Potentially inappropriate medication on communitydwelling older adults: Longitudinal analysis using the International Mobility in Aging Study. / Medicación potencialmente inapropiada en adultos mayores de la comunidad: análisis longitudinal del estudio IMIAS

Introduction: Medications are a fundamental part of the treatment of multiple pathologies. However, despite their benefits, some are considered potentially inappropriate medications for older people given their safety profile. Epidemiological data differences related to potentially inappropriate medications make it difficult to determine their effects on elderly people. Objective: To estimate the prevalence and types of potentially inappropriate medications using the 2019 Beers Criteria® in a cohort of adults older than 65 years. Materials and methods: We performed an observational, multicenter, retrospective, longitudinal study of a four-year follow-up of potentially inappropriate medications in community-dwelling older adults. Results: We followed 820 participants from five cities for four years (2012-2016) and evaluated them in three different moments (m1 = 2012, m2 = 2014, and m3 = 2016). The average age was 69.07 years, and 50.9% were women. The potentially inappropriate medication prevalence in the participants was 40.24%. The potentially inappropriate medications' mean among the studied subjects in the first moment was 1.65 (SD = 0.963), in the second was 1.73 (SD = 1.032), and in the third was 1.62 (SD = 0.915). There were no statistical differences between measurements (Friedman test, value = 0.204). The most frequent potentially inappropriate medications categories were gastrointestinal (39.4%), analgesics (18.8%), delirium-related drugs (15.4%), benzodiazepines (15.2%), and cardiovascular (14.2%). Conclusions: About half of the population of the community-dwelling older adults had prescriptions of potentially inappropriate medications in a sustained manner and without significant variability over time. Mainly potentially inappropriate medications were gastrointestinal and cardiovascular drugs, analgesics, delirium-related drugs, and benzodiazepines.

Introducción. Los fármacos son parte fundamental del tratamiento de múltiples enfermedades. Sin embargo, a pesar de sus beneficios, algunos se consideran medicamentos potencialmente inapropiados en adultos mayores, dado su perfil de seguridad. Las diferencias en los datos epidemiológicos relacionados con los medicamentos potencialmente inapropiados dificultan el establecimiento de sus efectos en adultos mayores. Objetivo. Estimar la prevalencia longitudinal y los tipos de medicamentos potencialmente inapropiados, utilizando los criterios Beers® del 2019 en una cohorte de adultos mayores de 65 años. Materiales y métodos. Se realizó un estudio observacional, multicéntrico, retrospectivo y longitudinal, de cuatro años de seguimiento de los medicamentos potencialmente inapropiados en adultos mayores de la comunidad. Resultados. Se evaluaron 820 participantes de cinco ciudades durante cuatro años (2012 a 2016) en tres momentos (m1: 2012, m2: 2014 y m3; 2016). La edad promedio fue de 69,07 años y el 50,9 % eran mujeres. La prevalencia de medicamentos potencialmente inapropiados en los participantes fue del 40,24 %. El promedio de estos medicamentos entre los sujetos estudiados en el primer momento fue de 1,65 (DE = 0,963), en el segundo fue de 1,73 (DE = 1,032) y en el tercero fue de 1,62 (DE = 0,915). No hubo diferencias estadísticas entre las mediciones (prueba de Friedman, p = 0,204). Las categorías de los medicamentos potencialmente inapropiados más frecuentes fueron: gastrointestinales (39,4 %), analgésicos (18,8 %), relacionados con delirium (15,4 %), benzodiacepinas (15,2 %) y cardiovasculares (14,2 %). Conclusiones. En cerca de la mitad de la población de adultos mayores de la comunidad, se prescribieron medicamentos potencialmente inapropiados de manera sostenida y sin variabilidad importante en el tiempo. Los más recetados fueron aquellos para tratar malestares gastrointestinales y cardiovasculares, analgésicos, para el delirium y benzodiacepinas.

Pharmacotherapy assessment and adverse drug reactions in older patients admitted to intensive care.

