks to health and quality of life. Consensus is needed on how anticholinergic burden is calculated by these scores, as well as standardization of the list of included drugs.

Objetivos: Estimar a carga anticolinérgica em idosos com base em duas escalas e avaliar o grau de concordância entre estas. Metodologia: Foram utilizados dados de um estudo observacional realizado em um serviço de atenção primária. A carga anticolinérgica foi avaliada pela escala belga Muscarinic Acetylcholinergic Receptor ANTagonist Exposure Scale e da Escala Brasileira de Medicamentos com Atividade Anticolinérgica. A pontuação da carga anticolinérgica cumulativa foi classificada utilizando uma abordagem categórica: escala brasileira (0: nenhuma, 1 ­ 2: baixa, ≥ 3: alta) e escala belga (0: nenhuma, 0,5 ­ 1,5: baixa, ≥ 2: alta). O grau de concordância entre as duas ferramentas foi obtido por meio do coeficiente Capa de Cohen. Resultados: Foram incluídos 374 idosos, a maioria do sexo feminino e com idade entre 60 a 69 anos. O uso de pelo menos um medicamento potencialmente inapropriado com atividade anticolinérgica foi verificado em 60,70% dos idosos com a aplicação da escala brasileira e em 32,89% com a escala belga. Em média, 20.85% estavam sob alta exposição anticolinérgica. De modo geral, os medicamentos mais recorrentes, para ambas as escalas, foram os indicados para o tratamento de transtornos psiquiátricos. A concordância entre as escalas foi moderada (Capa = 0,43). Conclusão: Um percentual elevado de idosos estava exposto a medicamentos com carga anticolinérgica, representando riscos para a saúde e a qualidade de vida. É necessário um consenso sobre como calcular a carga anticolinérgica nos diferentes escores, bem como a padronização da lista de medicamentos incluídos.

Potentially inappropriate prescribing among older patients and associated factors: comparison of two versions of STOPP/START criteria

Abstract The study aimed to estimate and compare the prevalence and type of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) between the STOPP/START original (v1) and updated version (v2) among older patients in various settings, as well as associated factors. The study included 440 patients attending a community pharmacy, 200 outpatients and 140 nursing home users. An increase in the prevalence of STOPP v2 (57.9%) compared to v1 (56.2%) was not statistically significant in the total sample and within each setting (p>0.05). A decrease in the prevalence of START v1 (55.8%) to v2 (41.2%) was statistically significant (p<0.001) in the total sample and within each setting (p<0.05). Drug indication (32.9%) and fall-risk medications (32.2%) were most commonly identified for STOPP v2, while cardiovascular system criteria (30.5%) were the most frequently detected for START v2. The number of medications was the strongest predictor for both STOPP v1 and v2, with odds ratio values of 1.35 and 1.34, respectively. Patients' characteristics associated with the occurrence of STOPP and START criteria were identified. According to both STOPP/START versions, the results indicate a substantial rate of potentially inappropriate prescribing among elderly patients. The prevalence of PIMs was slightly higher with the updated version, while the prevalence of PPOs was significantly lower

Medication package inserts do not present adequate information on potential risks for older adults in Brazil / Bulas de medicamentos não apresentam informações adequadas sobre potenciais riscos para idosos no Brasil

OBJECTIVE: To compare information on the risks of potentially inappropriate medications (PIMs) for older adults in the Beers criteria with data in the package inserts made available by the Brazilian Health Regulatory Agency. METHODS: This is an observational, cross-sectional study that compared information on the package inserts of 33 brand-name drugs in the Brazilian market with specific recommendations for older adults contemplated in the Beers criteria, categorizing them into: complete, incomplete, absent, or discrepant. RESULTS: Among the analyzed package inserts, 21.21% did not present a specific section dedicated to the use of these drugs by older adults and data were scattered throughout the text; 63.64% were classified as incomplete; 33.33% lacked data; and 3.03% had discrepant information. CONCLUSION: The analyzed package inserts presented incomplete data or lacked information characterizing the drugs as PIMs for older adults. This study demonstrated that some package inserts of drugs used in Brazil are not satisfactory, warranting higher caution in the medical community when prescribing these medications and guiding patients

OBJETIVO: Comparar as informações sobre os riscos de medicamentos potencialmente inapropriados (MPIs) para idosos contidas nos critérios Beers com as informações presentes nas bulas para profissionais de saúde disponibilizadas pela Agência Nacional de Vigilância Sanitária no Brasil. METODOLOGIA: Estudo observacional e transversal que comparou informações das bulas para profissionais de saúde de 33 medicamentos de referência no mercado brasileiro com recomendações específicas para idosos contempladas nos critérios Beers e que foram categorizadas em: completas, incompletas, ausentes ou discrepantes. RESULTADOS: Dentre as bulas dos MPIs analisadas, 21,21% não apresentam seção específica destinada ao uso desses medicamentos por idosos, nas quais as informações estão dispersas pelo texto; 63,64% delas foram classificadas como incompletas; 33,33% tinham informações ausentes; e 3,03% com informações discrepantes. CONCLUSÃO: As bulas analisadas apresentaram dados incompletos ou não apresentam qualquer informação que caracterizasse o medicamento como MPI para idosos. Este estudo demonstra que algumas bulas de medicamentos utilizados no Brasil não estão satisfatórias, sugerindo maior cautela à comunidade médica na prescrição e na orientação aos seus pacientes

Potentially inappropriate medication use in hospitalized elderly patients

SUMMARY OBJECTIVE: This study aimed to assess the prevalence of potentially inappropriate medication prescription in hospitalized elderly patients according to the 2019 American Geriatrics Society Beers Criteria. METHODS: This study is a prospective analysis of electronic medical records of elderly patients admitted to the Department of Medicine, Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo, between 1 September 2020 and 30 April 2021. RESULTS: A total of 142 patients (85 women and 57 men) with a mean age of 74.5±7.3 years (65-99 years) were assessed. Of these, 108 (76.1%) were elderly (age ≥65 years and <80 years) and 34 (23.9%) long-lived (age ≥80 years). The average length of stay found in the sample was 25.3±28.7 days (between 2 and 235 days), and 102 out of the 140 patients assessed remained in the hospital for up to 29 days. Sixteen drugs considered potentially inappropriate medication were found in the patients' prescriptions, with at least one potentially inappropriate medication having been prescribed to 141 (99.3%) patients. Elderly patients had a mean of 2.57±0.94 potentially inappropriate medication prescribed versus 2.56±0.89 among long-lived patients. The most prescribed potentially inappropriate medication were as follows: regular human insulin as required (85.2%), and omeprazole (73.9%) and metoclopramide as required (61.3%). CONCLUSION: The study sample showed significant percentages of potentially inappropriate medication prescriptions for the elderly admitted to the hospital.

Medication Appropriateness among Older Persons Admitted to a General Hospital in Malaysia

@#Introduction: Many tools have been developed to determine medication appropriateness in older persons including the 2015 American Geriatric Society (AGS) Beers criteria and the Screening Tool of Older People’s Prescriptions (STOPP) criteria. We aimed to determine and compare the prevalence of potentially inappropriate medications (PIMs) based on the Beers criteria 2015 and the STOPP criteria v2 among older persons admitted to a general hospital in Malaysia. Methods: A cross-sectional study comprising of 160 patients aged 65 years old and above admitted to the general medical wards of a tertiary teaching hospital were recruited. Beers criteria 2015 and the STOPP criteria v2 were used to evaluate participants’ medication list on admission, during hospitalisation and on discharge for PIMs. Prevalence of PIMs which was calculated as the total number of patients with one or more PIMs over the total number of patients. Results: The prevalence of PIMs identified by Beers criteria 2015 on admission, during hospitalisation and on discharge were 54.85%, 64.40% and 48.80% respectively. The prevalence of PIM based on STOPP criteria v2 were 33.08%, 47.50% and 42.50% respectively. The most prevalent PIMs according to Beers criteria 2015 and STOPP criteria v2 were diuretics, tramadol, ticlopidine, proton pump inhibitor, benzodiazepines and antipsychotics. Conclusion: The prevalence of PIMs use is high among hospitalised older persons in Malaysia. While it is not possible to avoid all PIMs listed in the Beers and STOPP criteria, clinicians should exercise caution in prescribing drugs such as benzodiazepines, antipsychotics and proton pump inhibitors for older persons weighing the risk versus benefit of the drugs.

Potentially inappropriate medication use in a comprehensive therapy management service: clinical outcomes and interventions

Abstract This study aimed to describe potentially inappropriate medication (PIM) use according to the Beers criteria among older adults followed in a comprehensive medication management (CMM) service, the pharmacists´ interventions, and the clinical outcomes of PIM use. All older adults in a CMM service delivered in the Brazilian public primary care system were included in the study (n = 389). Two methodological approaches were developed: (I) cross-sectional - prevalence of PIM use and associated factors were identified (univariate analysis - Pearson's chi-square; multivariate - logistic regression); (II) documental analysis of the negative clinical outcomes potentially associated with PIM use and pharmacists' interventions. The prevalence of PIM use was 48.3%, and it was independently and positively associated with the use of ≥ 5 drugs. For 21.3% of PIMs, a potential negative clinical outcome was identified. The most common negative clinical outcome was hypotension (35.1% of the negative outcomes), fractures or diagnosis of osteoporosis (21.1%), and hypoglycemia (14.0%). For most of them (78.9%), an intervention was performed to mitigate harm or discontinue use. A high prevalence of PIM was detected and was associated with polypharmacy. A significant proportion of PIM showed potential negative clinical outcomes that were identified by clinical pharmacists, and the majority of pharmacists' interventions aimed at its mitigation or deprescription. Overall, our findings reinforce the potential of CMM services for reducing PIM use and the occurrence of negative outcomes.

Use of potentially inappropriate medications and adverse events in older outpatients with acute conditions

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.

