Polypharmacy in the Elderly of an Educational Program in the Brazilian Capital: A Cross-Sectional Study

Vinícius Vieira da Costa; Camila de Oliveira Costa; Cássia Cristina de Paula Alves; Emília Vitória da Silva; Margô Gomes de Oliveira Karnikowski; Rinaldo Eduardo Machado de Oliveira

doi:10.30827/ars.v65i4.30673

Autores/as

Vinícius Vieira da Costa University of Brasilia
Camila de Oliveira Costa University of Brasilia
Cássia Cristina de Paula Alves University of Brasilia
Emília Vitória da Silva University of Brasilia
Margô Gomes de Oliveira Karnikowski University of Brasilia
Rinaldo Eduardo Machado de Oliveira University of Brasilia https://orcid.org/0000-0003-1684-1456

DOI:

https://doi.org/10.30827/ars.v65i4.30673

Palabras clave:

polifarmacia, anciano, envejecimiento, utilización de medicamentos, atención integral de salud, política de salud

Resumen

Introducción: Las personas mayores corresponden al grupo más medicalizado de la sociedad. Por lo tanto, los estudios relacionados con el uso de medicamentos son importantes para mejorar las políticas que garanticen una atención integral. El objetivo de este estudio fue investigar la polifarmacia entre adultos mayores que asisten a un programa educativo en el Distrito Federal de Brasil y estimar la prevalencia y variables asociadas.

Método: Se trata de un estudio transversal con 150 adultos mayores cuyos datos fueron recolectados en el período de diciembre de 2022 a abril de 2023 mediante llamadas telefónicas.

Resultados: La prevalencia de polifarmacia se estimó en 18,7 %. Las variables que mostraron asociación positiva con la polifarmacia fueron las siguientes: salud autopercibida como mala o muy mala (RP = 8,9; IC95 % 4,78 – 16,70), tabaquismo (RP = 2,50; IC95 % 1,06 – 5,89), arterial sistémica hipertensión (RP = 3,55; IC95 % 1,40 – 9,00), diabetes mellitus (RP = 3,46; IC95 % 1,67 – 7,18), depresión (RP = 3,32; IC95 % 1,58 – 6,75), multimorbilidad (RP = 8,97; IC95 % 1,26 – 64,10) e Índice de Comorbilidad de Charlson igual o mayor a 3 (RP = 7,21; IC95 % 1,14 – 26,17).

Conclusiones: La prevalencia de polifarmacia y variables asociadas son corroboradas por otros estudios brasileños. Por lo tanto, se señala que los equipos de salud deben prestar atención a este aspecto de la farmacoterapia geriátrica para favorecer el uso responsable de los medicamentos y obtener resultados clínicos positivos.

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Citas

Kawada T. Polypharmacy, frailty and disability-free survival in older adults. Arch Gerontol Geriatr. 2023; 110:104983. doi: 10.1016/j.archger.2023.104983.

Ramos LR. Determinant factors for healthy aging among senior citizens in a large city: the Epidoso Project in São Paulo. Cad Saúde Pública. 2003;19(3):793–797. doi: 10.1590/S0102-311X2003000300011.

Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivelä SL, Isoaho R. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol. 2002;55(8):809-817. doi: 110.1016/s0895-4356(02)00411-0.

Ramos LR, Tavares NUL, Bertoldi AD, Farias MR, Oliveira MA, Luiza VL, et al. Polypharmacy and polymorbidity in older adults in Brazil: a public health challenge. Rev Saúde Pública. 2016; 50:9s. doi: 10.1590/S1518-8787.2016050006145.

Lau SR, Waldorff F, Holm A, Frølich A, Andersen JS, Sallerup M, et al. Disentangling concepts of inappropriate polypharmacy in old age: a scoping review. BMC Public Health. 2023;23(1):245. doi: 10.1186/s12889-023-15013-2

Gosselin M, Talbot D, Simard M, Chiu YM, Mésidor M, Boiteau V, et al. Classifying Polypharmacy According to Pharmacotherapeutic and Clinical Risks in Older Adults: A Latent Class Analysis in Quebec, Canada. Drugs Aging. 2023;40(6):573-583. doi: 10.1007/s40266-023-01028-2.