INTRODUCTION: Older patients are more susceptible to medication use, and physiological changes resulting from aging and organic dysfunctions presented by critically ill patients may alter the pharmacokinetic or pharmacodynamic behavior. Thus, critically ill older people present greater vulnerability to the occurrence of pharmacotherapeutic problems. OBJECTIVE: To evaluate pharmacotherapy and the development of potential adverse drug reactions (ADRs) in older patients admitted to an intensive care unit (ICU). METHOD: A cohort study was conducted in an ICU for adults of a Brazilian University Hospital during a 12-month period. The patients' pharmacotherapy was evaluated daily, considering the occurrence of ADRs and drug-drug interactions (DDIs), the use of potentially inappropriate medications (PIMs) for older people, and the pharmacotherapy anticholinergic burden (ACB). A trigger tool was used for active search of ADRs, with subsequent causality evaluation. PIM use was evaluated by means of the Beers criteria and the STOPP/START criteria. The ABC scale was employed to estimate ACB. The Micromedex® and Drugs.com® medication databases were employed to evaluate the DDIs. RESULTS: The sample of this study consisted of 41 patients, with a mean age of 66.8 years old (±5.2). The 22 triggers used assisted in identifying 15 potential ADRs, and 26.8% of the patients developed them. The mean estimated ACB score was 3.0 (±1.8), and the patients used 3.1 (±1.4) and 3.3 (±1.6) PIMs according to the Beers and the STOPP criteria, respectively. A total of 672 DDIs were identified, with a mean of 16.8 (±9.5) DDIs/patient during ICU hospitalization. Our findings show an association between occurrence of ADRs in the ICU and polypharmacy (p=.03) and DDIs (p=.007), corroborating efforts for rational medication use as a preventive strategy. CONCLUSIONS: Using tools to evaluate the pharmacotherapy for older people in intensive care can assist in the recognition and prevention of pharmacotherapeutic problems, with emphasis on the identification of ADRs through the observation of triggers and subsequent causality analysis.

Lists of potentially inappropriate medications for older people in primary care: a systematic review of health outcomes / Listas de medicamentos potencialmente inapropriados para idosos em atenção primária: uma revisão sistemática sobre desfechos de saúde / Listas de medicamentos potencialmente inapropiados para adultos mayores en la atención primaria: una revisión sistemática de los resultados de salud

Abstract: This study is a systematic literature review of the association between lists of potentially inappropriate medications (PIM) in clinical practice and health outcomes of older adults followed up in primary health care. For this purpose, the PRISMA protocol was used to systematize the search for articles in the PubMed, Web of Science, Scopus, Cochrane Central, LIVIVO and LILACS databases, in addition to the gray literature. Studies with randomized clinical trials were selected, using explicit criteria (lists) for the identification and management of PIM in prescriptions of older patients in primary care. Of the 2,400 articles found, six were used for data extraction. The interventions resulted in significant reductions in the number of PIM and adverse drug events and, consequently, in potentially inappropriate prescriptions (PIP) in polymedicated older adults. However, there were no significant effects of the interventions on negative clinical outcomes, such as emergency room visits, hospitalizations and death, or on improving the health status of the older adults. The use of PIM lists promotes adequate medication prescriptions for older adults in primary health care, but further studies are needed to determine the impact of reducing PIM on primary clinical outcomes.

Resumo: Este estudo revisou sistematicamente a literatura sobre a associação de listas de medicamentos potencialmente inapropriados (MPI) na prática clínica e desfechos de saúde na população idosa acompanhada na atenção primária à saúde. Para tanto, o protocolo PRISMA foi usado para sistematizar a busca de artigos nas bases de dados PubMed, Web of Science, Scopus, Cochrane Central, LIVIVO e LILACS, além da literatura cinzenta. Foram selecionados estudos com ensaios clínicos randomizados, incluindo a utilização de critérios explícitos (listas) para identificar e manejar MPI em prescrições para idosos atendidos na atenção primária. Dos 2.400 artigos encontrados, seis foram utilizados para extração de dados. As intervenções reduziram significativamente o número de MPI e eventos adversos a medicamentos e, consequentemente, nas prescrições potencialmente inadequadas em idosos polimedicados. No entanto, não houve efeitos significativos das intervenções sobre desfechos clínicos negativos (como visitas a serviços de emergência, hospitalizações e óbito) ou melhora das condições de saúde dos idosos. O uso de listas de MPI pode promover a adequação da prescrição de medicamentos para idosos na atenção primária à saúde, mas mais estudos são necessários para determinar os impactos da redução de MPI em desfechos clínicos primários.