Conhecimento dos prescritores sobre medicamentos potencialmente inapropriados para idosos em uma Unidade Básica de Saúde / Prescribers' knowledge of potentially inappropriate medications in older adults in a Primary Care Unit

Introdução: O conhecimento dos prescritores sobre medicamentos potencialmente inapropriados (MPI) pode reduzir o risco de resultados adversos à saúde em idosos, uma vez que esses medicamentos podem trazer mais risco do que benefício a esses pacientes. O objetivo deste estudo é obter informações sobre o conhecimento dos prescritores em relação aos cuidados na prescrição de medicamentos para idosos e analisar o conhecimento destes em relação a critérios explícitos de classificação de MPI.Métodos: Trata-se de um estudo exploratório e observacional, de delineamento transversal, desenvolvido com a aplicação de questionário on-line respondido de forma anônima por prescritores de uma unidade básica de saúde.Resultados: Dos 20 profissionais que responderam ao questionário, 9 eram professores, 7 médicos residentes e 4 médicos contratados. Em relação aos idosos, 70% dos prescritores percebem boa adesão ao tratamento e 40% maior frequência de reações adversas a medicamentos, quando comparados à população em geral. Somente 30% dos profissionais relataram conhecimento sobre algum critério de classificação de MPI, e 25% destes já utilizou/utiliza algum dos critérios na prática clínica. Porém, os prescritores citaram as classes mais presentes no Critério de Beers para MPI como candidatas à desprescrição e ajuste de dose.Conclusão: O conhecimento e aplicação de critérios de classificação de MPI na prática clínica é ainda incipiente, mesmo em Unidade vinculada a Hospital Universitário.

Introduction: Knowledge of potentially inappropriate medications (PIMs) may reduce the risk of adverse health outcomes in older patients, given that PIMs may be more harmful than beneficial to this population. To investigate prescribers' knowledge of appropriate drug prescription in older adults and evaluate their knowledge of explicit criteria for PIM classification.Methods: We conducted a cross-sectional, exploratory, observational study. We developed an online questionnaire, which was anonymously answered by prescribers from a primary care unit.Results: A total of 20 prescribers answered the questionnaire, of whom 9 were professors, 7 were medical residents, and 4 were physicians. In older patients, 70% of prescribers reported good adherence to treatment and 40% reported a higher rate of adverse drug reactions compared with the general population. Only 30% of prescribers reported some knowledge of the criteria for PIM classification, and 25% of them had already used/use some of the criteria in clinical practice. However, the most prevalent drug classes in the Beers Criteria for PIM were mentioned by prescribers as potentially requiring deprescription and dose adjustment.Conclusion: Knowledge and application of the PIM classification in clinical practice is still incipient, even in a primary care unit affiliated with a teaching hospital.

Prescrição de medicamentos potencialmente inapropriados para idosos segundo os Critérios de Beers: revisão sistemática / Prescribing potentially inappropriate medications for the elderly according to Beers Criteria: systematic review

Resumo Objetivou-se realizar uma revisão sistemática para identificar e avaliar a prevalência da prescrição de medicamentos potencialmente inapropriados (MPI), segundo os Critérios de Beers, em idosos hospitalizados com ≥65 anos. Foram consultadas cinco bases de dados: BVS, Cochrane Library, CINAHL, MEDLINE e Web of Science. Foram identificados 19 artigos, selecionados a partir de critérios de elegibilidade. A média de idade foi 78,2 anos e o critério mais utilizado para a identificação dos MPI para idosos foi o de Beers 2015 (57,9%). Um total de 221.879 idosos recebeu prescrição inapropriada, a prevalência média foi de 65.0%, com destaque para o sistema gastrointestinal (15,3%) e os inibidores da bomba de prótons (27,7%) como a principal classe de medicamento prescrita. Conclui-se que os Critérios de Beers possibilitaram a identificação da alta prevalência na prescrição dos MPI. Os resultados desta revisão poderão auxiliar na tomada de decisão dos profissionais de saúde, no intuito de se evitar a administração dos MPI e propor melhores práticas que garantam a segurança do idoso hospitalizado.

Abstract The study aimed to perform a systematic review to identify and evaluate the prevalence of potentially inappropriate medicines (PIM) prescriptions for the elderly, according to Beers Criteria, in hospitalized elderly individuals aged 65 years or older. Five databases consulted: VHL; Cochrane Library; CINAHL; MEDLINE and Web of Science. Nineteen articles identified, selected based on eligibility criteria. The mean age was 78.2 years and the most used criterion for the identification of PIM for the elderly was Beers 2015 (57.9%). A total of 221,879 elderly received a prescription for PIM, the mean prevalence was 65.0%, for the gastrointestinal system (15.3%) and proton-pump inhibitors (27.7%) highlighted as the main class of medicine prescribed. It concluded that the Beers Criteria have made it possible to identify the high prevalence in the prescription of PIM. The results of this review may help in the decision making of health professionals, to avoid the administration of PIM and to propose best practices to ensure the safety of the elderly hospitalized.