Molist-Brunet N, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Barneto-Soto M, González-Bueno J, Espaulella-Panicot J. Improving individualized prescription in patients with multimorbidity through medication review. BMC Geriatr. 2022;22(1):417. doi: 10.1186/s12877-022-03107-2.

Garcia KR, Bento AP, de Oliveira AG, da Silva RA, Chiarello MD, Chariglione IPFS, et al. COVID-19 and the elaboration of personal plans in + 50: a Brazilian experience. BMC Public Health.2023;23(1):221. doi: 10.1186/s12889-023-15006-1

Melo LA de, Lima KC de. Prevalência e fatores associados a multimorbidades em idosos brasileiros. Ciênc saúde coletiva. 2020;25(10):3869–3877. doi: 10.1590/1413-812320202510.34492018.

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009; 42(2):377-381. doi: 10.1016/j.jbi.2008.08.010.

Meneses-Gaya C, Zuardi AW, Loureiro SR, Hallak JE, Trzesniak C, de Azevedo Marques JM, et al. Is the full version of the AUDIT really necessary? Study of the validity and internal construct of its abbreviated versions. Alcohol Clin Exp Res. 2010;34(8):1417-1424. doi: 10.1111/j.1530-0277.2010.01225.x.

WHO Collaborating Centre for Drug Statistics Methodology. Anatomical Therapeutic Chemical (ATC) Classification Index 2023. Oslo; 2023. Available from: http://www.whocc.no/atc_ddd_index/

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83. doi: 10.1016/0021-9681(87)90171-8.

Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson Comorbidity Index: a critical review of Clinimetric Properties. Psychother Psychosom. 2022;91(1):8–35. doi: 10.1159/000521288.

Costa GM da, Oliveira MLC de, Novaes MRCG. Factors associated with polypharmacy among elderly people receiving care under the family health strategy. Rev bras geriatr gerontol. 2017;20(4):525–533. doi: 10.1590/1981-22562017020.170005.

Oliveira PC de, Silveira MR, Ceccato M das GB, Reis AMM, Pinto IVL, Reis EA. Prevalence and factors associated with polypharmacy among the elderly treated in Primary Healthcare in Belo Horizonte, State of Minas Gerais, Brazil. Ciênc saúde coletiva. 2021;26(4):1553–1564. doi: 10.1590/1413-81232021264.08472019.

Pereira KG, Peres MA, Iop D, Boing AC, Boing AF, Aziz M, et al. Polypharmacy among the elderly: a population-based study. Rev bras epidemiol. 2017;20(2):335–344. doi: 10.1590/1980-5497201700020013.

Rezende GR de, Amaral TLM, Amaral C de A, Vasconcellos MTL de, Monteiro GTR. Prevalence of polypharmacy and associated factors in older adults living in Rio Branco, Acre, Brazil: a cross-sectional population-based study, 2014. Epidemiol Serv Saúde. 2021;30(2):e2020386. doi: 10.1590/S1679-49742021000200013.

Barghouth MH, Schaeffner E, Ebert N, Bothe T, Schneider A, Mielke N. Polypharmacy and the Change of Self-Rated Health in Community-Dwelling Older Adults. Int J Environ Res Public Health. 2023;20(5):4159. doi: 10.3390/ijerph20054159.

Mangin D, Lamarche L, Agarwal G, Ali A, Cassels A, Colwill K, et al. Team approach to polypharmacy evaluation and reduction: feasibility randomized trial of a structured clinical pathway to reduce polypharmacy. Pilot Feasibility Stud. 2023;9(1):84. doi: 10.1186/s40814-023-01315-0.

Scott IA, Hilmer SN, Reeve E, Potter K, Le Couteur D, Rigby D, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827-834. doi: 10.1001/jamainternmed.2015.0324.

Molist-Brunet N, Sevilla-Sánchez D, Puigoriol-Juvanteny E, Barneto-Soto M, González-Bueno J, Espaulella-Panicot J. Improving individualized prescription in patients with multimorbidity through medication review. BMC Geriatr. 2022;22(1):417. doi: 10.1186/s12877-022-03107-2.

Baah-Nyarkoh E, Alhassan Y, Dwomoh AK, Kretchy IA. Medicated-related burden and adherence in patients with co-morbid type 2 diabetes mellitus and hypertension. Heliyon. 2023;13;9(4):e15448. doi: 10.1016/j.heliyon.2023.e15448.

Daunt R, Curtin D, O’Mahony D. Polypharmacy stewardship: a novel approach to tackle a major public health crisis. Lancet Healthy Longev. 2023;4(5):e228-e235. doi: 10.1016/S2666-7568(23)00036-3.

Abdoli N, Salari N, Darvishi N, Jafarpour S, Solaymani M, Mohammadi M, et al. The global prevalence of major depressive disorder (MDD) among the elderly: A systematic review and meta-analysis. Neurosci Biobehav Rev. 2022; 132:1067-1073. doi: 10.1016/j.neubiorev.2021.10.041.

Qiao Y, Liu S, Zhang Y, Wu Y, Shen Y, Ke C. Bidirectional association between depression and multimorbidity in middle-aged and elderly Chinese adults: a longitudinal cohort study. Aging Ment Health. 2022; 26(4):784-790. doi: 10.1080/13607863.2021.1877609.

American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023. doi: 10.1111/jgs.18372.

Ishtiak-Ahmed K, Köhler-Forsberg O, Mortensen EL, Nierenberg AA, Gasse C. Concurrent use of polypharmacy and potentially inappropriate medications with antidepressants in older adults: A nationwide descriptive study in Denmark during 2015-2019. Gen Hosp Psychiatry. 2023; 82:66-74. doi: 10.1016/j.genhosppsych.2023.03.009.

Freire M de BO, Da Silva BGC, Bertoldi AD, Fontanella AT, Mengue SS, Ramos LR, et al. Benzodiazepines utilization in Brazilian older adults: a population-based study. Rev Saúde Pública. 2022; 56:10. doi: 10.11606/s1518-8787.2022056003740.

Eyigor S, Kutsal YG, Toraman F, Durmus B, Gokkaya KO, Aydeniz A, et al. Polypharmacy, physical and nutritional status, and depression in the elderly: do polypharmacy deserve some credits in these problems? Exp Aging Res. 2021; 47(1):79-91. doi: 10.1080/0361073X.2020.1846949.

Meng LC, Hsiao FY, Huang ST, Lu WH, Peng LN, Chen LK. Intrinsic Capacity Impairment Patterns and their Associations with Unfavorable Medication Utilization: A Nationwide Population-Based Study of 37,993 Community-Dwelling Older Adults. J Nutr Health Aging. 2022; 26(10):918-925. doi: 10.1007/s12603-022-1847-z.

Nascimento RCRM, Álvares J, Guerra Junior AA, Gomes IC, Silveira MR, Costa EA, et al. Polypharmacy: a challenge for the primary health care of the Brazilian Unified Health System. Rev Saúde Pública. 2017; 51:19s. doi: 10.11606/S1518-8787.2017051007136.

Marques PP, Assumpção D, Rezende R, Neri AL, Francisco PMSB. Polypharmacy in community-based older adults: results of the Fibra study. Rev bras geriatr gerontol. 2019; 22(5):e190118. doi: 10.1590/1981-22562019022.190118

Zhang L, Xu X. Construction of smart older adults care service model driven by primary health care. Front Public Health. 2023; 11:1157758. doi: 10.3389/fpubh.2023.1157758.

Oliveira REM, Ueta JM, Franco LJ. Variables associated with adherence to the treatment of type 2 diabetes mellitus among elderly people. Diabetol Int. 2021; 13(1):160-168. doi: 10.1007/s13340-021-00518-1.