Estudo de coorte sobre o uso de medicamentos potencialmente inapropriados em idosos
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2020-02-21
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Universidade Federal de Goiás
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INTRODUCTION: Population ageing is accompanied by an increase in chronic diseases and use of medicines. Although pharmacological therapy plays an important role in disease control, some drugs are classified as Potentially Inappropriate Medicines (PIM), creating new challenges for the elderly, their families andhealth services.OBJECTIVE: To analyze the evolution, incidence and mortality of elderly people using Potentially Inappropriate Medicines (PIM) in a decade-long cohort study. METHOD: Prospective cohort epidemiological study, with a ten-year follow-up period, carried out in Goiânia, with an initial sample (baseline) of 418 elderly people in 2008. A home interview was conducted, using a standardized questionnaire including socioeconomic, demographic, living conditions and healthvariables. Information was collected on the active ingredient, dosage, route and schedule of the drugs. PIM were classified according to theAmerican Geriatrics Society Beers Criteria. The analyses were performed withSTATA 15.0. To analyze the factors associated with the incidence of PIM usage, a generalized linear model was constructed, and presented as Adjusted Relative Risk (aRR). In order to analyze the evolution of PIM usage, a longitudinal analysis was performed using Generalized Estimating Equations models. Finally, the mortality rate was calculated, as well as the effect of refusals and 6%loss from follow-up, totaling 221 included in the year 2018. The mean age was 79.1 years (± 5.8); 67.4% were women; 21.2% rated their health as poor or very poor, 24.4% were hospitalized in the last year and 69.2% presented more than three diseases. In 2008, the mean number of drugs used was 3.3 (± 2.6); while in 2018 the mean was 8.0 (± 5.1). In 2008, the PIM most frequently consumed were in this order: nifedipine, glibenclamide and sodium diclofenac. In 2018, the mostfrequently consumed were: sodium diclofenac, amiodarone and scopolamine. The incidence of PIM use in the sample of the elderly cohort was 44.1 cases (95% CI: 35.2-54.7) per 1,000 person-years (56 incident cases/1,270 person-years). Multiple regression revealed that the incidence of PIM use was statistically associated with polypharmacy (aRR: 3.00; 95% CI: 1.31-6.88) and diabetes mellitus (aRR: 1.57; 95% CI: 1.03-2.39). In the longitudinal analysis, elderly people with a history of hospitalization (RTaj: 1.20; 95% CI: 1.01-1.40), with three or more morbidities (RTaj: 1.41; 95% CI: 1.14- 1.74), using polypharmacy aRR(RTaj: 1.81; 95% CI: 1.47-2.24) and diagnosed with diabetes mellitus (PIM on the survival of the elderly, using Cox proportional regression analysis, presented as Adjusted Hazard Ratio (aHR). The study was approved by HC/UFG ethics committee.RESULTS: From a total of 418 elderly followed up, 34.9% died, there were¨6% RTaj: 1.24; 95% CI: 1.05-1, 47) had a higher rate of PIM usage over the ten years. The overall mortality rate in the group that used PIM at the baseline was 46.3 deaths (70/1,513 person-years) and in the unexposed group it was 37.7 deaths (75/1,992 person-years). In the Cox regression analysis adjusted according to age, sex, economic class, polypharmacy and use of PIM, no statistical association was observed between survival of the elderly in the cohort and use of PIM in the adjusted analysis (aHR: 1.02; 95% CI: 0.69-1.51). CONCLUSION: This research indicated that the incidence of PIM usage in the elderly is high, and polypharmacy and Diabetes Mellitus are factors that increase both the incidence and the rate of use. Although PIM usage has not decreased, the survival of the elderly and the association of polypharmacy with mortality show that the use of medications in the elderly should be continuously monitored. The results are a warning to prescribers and health professionals regarding the rational use of medicines in the elderly population, in order to prevent adverse reactions and other health problems. Furthermore, they signal the need to review the type of drugs used and to monitor their use at all levels of health care and especially primary care.
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ARAÚJO, N. C. Estudo de coorte sobre o uso de medicamentos potencialmente inapropriados em idosos. 2020. 122 f. Dissertação (Mestrado em Enfermagem) - Universidade Federal de Goiás, Goiânia, 2020.