Potentially inappropriate medications, drug-drug interactions, and prescribing practices in elderly patients: a cross-sectional study

SUMMARY OBJECTIVE: To evaluate potentially inappropriate medications, potential drug-drug interactions, and prescribing practices in elderly ambulatory patients. METHODS: We carried out a cross-sectional study on 275 elderly patients attending different outpatient departments. We used the Screening Tool for Older Person's Prescriptions criteria version two to identify potentially inappropriate medications, IBM Micromedex, to categorize potential drug-drug interactions as major and moderate. World Health Organization prescribing indicators were used to evaluate prescribing practices. RESULTS: The prevalence of potentially inappropriate medications in 275 prescriptions was 21.9%. Diclofenac was the most common inappropriate drug (n=23). Metoprolol is the second most inappropriate drug (n=12). Amlodipine and clopidogrel, aspirin and furosemide, and aspirin and spironolactone together accounted for 71.42% of major interactions (n=15). Atorvastatin and clopidogrel was the most common moderate drug-drug interaction in our study (n=24). The average number of drugs per encounter, the percentage of drugs with a generic name, and the percentage of drugs from the essential drugs list must be improved. CONCLUSION: There is a need to provide awareness through education about the explicit criteria to identify potentially inappropriate medications and prescribing indicators that aid in rational prescribing in the elderly.

Prevalence and impact of potentially inappropriate medication on community-dwelling older adults / Prevalencia e impacto de la medicación potencialmente inapropiada en ancianos que viven en comunidad

Abstract | Introduction: Potentially inappropriate medication is associated with adverse health and functional outcomes, as well as increased health care costs. Objective: To estimate the prevalence and types of potentially inappropriate medication according to the Beers criteria in community-dwelling older persons and to identify the major clinical and functional consequences of potentially inappropriate medication during two years of following. Materials and methods: We conducted a longitudinal, descriptive, and observational study that included 400 65-year or older community-dwelling people (48% women) selected by simple random sampling in 2012. In 2014, 372 people were re-evaluated and classified into two groups based on the presence or absence of potentially inappropriate medication through the follow-up period. Results: In total, 31% had polypharmacy (5-9 medications) and 1,8% had excessive polypharmacy (10 or more medications). The mean of the number of medications was higher in the potentially inappropriate medication group (3 vs. 5.78; p<0.001) and 21.9% still had the potentially inappropriate medication status during the follow-up; of them, 75% had one potentially inappropriate medication and 23% two. The presence of potentially inappropriate medication was more frequent among frail and depressed male individuals with a bad health self-assessment and comorbidities, especially diabetes mellitus and chronic obstructive pulmonary disease. In the group with sustained potentially inappropriate medication, we found a worsening health self-assessment, increased frailty, a higher incidence of recurrent falls and prevalence of depression, as well as a higher hospital admission rate, ambulatory medical consultation, and more prescribed medications. We did not find an impact on functional capacity. Conclusions: We validated the negative effects of potentially inappropriate medication in the long run for the health of older people and, therefore, potentially inappropriate medications should be monitored in primary care services to avoid greater risks.

Resumen | Introducción. La medicación potencialmente inapropiada se asocia con consecuencias clínicas, geriátricas, funcionales y farmacoeconómicas negativas. Objetivo. Estimar la prevalencia y los tipos de medicación potencialmente inapropiada según los criterios de Beers en ancianos que viven en comunidad y determinar las principales consecuencias clínicas y funcionales a lo largo de dos años de seguimiento. Materiales y métodos. Se hizo un estudio descriptivo, observacional y longitudinal que incluyó 400 mayores de 65 años (48 % mujeres) residentes en la comunidad seleccionados mediante muestreo aleatorio simple en el 2012. En el seguimiento del 2014 se reevaluaron 372 de ellos y se clasificaron en dos grupos: quienes a lo largo de los dos años siguieron tomando medicación potencialmente inapropiada y quienes no. Resultados. El 31 % de los ancianos estaban polimedicados, (5 a 9 medicamentos) y 1,8 % polimedicados de forma excesiva (10 o más medicamentos). El promedio de consumo de medicamentos era mayor en el grupo de medicación potencialmente inapropiada (3 Vs. 5,78; p<0,001), y el 21,9 % siguieron recibiendo medicación poitencialmente inapropiada durante el seguimiento; de ellos, el 75 % recibía un medicamento de este tipo y el 23 %, dos. El uso de dicha medicación fue más frecuente en hombres frágiles con una mala percepción de la propia salud, depresión y un mayor número de comorbilidades, especialmente diabetes mellitus y enfermedad-pulmonar-obstructiva-crónica. En el grupo que siguió recibiendo medicación potencialmente inapropiada la percepción de la propia salud empeoró, con un incremento de la fragilidad, las caídas recurrentes y la depresión, así como en los ingresos hospitalarios y las consultas médicas y mayor cantidad de medicamentos formulados. No se evidenció un impacto en la capacidad funcional. Conclusiones. Se corroboran los efectos negativos a largo plazo de la medicación potencialmente inapropiada en la salud de los ancianos, por lo cual se la debe monitorizar en la atención primaria para evitar mayores riesgos.

