Uso de psicofármacos entre idosos residentes em comunidade: prevalência e fatores associados

Evaluation of Quality of Life of Primary Health Care Patients in Brazil: Influence of Drug Interactions, Common Mental Disorders, and Use of Psychiatric Medication

The objectives of this study were to identify the interaction between drug interaction risk, common mental disorders, use of psychiatric medication and quality of life in patients treated in primary health care settings in Brazil. In this quantitative research, 452 patients were interviewed in ten basic Brazilian health units. Sociodemographic and pharmacotherapeutic questionnaires, use of psychiatric medication, prevalence of common mental disorders, and quality of life were utilised. The structural equation model was used to evaluate the relationships among the variables. The prevalence of drug interaction risk was 66.59%. The variables associated with drug interaction risk were polypharmacy and income. The use of psychiatric medication was associated with diagnosis of common mental disorders, income and gender. The use of psychiatric medication and common mental disorders negatively influenced quality of life.

Prevalence and predictors of Potentially Inappropriate Psychotropic Medication in older adults with psychiatric illness

BACKGROUND

There is limited information available on the use of Potentially Inappropriate Psychotropic (PIP) medication in older adults having a psychiatric illness.

OBJECTIVE

To determine the prevalence of and predictors of prescribing PIP medications in older adults with psychiatric illness.

METHODS

A cross-sectional study was carried out at a tertiary care hospital on 456 patients of either sex, with a median age of 65 years attending the psychiatry outpatient department. Evaluation of PIP medication was done using Beers criteria 2019 and Screening tool of Older Persons Potentially Inappropriate Medication (STOPP) criteria 2015. Bivariate logistic regression was used to find out the predictors of PIP prescribing.

RESULTS

Results of the study reflect that a staggering number of older adults, (more than 91% and 73%) out of a total of 456 patients were prescribed with at least one PIP medication identified by Beers criteria and STOPP criteria, respectively. Long-acting benzodiazepine (LABZD) like clonazepam was identified as one of the most commonly prescribed PIP medications by both sets of criteria. Further analysis revealed that older adults from rural background (Odds Ratio (OR) 2.60, 95% Confidence Interval (CI) 1.20-5.65; P = 0.015), