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Resumo Objetivo Analisar a frequência de polifarmácia e prescrição de medicamentos potencialmente inapropriados (MPI) segundo os Critérios de Beers e CBMPI em pessoas idosas com vulnerabilidade clínico-funcional. Método Trata-se de um estudo transversal onde analisou-se os prontuários de 496 participantes com 60 anos ou mais, atendidos em primeira consulta em uma Policlínica Gerontológica. Os dados sociodemográficos, medicamentos, e o Índice de Vulnerabilidade Clínico Funcional 20 (IVCF-20) e quedas foram extraídos dos prontuários. A polifarmácia foi definida como o uso simultâneo de cinco ou mais medicamentos. Os participantes foram classificados em três grupos: robusto, em risco e vulnerável. Resultados A análise demonstrou que 69 (13,91%) dos participantes faziam uso de polifarmácia. Entre os usuários de polifarmácia, 40 (57,97%) faziam uso de pelo menos um MPI. Os MPIs mais encontrados foram a glibenclamida e o omeprazol, respectivamente. Pessoas idosas com vulnerabilidade apresentaram um risco três vezes maior de apresentar polifarmácia (RP 3,59; IC95% 2,109-6,092). Conclusão O uso de polifarmácia e MPI neste estudo estavam associados à vulnerabilidade da pessoa idosa, reforçando a necessidade de avaliação criteriosa de prescrições medicamentosas para essa população.
Abstract Objective To analyze the frequency of polypharmacy and the prescription of Potentially Inappropriate Medications (PIM) according to the Beers Criteria and CBMPI in older adults with clinical-functional vulnerability. Method This is a cross-sectional study where the medical records of 496 participants aged 60 and older, seen in their first appointment at a Gerontological Polyclinic, were analyzed. Sociodemographic data, medications, the Clinical-Functional Vulnerability Index-20 (IVCF-20), and falls were extracted from the medical records. Polypharmacy was defined as the simultaneous use of five or more medications. Participants were classified into three groups: robust, at risk, and vulnerable. Results The analysis revealed that 69 (13.91%) participants were using polypharmacy. Among polypharmacy users, 40 (57.97%) were using at least one PIM. The most commonly found PIM were glibenclamide and omeprazole, respectively. Older adults with vulnerability were three times more likely to have polypharmacy (OR 3.59; 95% CI 2.109-6.092). Conclusion The use of polypharmacy and PIM in this study was associated with the vulnerability of older adults, emphasizing the need for a thorough evaluation of medication prescriptions for this population.
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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.
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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.
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Objective:To investigate the levels of knowledge, attitudes and practice of general practitioners on potentially inappropriate medication(PIM)in the elders in Shanxi Province and to explore its relevant factors.Methods:A cross-sectional survey on knowledge, attitudes and practice of general practitioners on PIM in the elders was conducted from January to February 2021. A self-designed questionnaire was used for the survey, which included the basic information of general practitioners and the knowledge, attitudes and practice of elderly PIM. The convenient sampling method was used to select 16 primary, secondary and tertiary hospitals from the general practice alliance units in Shanxi Province, and 257 general practitioners in the selected hospital were recruited as the research objects. The related factors were investigated by univariate regression and multiple stepwise linear regression analyses.Results:A total of 257 questionnaires were distributed, and 248 valid questionnaires were recovered, with an effective rate of 96.5%. The scores of elderly PIM knowledge, attitudes and behavior of 248 general practitioners were (31.4±9.2), (32.9±4.6) and (34.9±8.3), respectively, with the scoring rates of 62.8% (31.4/50.0), 82.3% (32.9/40.0) and 69.8% (34.9/50.0). The total score was (99.2±16.3), and the total score rate was 70.9% (99.2/140.0). There was a statistically significant difference in the total score of elderly PIM knowledge, attitudes and practice among general practitioners with different educational background, work units, professional title, awareness level of PIM and needs for PIM training( F=6.14,4.39 and 5.38, t=2.97 and 2.62, all P<0.05). Multivariate analysis showed that general practitioners with undergraduate and graduate education and higher professional titles had better knowledge, attitudes and practice of PIM ( t=2.69, 2.98 and 2.36, all P<0.05), and general practitioners without knowledge of PIM and no needs for PIM training had worse knowledge, attitudes and practice of PIM ( t=-2.96 and -2.09, all P<0.05). Conclusions:The knowledge, attitudes and behavior intervention of general practitioners on elderly PIM needs to be improved. It is necessary to strengthen the elderly PIM knowledge and skill training for general practitioners with low educational background, lower professional titles without awareness and training of PIM.