Nurse knowledge about potentially inappropriate medications for elderly

Due to the consequences of changes in fertility and mortality rates, there is an increase in population aging. In this context, the use of potentially inappropriate medications in this population makes nurses important agents in the identification of adverse reactions, requiring their knowledge about these drugs and their effects. The study aimed to verify nurses knowledge about the 2015 AGS BeersCriteria, regarding the potentially inappropriate medications for the elderly, and their adverse effects. It is a cross-sectional, descriptive, and analytical study with a quantitative and qualitative approach performed in a teaching hospital in the Triângulo Mineiro, Minas Gerais. Of the 80 professionals, 74.1% reported attending the elderly frequently, and only 3.8% had a specialization course in elderly health. Only 13.8% reported knowing the Beers Criteria. And 69% believe that adverse drug reactions can be confused as a new symptom and because of this, new drugs can be inserted into the therapeutic plan. Three categories emerged: The importance of assertive knowledge about PIMs, The nurse as a fundamental character in ADR, and Knowledge as a reinforcer of care. There is evidence of the need to train nurses to better identify adverse drug reactions so that they can act on these events avoiding the worsening of the individual.

Prevalência e fatores associados à utilização de medicamentos potencialmente inapropriados para pessoas idosas em Rio Branco, Acre, Brasil: um estudo de base populacional / Prevalence and factors associated the use of potentially inappropriate medications by older adults in Rio Branco, Acre, Brazil: a population-based study

Resumo Objetivo Verificar a prevalência e analisar os fatores associados ao uso de medicamentos potencialmente inapropriados (MPI) em pessoas idosas de Rio Branco, Acre, Brasil. Método Trata-se de um estudo transversal de base populacional. A variável dependente foi uso de pelo menos um MPI, de acordo com os critérios do Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos (CBMPII), independentemente da condição clínica. Na avaliação da associação entre o uso de medicamentos inapropriados e as variáveis independentes, realizou-se análise bruta e ajustada por meio de regressão logística, utilizando-se o modelo hierarquizado por razão de chances (OR). Resultados A prevalência de uso de pelo menos um MPI entre os 1.016 participantes foi de 25,9% (IC95% 22,3; 29,8), associada positivamente a sexo feminino (OR=1,38; IC95% 1,01; 1,90), dependência quanto às atividades instrumentais da vida diária (OR=1,37; IC95% 1,02; 1,83), autoavaliação de saúde negativa (OR=1,54; IC95% 1,12; 2,11), internação nos últimos 12 meses (OR=1,79; IC95% 1,19; 2,69) e presença de mais de três comorbidades (OR= 2,56; IC95% 1,97; 3,33). A subcategoria mais utilizada foi dos inibidores de bombas de prótons, por 11,3% (9,2; 13,8). Conclusão A prevalência de uso de MPI por idosos da amostra foi de um quarto, estando associada ao sexo feminino e a condições de saúde. Ações de conscientização fazem-se necessárias para garantia dos benefícios no uso dos medicamentos.

Abstract Objective To verify the prevalence and analyze the factors associated with the use of potentially inappropriate medications (PIM) in the older adults in Rio Branco, Acre, Brazil. Method This is a cross-sectional population-based study. The dependent variable was the use of at least one PIM, according to the criteria of the Brazilian Consensus on Potentially Inappropriate Medicines for the older adults, regardless of clinical condition. In evaluating the association between the use of inappropriate medications and the independent variables, a crude and adjusted analysis was performed using logistic regression, using the hierarchical model by odds ratio (OR). Results The prevalence of using at least one PIM among the 1,016 participants was 25.9% (95%CI 22.3; 29.8), positively associated with female sex (OR=1.38; 95%CI 1.01; 1.90), dependence on instrumental activities of daily living (OR=1.37; 95%CI 1.02; 1.83), negative self-rated health (OR=1.54; 95%CI 1.12; 2.11), hospitalization in the last 12 months (OR=1.79; 95%CI 1.19; 2.69) and presence of more than three comorbidities (OR=2.56; 95%CI 1.97; 3.33). The most used subcategory was proton pump inhibitors by 11.3% (9.2; 13.8). Conclusion The prevalence of PIM use by elderly in this population was a quarter, being associated with female gender and health conditions. Awareness actions are necessary to guarantee the benefits of using medications.

Evidence of association between the use of drugs and community-dwelling older people frailty: a cross-sectional study

ABSTRACT BACKGROUND: The scientific literature has shown that an association between polypharmacy and frailty exists. However, few studies have also considered drug interactions and the use of potentially inappropriate medications. OBJECTIVE: To evaluate the association between the use of drugs and frailty among community-dwelling older people. DESIGN AND SETTING: Cross-sectional study carried out among 580 older people in Uberaba (MG). METHODS: Data were collected at these older people's homes using instruments validated in Brazil. Descriptive, bivariate and binary logistic regression analyses were performed (P < 0.05). RESULTS: Most of these individuals were classified as pre-frail (55.7%), while 13.1% were frail. It was found that 31.7% of them presented polypharmacy, 41.7% had drug interactions and 43.8% were using potentially inappropriate medications. In the initial model, polypharmacy (odds ratio, OR = 1.91; confidence interval, CI = 1.27-2.86) and use of potentially inappropriate medications (OR = 2.45; CI = 1.68-3.57) increased the chance that these older people would be pre-frail or frail. In the final adjusted model, use of potentially inappropriate drugs remained associated with the outcome (OR = 2.26; CI = 1.43-3.57). CONCLUSION: Use of potentially inappropriate medications was the independent variable that explained the occurrence of frailty in a representative sample of community-dwelling older adults.

Drug interactions for elderly with respiratory disorders and times of covid-19: a systematic scoping review / Interacciones farmacológicas para ancianos con enfermedades respiratorias y tiempos de covid-19: una revisión sistemática del alcance

Background: The elderly people have high morbimortality associated with respiratory disorders, in addition to the presence of other safety risk factors, such as the use of potentially inappropriate medication and the occurrence of drug interactions. Objective: Considering the current pandemic scenario, it was intended to identify explicit criteria-based tools that reported drug interactions between potentially inappropriate medication and respiratory system disorders and possibly worse prognosis of COVID-19 infection. Methods: A systematic scoping review was conducted until February 2020. Study characteristics of explicit criteria-based tools, and potentially inappropriate medication, drug interactions, and therapeutic management, were extracted. Results: Nineteen explicit criteria-based tools were included. Nineteen drug interactions and 17 potentially inappropriate medications with concerns for three respiratory disorders (asthma, chronic pulmonary obstructive disease, and respiratory failure) were identified. The most frequent pharmacological classes reported were benzodiazepines and beta-blockers. For clinical management, the tools recommend using cardioselective beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin II type I receptor blockers and benzodiazepines with a short or intermediate half-life. Conclusion: Considering the increased risk of COVID-19 infection in the elderly, drug interactions and the use of potentially inappropriate medication associated with the occurrence of adverse drug events in the respiratory system may also worsening COVID-19 infection in patients with uncontrolled respiratory disorders. Thus, it is essential to assess drug therapy in use, to identify safety risks and monitor the elderly in general and those with a worse prognosis concerning COVID-19, promoting patient safety.

Antecedentes: Los ancianos tienen alta morbimortalidad asociada a trastornos respiratorios, además de la presencia de otros factores de riesgo de seguridad, como el uso de medicación potencialmente inapropiada y la ocurrencia de interacciones medicamentosas. Objetivo: Teniendo en cuenta el escenario pandémico actual, se pretendía identificar herramientas explícitas basadas en criterios que informaran interacciones farmacológicas entre medicamentos potencialmente inapropiados y trastornos del sistema respiratorio y posiblemente un peor pronóstico de la infección por COVID-19. Métodos:Se realizó una revisión sistemática del alcance hasta febrero de 2020. Se extrajeron las características del estudio de las herramientas explícitas basadas en criterios y la medicación potencialmente inapropiada, las interacciones entre medicamentos y el manejo terapéutico. Resultados: Se incluyeron diecinueve herramientas explícitas basadas en criterios. Se identificaron diecinueve interacciones farmacológicas y 17 medicamentos potencialmente inapropiados con preocupaciones por tres trastornos respiratorios (asma, enfermedad pulmonar obstructiva crónica e insuficiencia respiratoria). Las clases farmacológicas más frecuentes comunicadas fueron las benzodiacepinas y los betabloqueantes. Para el manejo clínico, las herramientas recomiendan el uso de betabloqueantes cardioselectivos, bloqueadores de los canales de calcio, inhibidores de la enzima convertidora de angiotensina y bloqueadores del receptor de angiotensina II tipo I y benzodiacepinas con una vida media corta o intermedia. Conclusión: Teniendo en cuenta el mayor riesgo de infección por COVID-19 en los ancianos, las interacciones farmacológicas y el uso de medicamentos potencialmente inapropiados asociados con la aparición de eventos farmacológicos adversos en el sistema respiratorio también pueden empeorar la infección por COVID-19 en pacientes con trastornos respiratorios no controlados. Por tanto, es fundamental evaluar la farmacoterapia en uso, identificar los riesgos de seguridad y monitorizar a los ancianos en general y a aquellos con peor pronóstico en relación con el COVID-19, promoviendo la seguridad del paciente.

Risk factors associated with potential cardiovascular and cerebrovascular adverse events in elderly individuals assisted at secondary level

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.

RESUMO OBJETIVO Identificar o uso de Medicamentos Potencialmente Inapropriados (MPI) com risco iminente de EAM cardiovascular e cerebrovascular (EAM-CC), além dos fatores associados a um grupo de idosos em vigência terapêutica de um serviço público brasileiro. MÉTODOS Estudo seccional e retrospectivo realizado em um serviço de nível secundário localizado em Carapicuíba, SP, Brasil. Incluíram-se, apenas, idosos (idade ≥60 anos) que foram tratados em um departamento de atendimento ambulatorial. O uso de MPI com risco iminente de EAM-CC foi definido empregando a lista PIM-CCVAEs. Nesta pesquisa, apropriou-se da estatística descritiva e de regressão logística para identificação e rastreio de possíveis preditores de uso de MPI. Todas as análises estatísticas foram realizadas usando o software Stata version 15.1 (Stata Corporation). RESULTADOS Incluíram-se, na casuística, 233 idosos, com média de idade igual a 74,9 (±9,4) anos. Destes, 74,2% faziam uso de pelo menos um MPI com risco de EAM-CC, atingindo uma média de consumo diário igual a 1,3 (± 1) MPI/idoso. Verificou-se que a presença de comorbidades, doenças do aparelho circulatório, polifarmácia e score baixo a moderado em índices de morbimortalidade foram importantes fatores associados ao aumento da razão de chances para o consumo de MPI com risco de EAM-CC. Ressalta-se ainda que a presença de sintomas neurológicos mostrou-se como fator protetor para este desfecho. CONCLUSÃO Dada a gravidade clínica e o risco iminente de EAM-CC do grupo pesquisado, medidas de prevenção devem ser instituídas com o intuito de minimizar os problemas de saúde relacionados à medicação na rede pública.

Beers AGS 2019 criteria in very old hospitalized patients

SUMMARY OBJECTIVE To define the rates and types of potentially inappropriate medications (PIMs) for older adults according to the Beers AGS 2019 criteria in oldest-old patients (aged ≥80 years) hospitalized in an Internal Medicine ward. METHODS A retrospective analysis of prescriptions from medical records of oldest-old patients hospitalized in an Internal Medicine Teaching-Hospital ward using the Beers AGS 2019 criteria was performed. Data was also collected for gender, mean age, days of hospitalization, presence of feeding tube, delirium, and polypharmacy (≥5 drugs/day). The drugs listed in Table 2 of the Beers criteria were considered PIMs. RESULTS The series comprised 39 very old patients (22 men, 17 women), with a mean age of 86.3±4.7 years and hospitalization of 22.8±21.3 days. All patients were admitted via the Emergency Room. Feeding tube placement and polypharmacy occurred in 84.6% of cases and delirium in 71.8%. The prescription of a total of 16 drugs considered PIM was detected by the Beers AGS 2019 criteria (mean 1.8 ± 1.0 PIM per patient). Main prescribed PIMs were Metoclopramide "if necessary" [IN] (41.0% of cases), Omeprazole (38.5%), Regular Insulin [IN] (23.1%), Haloperidol [IN] (18.0%), Quetiapine and Amiodarone (10% each). CONCLUSION In the present series of oldest-old hospitalized patients, significant rates of PIM were found, especially for drugs prescribed as "If Necessary", thereby increasing the risk of side-effects to that of the common polypharmacy in this age group.

RESUMO OBJETIVO Definir percentual e tipos de medicamentos potencialmente inapropriados para idosos (MPII) pelos critérios de Beers AGS 2019 em longevos (idade ≥80 anos) hospitalizados em enfermaria de clínica médica. MÉTODO Análise retrospectiva das prescrições de prontuários de longevos internados em enfermaria de clínica médica de hospital terciário pelos critérios de Beers AGS 2019. Outros dados coletados: gênero, idade média, dias de hospitalização, presença de sonda de alimentação, delirium, polifarmácia (≥5 fármacos/dia). Consideraram-se como MPII os fármacos listados na Tabela 2 do referido critério. RESULTADOS Trinta e nove longevos (22 homens, 17 mulheres), idade média 86,3±4,7 anos e 22,8±21,3 dias de hospitalização. A presente casuística foi integralmente admitida pelo pronto-socorro, ocorrendo sonda de alimentação e polifarmácia em 84,6% dos casos e delirium em 71,8%. Detectou-se a prescrição de 16 fármacos considerados MPII pelos critérios de Beers AGS 2019 (média de 1,8±1,0 MPII por paciente). Principais MPII prescritos: metoclopramida, se necessário [SN] (41,0% dos casos), omeprazol (38,5%), insulina regular [SN] (23,1%), haloperidol [SN] (18,0%), quetiapina e amiodarona (10% cada). CONCLUSÃO Na presente casuística, longevos hospitalizados apresentaram percentuais significativos de MPII, notadamente em fármacos indicados como "se necessário", o que aumenta o risco de efeitos colaterais ao fato comum de polifarmácia nessa faixa etária.

Fac10.1590/0034-7167-2020-0078tors associated with the use of potentially inappropriate medications by elderly people with hypertension / Factores asociados al uso de medicamentos potencialmente inapropiados por ancianos con hipertensión / Fatores associados ao uso de medicamentos potencialmente inapropriados por idosos com hipertensão

ABSTRACT Objective: to analyze factors associated with the use of potentially inappropriate medications by elderly people with hypertension. Method: a cross-sectional study, conducted in the first semester of 2016, with elderly people undergoing treatment for hypertension, living in the city of Maringá. Interviews, medical records analysis, and measurement of clinical and anthropometric parameters of the participants were carried out. Inferential analysis was used. Results: a total of 260 elderly people who used potentially inappropriate medications participated in the study. The high use of these medications was associated with clinical and anthropometric conditions, such as obesity (p=0.022), smoking (p=0.004), polypharmacy (p=0.034) and the health services provided, such as organizationally accessible treatment (p=0.027) and consultation time (p=0.007), predisposing to low adherence to routine consultations (p=0.003). Conclusion: it was shown that the factors associated with the use of potentially inappropriate medications were associated with anthropometric, clinical, and organizational variables, intrinsic to the family health strategy.

RESUMEN Objetivo: analizar factores asociados con el uso de medicamentos potencialmente inapropiados por ancianos con hipertensión. Método: estudio transversal, realizado en el primer semestre de 2016, con ancianos en tratamiento por hipertensión, residentes en la ciudad de Maringá. Se realizaron entrevistas, análisis de historias clínicas y medición de parámetros clínicos y antropométricos de los participantes. Se utilizó análisis inferencial para tratar las variables. Resultados: en el estudio participaron 260 ancianos, que utilizaron medicamentos potencialmente inapropiados. El alto uso de estos medicamentos se asoció con condiciones clínicas y antropométricas, como obesidad (p=0,022), tabaquismo (p=0,004), polifarmacia (p=0,034) y los servicios de salud ofrecidos, como tratamiento organizacionalmente accesible (p=0,027) y tiempo de consulta (p=0,007), lo que predispone a una baja adherencia a las consultas de rutina (p=0,003). Conclusión: se evidenció que los factores asociados al uso de medicamentos potencialmente inapropiados se asociaron con variables antropométricas, clínicas y organizacionales, intrínsecas a la Estrategia de Salud Familiar.

RESUMO Objetivo: analisar os fatores associados ao uso de medicamentos potencialmente inapropriados por idosos com hipertensão. Método: estudo transversal, realizado no primeiro semestre de 2016, com idosos em tratamento da hipertensão, residentes no município de Maringá. Realizou-se entrevista, análise de prontuário e aferição de parâmetros clínicos e antropométricos dos participantes. Utilizou-se análise inferencial para tratamento das variáveis. Resultados: participaram do estudo 260 idosos, que faziam uso de medicamentos potencialmente inapropriados. O uso elevado dessas medicações se associou às condições clínicas e antropométricas, como obesidade (p=0,022), tabagismo (p=0,004), polifarmácia (p=0,034) e aos serviços de saúde ofertados, como tratamento organizacionalmente acessível (p=0,027) e tempo de consulta (p=0,007), predisponente à baixa aderência às consultas de rotina (p=0,003). Conclusão: evidenciou-se que os fatores associados ao uso de medicamentos potencialmente inapropriados se associaram a variáveis antropométricas, clínicas e organizacionais, intrínsecas a estratégia saúde da família.

Conhecimento sobre uso de medicamentos potencialmente perigosos entre enfermeiros da assistência hospitalar à saúde / Knowledge about the use of potentially dangerous drugs among hospital health care nurses

RESUMO Objetivo caracterizar o conhecimento sobre uso de medicamentos potencialmente perigosos entre enfermeiros da assistência hospitalar à saúde. Métodos pesquisa quantitativa, descritiva-exploratória, com aplicação de questionário validado, traduzido e adaptado no Brasil, sobre medicamentos potencialmente perigosos, com 26 enfermeiros assistenciais em hospital universitário. Realizou-se análise estatística descritiva univariada e bivariada dos dados, por meio do Statistical Package for Social Science, versão 20. Consideraram-se como conhecimento suficiente escores ≥70% ou conhecimento insuficiente escores <70%. Resultados no primeiro domínio do questionário, denominado Administração dos medicamentos, o percentual médio de acertos foi de 64,6%. No segundo domínio, Procedimentos clínicos, encontrou-se média de 53,7% de acertos. O uso dos eletrólitos, quimioterápicos e de insulina foram as principais fragilidades no saber dos profissionais. Conclusão identificou-se conhecimento insuficiente sobre a administração e os procedimentos clínicos de medicamentos potencialmente perigosos entre os enfermeiros assistenciais hospitalares neste cenário.

ABSTRACT Objective to characterize the knowledge about the use of potentially dangerous drugs among hospital health care nurses. Methods quantitative, descriptive-exploratory research, with the application of a validated questionnaire, translated and adapted in Brazil, on potentially dangerous medications, with 26 nursing assistants in a university hospital. Univariate and bivariate descriptive statistical analysis of the data was performed using the Statistical Package for Social Science, version 20. Scores ≥70% were considered as sufficient knowledge and insufficient knowledge scores <70%. Results in the first domain of the questionnaire, called Medication Administration, the average percentage of correct answers was 64.6%. In the second domain, Clinical procedures, an average of 53.7% of correct answers was found. The use of electrolytes, chemotherapy and insulin were the main weaknesses in the knowledge of professionals. Conclusion insufficient knowledge about the administration and clinical procedures of potentially dangerous drugs was identified among hospital care nurses in this scenario.