Resumen: Este estudio realizó una revisión sistemática en la literatura sobre la asociación de listas de medicamentos potencialmente inapropiados (MPI) en la práctica clínica y los resultados de salud en la población de edad avanzada monitoreada en atención primaria de salud. Para ello, se utilizó el protocolo PRISMA para sistematizar la búsqueda de artículos en las bases de datos PubMed, Web of Science, Scopus, Cochrane Central, LIVIVO y LILACS, además de la literatura gris. Se seleccionaron estudios con ensayos clínicos aleatorizados, incluyendo el uso de criterios explícitos (listas) para identificar y manejar MPI en prescripciones para adultos mayores atendidos en atención primaria. De los 2.400 artículos encontrados, seis se utilizaron para la recolección de datos. Las intervenciones tuvieron una significativa disminución en la cantidad de MPI y eventos adversos de medicamentos y, en consecuencia, en prescripciones potencialmente inapropiadas en adultos mayores polimedicados. Sin embargo, no hubo efectos significativos de las intervenciones en los resultados clínicos negativos (como consultas a servicios de urgencias, hospitalizaciones o muerte) o mejora en las condiciones de salud de los adultos mayores. El uso de listas de MPI puede promover una adecuada prescripción de medicamentos a los adultos mayores en la atención primaria de salud, si bien se necesitan más estudios para determinar los impactos de la reducción de MPI en los resultados clínicos primarios.

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.

Polypharmacy, potentially inappropriate medications and associated factors among older adults with hypertension in primary care / Polifarmacia, medicamentos potencialmente inapropiados y factores asociados entre adultos mayores con hipertensión en atención primaria / Polifarmácia, medicamentos potencialmente inapropriados e fatores associados entre idosos com hipertensão na atenção básica

ABSTRACT Objective: to identify the prevalence and associations of polypharmacy and potentially inappropriate medication use among older adults with hypertension treated in primary care. Methods: a cross-sectional study carried out with older adults with hypertension treated at a Family Health Strategy unit. Data collection included analysis of medical records, interviews and multidimensional assessment of older adults. Socio-demographic information and clinical variables were collected. Statistical analysis was performed by multiple logistic regression. Results: polypharmacy prevalence was 38.09%, and potentially inappropriate medication (PIM), 28.57%. There was a significant association between polypharmacy and PIM use, altered sleep and ethnicity. PIM use was associated with polypharmacy, worse family functioning, and absence of a caregiver. Cognitive decline reduces the prevalence of these medications. Conclusions: polypharmacy and PIM use among older adults with hypertension represent a problem in this population, especially among the most vulnerable.

RESUMEN Objetivo: identificar la prevalencia y asociaciones de polifarmacia y uso de medicamentos potencialmente inapropiados entre ancianos hipertensos atendidos en atención primaria. Métodos: estudio transversal, realizado con ancianos hipertensos atendidos en una unidad de la Estrategia Salud de la Familia. La recolección de datos incluyó análisis de historias clínicas, entrevistas y evaluación multidimensional de los ancianos. Se recogió información sociodemográfica y variables clínicas. El análisis estadístico se realizó mediante regresión logística múltiple. Resultados: la prevalencia de polifarmacia fue de 38,09% y de medicación potencialmente inapropiada (MPI), de 28,57%. Hubo una asociación significativa entre la polifarmacia y el uso de MPI, la alteración del sueño y el origen étnico. El uso de MPI se asoció con polifarmacia, peor funcionamiento familiar y ausencia de un cuidador. El deterioro cognitivo reduce la prevalencia de estos medicamentos. Conclusiones: la polifarmacia y el uso de MPI entre personas mayores con hipertensión representan un problema en esta población, especialmente entre los más vulnerables.

RESUMO Objetivo: identificar a prevalência e as associações da polifarmácia e uso de medicamentos potencialmente inapropriados entre idosos com hipertensão atendidos na atenção básica. Métodos: estudo transversal, realizado com idosos com hipertensão atendidos em unidade da Estratégia Saúde da Família. A coleta de dados englobou análise de prontuário, entrevista e avaliação multidimensional dos idosos. Foram coletadas informações socioedemográficas e variáveis clínicas. A análise estatística se deu por regressão logística múltipla. Resultados: a prevalência de polifarmácia foi de 38,09%, e de medicamentos potencialmente inapropriados (MPI), de 28,57%. Houve associação significativa entre polifarmácia e uso de MPI, sono alterado e etnia. O uso de MPI foi associado à polifarmácia, pior funcionalidade familiar e ausência de cuidador. O declínio cognitivo reduz a prevalência destes medicamentos. Conclusões: a polifarmácia e o uso de MPI entre idosos com hipertensão representam um problema nessa população, especialmente entre aqueles mais vulneráveis.

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.

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 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

Factors Associated With PIM use in the Frail Elderly: A Cross-sectional Study.

Background: The use of potentially inappropriate medications (PIM) by the elderly is commonly studied, but studies evaluating the use of PIM by frail elderly covered by prepaid health plans are still lacking. Objective: To identify the prevalence of use and the factors associated with the use of PIM by the elderly patients with high and moderate risk of clinical-functional vulnerability, according to the Beers criteria 2019. Methods: A cross-sectional study was developed with elderly people from a private health plan in Vitória-ES, Brazil. Socioeconomic, demographic and clinical data were collected through a digital platform and a structured questionnaire through an interview, from October 2018 to June 2019. The association between the use of PIM and independent variables was verified by univariate logistic regression with their respective confidence intervals (CI) 95%. The Multiple Model included the variables with P ≤ .20. Results: 332 elderly patients were interviewed (mean age 81.5 years, gender 237 female, 95 male). A 65% prevalence of PIM use was identified. In the multiple logistic regression model, the variables associated with the use of PIM were self-medication (P = .004), high risk of clinical-functional vulnerability (P = .022), use of psychotropic medications (P = .000001), musculoskeletal medications (P = .04) and alimentary tract medications (P = .03). Physical exercises were considered a protection factor (P = .02). Conclusion: The high prevalence of PIM use indicates the need for improvement in elderly private health care, to increase pharmacotherapy safety for this population.

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.

A comprehensive look at explicit screening tools for potentially inappropriate medication: A systematic scoping review.

OBJECTIVE: To map explicit screening tools to identify potentially inappropriate medication (PIMs), and the characteristics and limitations of these tools. Including PIMs-interactions, therapeutic alternatives and the clinical management of PIMs. METHODS: A systematic scoping review was conducted in PubMed and Scopus (until May 2021). The number of PIMs listed as essential drugs was identified in Model List of Essential Medicines by the World Health Organization (WHO) and National List of Essential Medicines (Brazil). In addition to reporting the therapeutic alternatives and clinical management proposed by explicit screening tools to identify PIMs, we suggested our own alternatives for the PIMs most frequently reported. RESULTS: Fifty-eight tools reported 614 PIMs and 747 PIMs-interactions. Limited overlap between the tools was observed: 123 (69.1%) of 178 therapeutic alternatives proposed by the tools were considered inappropriate by other tools, and 222 (36.1%) of the 614 PIMs identified were named as being inappropriate only once. Only 21 tools were developed by a Delphi panel technique associated with systematic review. The PIMs listed as essential medication in Brazil and by the WHO were 30.6% and 23.3% of the total reported, respectively. For the most-cited PIMs, such as non-steroidal anti-inflammatory drugs, tricyclic antidepressants and benzodiazepines, we suggested the use of non-opioid and opioid analgesics; agomelatine, bupropion or moclobemide; and melatonin, respectively. CONCLUSIONS: The next stages in the development of explicit screening tools to identify PIMs include achieving more consensus between them and improving their applicability across countries. Further, it is recommended that tools include PIMs risks and advice on therapeutic alternatives.

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.

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.

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

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.

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 potencialmente 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.

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.