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Aim: The study aimed to determine the prevalence of potential drug-drug interactions (PDDIs) and potentially inappropriate medications (PIMs) among geriatrics. Methods: A prospective observational study was conducted for six months in the Department of Geriatrics, M.S. Ramaiah Teaching Hospital, Bangalore. PDDIs and PIMS were analyzed using micromedex database and Beer's criteria respectively. Results: Among 395 prescriptions, 221(56%) prescriptions showed 559 pDDIs and 41(10.4%) PIMs. Almost 281(50.3%), 260(46.5%), 16(2.7%) and 2(0.3%) pDDIs were categorised as major, moderate, minor and contraindicated respectively. Almost 321(57.5%) were synergistic and 196(35.0%) were antagonistic drug interactions. Pearson correlation value (R) is 0.9957 which showed a strong positive correlation. Conclusion: This study created awareness on drug interactions among geriatrics and help the practitioners to prescribe drugs with a low risk of pDDIs. The authors suggest PIM monitoring in geriatrics to avoid adverse effects and improve patients' quality of life.
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Background: Inappropriate prescribing is more prevalent in geriatric patients. A popular tool for screening appropriateness of prescribing is the screening tool of older person’s prescriptions (STOPP) and screening tool to alert doctors to right treatment (START) criteria. In this study, our aim was to estimate the incidence of potentially inappropriate prescribing (PIP) utilizing these criteria among patients attending outpatient departments. In addition, we aimed to identify potential factors that are associated with PIP. Aims and Objectives: The objectives of the study are as follows: (1) To estimate incidence of potentially inappropriate medications (PIMs) using STOPP criteria; (2) To estimate incidence of potential prescribing omissions (PPOs) using START criteria; and (3) To identify potential factors that are associated with PIP. Materials and Methods: A prospective and cross-sectional study that was observational in nature was performed in patients with age 65 years and above. Prescriptions of these patients were analyzed by collecting relevant data that were subsequently entered in specially designed case record forms. The modified version 2.0 of STOPP/START criteria was utilized to assess PIP in the form of PIMs and PPOs. Data were entered in Microsoft Excel 2013 and analyzed. Categorical variables were described as frequency and percentage whereas continuous variables were described as mean with standard deviation. Results: Prescriptions of a total 306 patients were evaluated (mean age: 69.4, 60% male, average number of medications per prescription: 5.04 ± 2.44), PIMs were detected in 88 (28.75%) and PPOs in 30 (9.8%) patients. Ninety-six patients had either a PIM or a PPO. PIMs mainly involved were duplication of drug class (26.5%), use of first generation antihistaminic for >1 week (20.4%) and use of glimepiride (18.6%). Major PPOs identified were non-use of angiotensin converting enzyme inhibitors following acute myocardial infarction (26%), non-use of statin therapy (26%), and antiplatelet therapy (21.7%) in patients with diabetes mellitus along with cardiovascular risk factor. Polypharmacy (OR 6.011, P < 0.0001) and comorbidity (OR 3.097, P = 0.015) significantly increase the risk of PIM encounter. Conclusion: PIP in the form of PIMs and PPOs was prevalent in the studied patients. Polypharmacy and comorbidity were associated with an increased likelihood of PIM.
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Resumo Os idosos são vulneráveis aos riscos do uso de medicamentos, principalmente daqueles considerados potencialmente inapropriados (MPI) em que os riscos superam os benefícios. O estudo buscou avaliar os MPI prescritos na Atenção Primária à Saúde (APS) e seus fatores associados. Realizou-se um estudo transversal, analítico, de março a dezembro de 2019, na APS em Campina Grande, Paraíba, através de entrevistas com 458 idosos. As variáveis independentes abrangeram características socioeconômicas, condição de saúde e utilização de medicamentos e o desfecho foi medicamento classificado como MPI pelo Consenso Brasileiro de Medicamentos Potencialmente Inapropriados. Verificou-se a prescrição de pelo menos um MPI para 44,8% dos idosos e a maioria de atuação no Sistema Nervoso Central (54,4%). No modelo ajustado, depressão (RP=2,01; IC95% 1,59-2,55), utilizar outros medicamentos além dos prescritos (RP=1,36; IC95% 1,08-1,72) e polifarmácia (RP=1,80; IC95% 1,40-2,33) permaneceram como fator associado e autorreferir ser portador de hipertensão arterial sistêmica tornou-se fator de proteção (RP=0,65; IC95% 0,49-0,87). Evidencia-se necessidade de ações que qualifiquem o uso de medicamentos por idosos, de modo a garantir acesso aliado à segurança.
Abstract The elderly population is vulnerable to the risks of the use of medications, especially those considered potentially inappropriate medications (PIMs), in which the risks outweigh the benefits. The study sought to evaluate the PIMs prescribed in Primary Health Care (PHC) and associated factors. A cross-sectional, analytical study was carried out from March to December 2019 in PHC in Campina Grande, Paraíba, through interviews with 458 elderly individuals. The independent variables included socioeconomic characteristics, health status and the use of medications, and the outcome was classified as PIM by the Brazilian Consensus on Potentially Inappropriate Medications. There was a prescription of at least one PIM for 44.8% of the elderly and the majority affecting the Central Nervous System (54.4%). In the adjusted model, depression (PR=2.01; 95%CI 1.59-2.55), using other medications in addition to those prescribed (PR=1.36; 95%CI 1.08-1.72) and polypharmacy (PR=1.80; 95%CI 1.40-2.33) remained an associated factor, and self-reporting systemic arterial hypertension became a protective factor (PR=0.65; 95%CI 0.49-0.87). This reveals the need for actions to monitor closely the use of PIMs by the elderly to ensure access in conjunction with safety.
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Humans , Aged , Inappropriate Prescribing , Potentially Inappropriate Medication List , Primary Health Care , Brazil , Cross-Sectional Studies , Risk Factors , Polypharmacy , PrescriptionsABSTRACT
ABSTRACT BACKGROUND: Physician and patient-related characteristics can influence prescription of medications to older patients within primary healthcare. Use of Brazilian criteria may indicate the real prevalence of prescription of potentially inappropriate medications to this population. OBJECTIVES: To evaluate prescription of potentially inappropriate medications to older patients within primary care and identify patient-related and prescribing physician-related factors. DESIGN AND SETTING: This cross-sectional study was conducted in 22 public primary care facilities in Brazil, among older people (≥ 60 years) who were waiting for medical consultations. METHODS: Interviews were conducted before and after the medical consultations. If the patient received a medical prescription at the consultation, all the drugs prescribed and the physician's medical council registration number were recorded. Prevalence ratios were estimated to ascertain the magnitude of prescription of potentially inappropriate medications, along with patient and physician-related factors associated with such prescription. RESULTS: In total, 417 older patients were included; 45.3% had received ≥ 1 potentially inappropriate medication, and 86.8% out of 53 physicians involved had prescribed ≥ 1 potentially inappropriate medication. The strongest patient-related factor associated with higher prevalence of prescription of potentially inappropriate medications was polypharmacy. Among physician-related factors, the number of patients attended, number of prescriptions and length of medical practice < 10 years were positively associated with prescription of potentially inappropriate medications. CONCLUSIONS: High prevalence of prescription of potentially inappropriate medications was observed. Physician-related characteristics can influence prescription of medications to older people within primary healthcare. This suggests that there is a need for interventions among all physicians, especially younger physicians.
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Humans , Aged , Physicians , Inappropriate Prescribing , Primary Health Care , Brazil , Cross-Sectional Studies , PolypharmacyABSTRACT
O envelhecimento populacional é uma realidade crescente e os idosos apresentam a necessidade de utilização de medicamentos, muitas vezes expondo-os a riscos. Os medicamentos potencialmente inapropriados (MPI) para idosos são aqueles em que os riscos superam os benefícios. Os medicamentos essenciais devem atender as necessidades prioritárias de saúde de uma população e a prescrição de medicamentos é considerada um dos aspectos determinantes para o uso. O objetivo do estudo foi analisar os medicamentos potencialmente inapropriados para idosos, desde a seleção de medicamentos essenciais à prescrição na Atenção Primária à Saúde (APS). Foi realizado um estudo descritivo e analítico com abordagem qualitativa e quantitativa, de março a dezembro de 2019, na APS em Campina Grande, PB. A pesquisa foi desenvolvida através da triangulação de métodos: 1) pesquisa documental, que analisou os medicamentos das Relação Nacional de Medicamentos Essenciais (RENAME nas edições 2010 e 2020 de acordo com as listas AGS/Beers e as Listas de Medicamentos Essenciais (LME) da Organização Mundial de Saúde vigentes à época; 2) estudo transversal, realizado através de entrevistas com 458 idosos usuários de 71 unidades básicas de saúde. As variáveis independentes abrangeram características demográficas e socioeconômicas, condição de saúde e utilização de medicamentos e a variável dependente foi o medicamento prescrito ser classificado como inapropriado pelo Consenso Brasileiro de Medicamentos Potencialmente Inapropriado. Foi feita análise descritiva dos dados e regressão de Poisson; e, 3) estudo de caso, realizado através de entrevistas com 10 prescritores da APS para conhecer a percepção desses profissionais sobre a prática prescritiva para idosos. Foram prescritos 1449 medicamentos e 244 MPI (16,8%), dos quais 91,6% e 70,5% estavam elencados na RENAME, respectivamente. A maioria dos MPI atuavam no Sistema Nervoso Central (54,4%) e trato alimentar e metabolismo (20,1%). Entre os principais MPI, observou-se ausência de alternativas terapêuticas mais seguras disponíveis na RENAME. No estudo transversal, identificou-se uma prevalência de prescrição de pelo menos um MPI em 44,8% (IC95% 40,2-49,3) dos idosos. No modelo ajustado, depressão (RP=2,01; IC95% 1,59-2,55), utilizar outros medicamentos além dos prescritos (RP=1,36; IC95% 1,08-1,72) e polifarmácia (RP=1,80; IC95% 1,40-2,33) permaneceram como fator associado ao uso de MPI e autorreferir ser portador de hipertensão arterial sistêmica tornou-se fator de proteção (RP=0,65; IC95% 0,49-0,87). Na análise qualitativa, emergiram duas categorias: 1) Abordagem dos prescritores no atendimento aos idosos na APS; e, 2) Uso de medicamentos por idosos: o olhar dos prescritores. Os médicos relataram promover atividades de prevenção, porém enfatizaram o tratamento das doenças crônicas prevalentes entre idosos. Também destacaram a polifarmácia e consideraram inadequada a utilização de benzodiazepínicos. Constatou-se desconhecimento dos médicos sobre as listas de medicamentos inapropriados. A medicalização dos idosos e a disponibilidade de medicamentos essenciais foram descritos como desafios. O estudo identificou uma alta ocorrência de prescrição de medicamentos potencialmente inapropriados para idosos na Atenção Primária à Saúde em conformidade com a lista nacional de medicamentos essenciais e escassez de alternativas terapêuticas mais seguras para idosos. Evidencia-se necessidade de ações que busquem qualificar o acesso a medicamentos por idosos como a elaboração de uma lista de medicamentos específica ou a inserção de alternativas terapêuticas mais seguras para idosos na RENAME, juntamente com a capacitação dos profissionais prescritores e o acompanhamento dos idosos. Diante do envelhecimento da população brasileira, faz-se pertinente garantir acesso a medicamentos aliado à segurança dos idosos (AU).
Population aging is a growing reality, and the elderly need medications, which often expose them to risks. Potentially inappropriate medications (PIMs) in the elderly are those in which risks outweigh benefits. Essential medications must meet health needs of a population, and medication prescription is one determinant for its use. This study aimed to analyze PIM in the elderly from the selection of essential drugs to prescription in primary health care (PHC). A descriptive and analytical study with quali-quantitative approach was conducted in PHC in Campina Grande (PB) between March and December 2019. The study was developed triangulating methods: 1) documentary research, which analyzed medicines of the National Essential Medicines List (RENAME) in 2010 and 2020 editions according to AGS/Beers criteria and essential medicines lists (EML) of the World Health Organization; 2) crosssectional study, conducted using interviews with 458 elderly users of 71 basic health units. Independent variables were demographic and socioeconomic characteristics, health condition, and use of medication, whereas the dependent variable was prescribed medication classified as inappropriate by the Brazilian Consensus on Potentially Inappropriate Medications. Descriptive data analysis and Poisson regression were performed; and 3) case study, using interviews conducted with 10 PHC prescribers to observe perception of these professionals regarding prescription for the elderly. One thousand four hundred and forty-nine medications and 244 PIM (16.8%) were prescribed; of these, 91.6% and 70.5% were listed in RENAME, respectively. Most PIM acted in the central nervous system (54.4%) and gastrointestinal tract and metabolism (20.1%). RENAME lacked safer therapeutic alternatives for main PIMs. In the cross-sectional study, at least one PIM was prescribed for 44.8% (95%CI 40.2 Ë 49.3) of the elderly. In the adjusted model, depression (PR=2.01; 95%CI 1.59 Ë 2.55), use of medication other than those prescribed (PR=1.36; 95%CI 1.08 Ë 1.72), and polypharmacy (PR = 1.80; 95%CI 1.40 Ë 2.33) were associated with PIM, whereas self-reported hypertension was a protective factor (PR=0.65; 95%CI 0.49 Ë 0.87). Two categories emerged in the qualitative analysis: 1) approach of prescribers to assist the elderly in PHC and 2) use of medication by the elderly: view of prescribers. Doctors reported preventive activities but emphasized treatment of prevalent chronic diseases among the elderly. They also highlighted polypharmacy and considered benzodiazepines to be inappropriate. Doctors lacked knowledge about inappropriate medication lists. Medicalization of the elderly and availability of essential medication were described as challenges. PIMs were highly prescribed for the elderly in PHC according to the RENAME and safer therapeutic alternatives were absent. Actions to qualify access of the elderly to medication are needed, such as elaborating a specific list of medication, inserting safer therapeutic alternatives for the elderly in RENAME, training prescribers, and monitoring the elderly. Access to medication and safety of the elderly must be guaranteed because of aging of the Brazilian population (AU).
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Humans , Male , Female , Aged , Aged, 80 and over , Drug Prescriptions , Primary Health Care , Health of the Elderly , Drugs, Essential , Potentially Inappropriate Medication List , Epidemiology, Descriptive , Cross-Sectional Studies/methods , Qualitative Research , Document AnalysisABSTRACT
INTRODUÇÃO: Medicamentos potencialmente inapropriados a idosos (MPII) provocam mais efeitos adversos do que benefícios. Os critérios de Beers (CB) da American Geriatrics Society 2019 (CB2019) consideraram cinco situações clínicas como MPII. A análise de medicamentos por essas situações pode auxiliar na prescrição a idosos? Procurando exemplo prático dessa questão, optou-se por análise de fármacos atualmente questionados quanto ao seu uso seguro em idosos. OBJETIVO: Verificar se cloroquina e hidroxicloroquina se enquadram como MPII e se essa análise é aplicável clinicamente. METODOLOGIA: Sistematizou-se o objetivo pelas cinco situações clínicas definidas como MPII pelos CB2019. RESULTADOS: Ambos os fármacos preenchem respectivamente quatro (cloroquina) e cinco (hidroxicloroquina) dessas situações clínicas. Esta análise permitiu a provável definição de MPII para esses medicamentos de forma simples, por intermédio de breve análise de literatura acessível. CONCLUSÃO: Cloroquina e hidroxicloroquina podem ser considerados MPII. Espera-se replicar essa análise para outros medicamentos e reduzir iatrogenias em idosos.
INTRODUCTION: Potentially inappropriate medications (PIMs) for older adults cause more adverse effects than benefits. The 2019 American Geriatrics Society Beers Criteria (2019BC) considered five clinical situations as PIM use in older adults. Can drug analysis, according to these situations, assist in the act of making prescriptions for older people? Seeking a practical example for this question, we assessed drugs currently questioned as to their safe use among older people. OBJECTIVE: To check if chloroquine and hydroxychloroquine fit the PIM criteria for older adults and whether this analysis is clinically applicable. METHODS: We systematized the objective based on the five clinical situations defined as PIM use in older adults by the 2019BC. RESULTS: Chloroquine and hydroxychloroquine fulfill, respectively, four and five of these clinical situations. This evaluation allowed the likely definition of these drugs as PIMs for older adults in a simple way, based on a brief analysis of the available literature. CONCLUSION: Chloroquine and hydroxychloroquine may be considered PIMs for older adults. We expect that this analysis can be replicated with other drugs and reduce iatrogenesis in older people.
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Humans , Aged , Chloroquine/adverse effects , Potentially Inappropriate Medication List , Hydroxychloroquine/adverse effects , Aging/physiology , Health of the Elderly , Inappropriate Prescribing/adverse effects , Iatrogenic Disease/prevention & controlABSTRACT
Objective: The objectives of the present study were to determine the prevalence of Potentially Inappropriate Medications and Adverse Drug Reactions in older adults and to collect doctors’ responses regarding the PIM list or any other criteria to treat older adults in India. Methods: This was an observational study conducted in different tertiary care hospitals of two districts, Erode and Salem after obtaining approval of the Institutional Ethics Committee. A sample of 250 older adults (60 y and above) and 97 doctors were included during the study period of 6 mo from February 2019 to July 2019. Inappropriate medications were identified by using 2019 updated Beer’s criteria. The causality of the adverse events was assessed by Naranjo Adverse Drug Reaction Probability Scale. Results: Out of the 250 prescriptions, only 86(34.4%) of the prescriptions were appropriate and 164(65.6%) were inappropriate. The most commonly inappropriate prescribed medications were diuretics, ranitidine, and tramadol. A total of 74 ADRs was observed in 74 patients. Of these, 57(22.8%) ADRs were due to inappropriate medications listed in Beers criteria. There was a significant association between the occurrence of ADRs and the use of PIMs listed in 2019 updated Beer’s criteria [χ2 = 6.08, P = 0.013 (df = 1)]. Conclusion: The study shows that there is a high prevalence of inappropriate medications and adverse drug reactions in hospitalized older adults. Beer’s criteria can be used as a guideline by the physicians while prescribing the drugs to the geriatric population.
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Resumo Este trabalho teve como objetivo verificar a prevalência do uso de medicamento potencialmente inapropriado (MPI) para idosos residentes em Instituições de Longa Permanência para Idosos (ILPI), assim como os tipos de medicamentos e seus fatores associados. Trata-se de estudo transversal realizado em 10 ILPI da cidade do Natal, entre outubro e dezembro de 2013. Os medicamentos inapropriados foram classificados de acordo com os Critérios de Beers da American Geriatric Society 2015. Foram analisadas variáveis sociodemográficas, relacionadas à ILPI e às condições de saúde. Para as análises univariada e multivariada entre a variável principal (uso de MPI) e as demais foi utilizada a regressão de Poisson. A amostra foi composta por 321 idosos e, destes, 304 utilizavam medicamentos. A prevalência de uso de MPI foi de 54,6% (IC 95%: 48,9-60,2) e no modelo final esteve associada à polifarmácia e à demência. As classes terapêuticas de MPI mais identificadas foram antipsicóticos e benzodiazepínicos. O estudo revelou alta prevalência de MPI entre os idosos das ILPI, configurando a necessidade de adoção de indicadores do uso destes medicamentos e a implantação de estratégias que tornem a farmacoterapia mais segura e adequada aos idosos.
Abstract This study aimed to verify the prevalence of the use of Potentially Inappropriate Medications (PIM) for elderly living in Long-Term Care Institutions for the Elderly (LTCIE), as well as the types of medications and their associated factors. This is a cross-sectional study carried out in 10 LTCIEs in the city of Natal in the period October-December 2013. Potentially inappropriate medications were classified according to the 2015 American Geriatric Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults - 2015. Sociodemographic, LTCIE-related and health-related variables were considered. Univariate and multivariate analyses were performed between the primary variable (PIM use) and the independent variables using Poisson regression. The sample consisted of 321 older people, of whom 304 used medications. The prevalence of PIM use was 54.6% (95% CI: 48.9-60.2) and was associated with polypharmacy and dementia in the final model. The most common PIMs were antipsychotics and benzodiazepines. The study revealed a high prevalence of PIM use among the elderly of the LTCIEs, evidencing the need to adopt indicators on the use of these drugs and the implementation of strategies that make drug therapy safer and more adequate for older adults.
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Humans , Aged , Inappropriate Prescribing , Potentially Inappropriate Medication List , Prevalence , Cross-Sectional Studies , Risk Factors , PolypharmacyABSTRACT
AIM: To measure medication consumption and the prevalence of potentially inappropriate medications (PIMs) during hospitalization and hospital discharge in the geriatric condition of frailty and to provide bases for rational medications use and further deprescribing. METHODS: A clinical data questionnaire, including the basic situation of patients and medications was designed. Charlesson comorbidity index was used to determine the patient's burden and status and the number of medication consumption in the geriatric condition of frailty. The medication consumption was determined by examining Hospital Medication Administration Records. PIMs were defined using STOPPFrail deprescribing criteria and McLeod criteria, whose sensitivity was compared to determine the PIMs independent related factors. RESULTS: This study included 169 patients. The mean age of participants was 83.49±6.73, 42.6% were female. The median number of days spent in hospital was 19 (interquartile range (IQR)12-33). During the first 24 hours of hospitalization, the mean number of individual medications consumed was 9.01 (standard deviation 4.12). Of hospital discharge, the mean number of individual medications consumed was 11.27 (standard deviation 4.57). Over 60% of patients were prescribed at least one PIM at discharge and 7.69% had ≥3 PIMs. Leukotriene antagonists, proton pump inhibitors (PPIs), lipid-lowering medications and diabetic oral agents accounted for major PIMs. Compared with McLeod's criteria, STOPPfrail criteria was a more sensitive tool for 24-hour hospitalization and hospital discharge PIMs screening (t=6.78, P=0.00<0.01; t=10.10, P=0.00<0.01). Full implementation of STOPPFrail recommendations would have resulted in one-in-seven long-term medications being discontinued. CONCLUSION: High levels of medication consumption in the geriatric condition of frailty will result in high burden experienced by patients in the condition of frailty and continued prescribing of futile medications. It is necessary to improve and pay more attention to the safety of medications. The STOPPFrail criteria is highly sensitive, simple and easy to use. Screening for medication consumption in geriatric condition of frailty with STOPPFrail tool will decrease medication burden.
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Background: Use of inappropriate medication is an important problem in present geriatric clinical practice. No specific potentially inappropriate medications (PIM) tools are available considering the availability of drugs in India. Aim and objective were to assess prevalence and pattern of potentially inappropriate medication (PIM) use in elderly inpatients by updated Beers criteria 2015 and EU(7) PIM list 2015.Methods: This cross-sectional study was carried out on medical records of elderly patients (?65 yrs) admitted in the internal medicine wards and intensive care units (ICU) over a period of 6 weeks. The medications were evaluated for the PIM use as per Beers criteria and EU(7) PIM list.Results: A total of 225 patients (mean age- 71.48 yrs) were admitted in internal medicine wards and ICU during study period. Total 184 PIM belonged to 33 different medications were used during study period. The prevalence of PIM in internal medicine wards and ICUs were 51.96% and 57.14%, respectively. The prevalence of PIM was significantly higher with the EU(7) PIM list than Beers criteria (49.77% vs. 21.77%) [p<0.0001]. The commonly prescribed PIM were dextromethorphan (13.33%), ranitidine (11.11%) and glipizide (10.22%).Conclusions: Elderly patients frequently receive PIM. EU(7) PIM list identifies more PIM among elderly inpatients than Beers criteria.
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Background: Prescribing in elderly is a challenging task as they have age related physiological changes, various co-morbidities, altered pharmacological properties and higher propensity for adverse events. They are often prescribed medications which are potentially inappropriate for them, sometimes may even be unnecessary. The medicines are considered as inappropriate if the risk associated with them outweighs benefits. The objective of this study is to assess the prevalence of potentially inappropriate medications (PIM) at a tertiary care teaching hospital according to the Beers updated 2015 criteria and STOPP criteria and to compare the two criteria in detection of PIMs.Methods: A prospective observational study involving 228 elderly patients (>65years) of medicine wards was conducted from October 2015 to March 2016. Relevant information was recorded in a predesigned proforma. The use of potentially inappropriate medications is assessed using Beers updated 2015 criteria and STOPP criteria using descriptive statistics.Results: The prevalence of PIM use in the sample was 26.31% according to the 2015 Beers criteria and 14.03% using the STOPP criteria. The most prevalent PIM according to the Beers criteria were sliding scale insulin (17.54%) and long acting benzodiazepines (5.26%); according to the STOPP criteria, they were aspirin in heart failure (5.26%) and chlorpheniramine (3.07%).Conclusions: The prevalence of PIM varied when different criteria were applied. The 2015 Beers criteria identified more PIM than the STOPP criteria.
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OBJECTIVE: To evaluate the prevalence and risk factors of potentially inappropriate medication (PIM) among elderly inpatients in community health care institutions in Dongcheng district. METHODS: The outpatient prescriptions of patients aged 60 and above in community health care institutions in Dongcheng district in 2017 were analyzed. The proportion of PIM prescriptions and the utilization rate of PIM drugs were calculated according to the criteria of potentially inappropriate medications for older adults in China (2017). Logistic model was built to analyze the influence factors of PIM. RESULTS: The 1 045 269 prescriptions were collected in this study. The 12.9% prescriptions had at least one PIM prescribed. The top 3 drugs in PIM prescriptions were clopidogrel (42.5%), estazolam (24.2%) and ibuprofen (11.4%). The logistic regression analysis revealed that the significant predictors for PIM prescription were: visits of healthcare center; doctors′ male gender and lower-class title; patients′ male gender, elder age, more illness and more drugs. CONCLUSION: The situation of PIM prescriptions needs to be improved for the elderly inpatients in community health care institutions in Dongcheng district. To reduce the incidence of PIM in elderly patients, the criteria of potentially inappropriate medications for older adults in China requires further promotion.
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Introduction: Polypharmacy is the practice of prescribing many medications. In this study, we assessed the current status of polypharmacy among elderly patients and cases of inappropriate prescription (IP) at the Department of General Internal Medicine (GIM) at Sendai Medical Center.Methods: We retrospectively surveyed 136 inpatients who were over 65 years old between April 2015 and March 2016 at the Department of GIM.We examined the patient's current medications and used the STOPP (screening tool of older person's potentially inappropriate prescriptions) criteria version 2 to analyze potentially inappropriate medication (PIM) cases.Results: Of 136 study patients, 77 (56.6%) patients were taking more than 6 medications. For patients over 75 years old, the average number of current medications increased.In addition, 33 cases of PIM were confirmed and the number increased in proportion to the number of current medications. Furthermore, there were 4 cases of adverse reactions in which the STOPP criteria version 2 were not applied.Conclusion: In this study, we confirmed polypharmacy in the examined patients.In order to solve the problem of polypharmacy, all medical staff must cooperate and review the prescriptions of individual patients.General physicians should assume the leading role in the distribution and improvement of polypharmacy and IP.
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ABSTRACT Objective: To identify polypharmacy and potentially inappropriate medications (PIM) for elder people with chronic health situations and its implications for gerontological nursing. Method: Descriptive and transversal study, conducted from March to September 2016 by pharmaceutical residents in the clinic of Endocrinology of a hospital in Mid-West region of Brazil. Results: 44 elder people with an average age of 69.5 (± 6.79) years old had their assessed prescriptions. We identified 65 medications prescribed 253 times, in which 10 PIM (15.4%) were prescribed 51 times. 33 seniors (72.7%) had at least one PIM, of those, 66.7% were polymedicated. Of the total, 22 elder people (50%) were subjected to polypharmacy and made use of at least one PIM. Conclusion: The results showed high incidence of PIM and polypharmacy, as well as their physiological impacts to the elder population. The study provokes discussions about that the trained nurse in human aging has skills and competencies able to enhance interventions related to pharmacotherapy.
RESUMEN Objetivo: Identificar polifarmacia y medicamentos potencialmente inapropiados (MPI) para ancianos con situaciones crónicas de salud y sus implicaciones para enfermería gerontológica. Método: Estudio descriptivo, transversal, realizado de marzo a septiembre de 2016 por residentes farmacéuticos, en el ambulatorio de endocrinología de un hospital en el Centro-Oeste de Brasil. Resultados: Cuarenta y cuatro ancianos con edad media de 69,5 (± 6,79) años tuvieron sus prescripciones evaluadas. Se identificaron 65 medicamentos prescritos 253 veces, siendo que 10 MPI (15,4%) fueron prescritos 51 veces. Treinta y tres ancianos (72,7%) presentaron al menos un MPI, de los que el 66,7% eran polimedicados. Del total, 22 ancianos (50%) estaban sometidos a la polifarmacia y utilizaban al menos un MPI. Conclusión: Los resultados evidenciaron alta incidencia de MPI y polifarmacia, así como sus impactos fisiológicos a la población anciana. El estudio provoca discusiones acerca de que el enfermero capacitado sobre el envejecimiento humano tiene habilidades y competencias que potencializan intervenciones relacionadas a la farmacoterapia.
RESUMO Objetivo: Identificar polifarmácia e medicamentos potencialmente inapropriados (MPI) para idosos com situações crônicas de saúde e suas implicações para enfermagem gerontológica. Método: Estudo descritivo, transversal, realizado de março a setembro de 2016 por residentes farmacêuticos, no ambulatório de endocrinologia de um hospital no Centro-Oeste do Brasil. Resultados: Quarenta e quatro idosos com idade média de 69,5 (± 6,79) anos tiveram suas prescrições avaliadas. Identificaram-se 65 medicamentos prescritos 253 vezes, sendo que 10 MPI (15,4%) foram prescritos 51 vezes. Trinta e três idosos (72,7%) apresentaram pelo menos um MPI, desses, 66,7% eram polimedicados. Do total, 22 idosos (50%) estavam submetidos à polifarmácia e faziam uso de pelo menos um MPI. Conclusão: Os resultados evidenciaram alta incidência de MPI e polifarmácia, bem como seus impactos fisiológicos à população idosa. O estudo provoca discussões acerca de que enfermeiro capacitado sobre o envelhecimento humano possui habilidades e competências capazes de potencializar intervenções relacionadas à farmacoterapia.
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Humans , Male , Female , Aged , Polypharmacy , Medical Overuse/trends , Geriatric Nursing/methods , Brazil , Risk Factors , Middle Aged , Nursing ProcessABSTRACT
@#<p style="text-align: justify;"><strong>BACKGROUND:</strong>The number of elderly people (aged 60 years or over) is expected to double in the next 35 years as a result of decreasing mortality and declining fertility worldwide. The elderly population is at increased risk of being prescribed potentially inappropriate medications (PIM).<br /><strong>OBJECTIVES:</strong>To determine the prevalence of PIM prescribed among the geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014.<br /><strong>METHODS:</strong>This is a retrospective cross-sectional study on patients who are 65 years and older admitted under Internal Medicine between January 2014 to December 2014. Medical records were reviewed for PIM prescription according to the updated 2012 Beers Criteria.<br /><strong>RESULTS:</strong> PIMs were noted in 303 out of of 618 patients.The most common PIMs were insulin sliding scale, digoxin,orphenadrine, ipratropium, ketorolac, clonazepam, clonidine, hydroxyzine, amiodarone and spironolactone.<br /><strong>CONCLUSION:</strong>The prevalence of PIM prescription is 49% among geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014. It is recommended to determineprevalence of PIM use in other geriatric care settings, the predictors for PIM use, and the economic burden of PIM use.</p>
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Humans , Male , Female , Aged , Clonazepam , Potentially Inappropriate Medication List , Spironolactone , Amiodarone , Clonidine , Ketorolac , Orphenadrine , Digoxin , Ipratropium , Insulin , Hydroxyzine , Fertility , Prescriptions , PatientsABSTRACT
BACKGROUND:The number of elderly people (aged 60 years or over) is expected to double in the next 35 years as a result of decreasing mortality and declining fertility worldwide. The elderly population is at increased risk of being prescribed potentially inappropriate medications (PIM).OBJECTIVES:To determine the prevalence of PIM prescribed among the geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014.METHODS:This is a retrospective cross-sectional study on patients who are 65 years and older admitted under Internal Medicine between January 2014 to December 2014. Medical records were reviewed for PIM prescription according to the updated 2012 Beers Criteria.RESULTS: PIMs were noted in 303 out of of 618 patients.The most common PIMs were insulin sliding scale, digoxin,orphenadrine, ipratropium, ketorolac, clonazepam, clonidine, hydroxyzine, amiodarone and spironolactone.CONCLUSION:The prevalence of PIM prescription is 49% among geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014. It is recommended to determineprevalence of PIM use in other geriatric care settings, the predictors for PIM use, and the economic burden of PIM use.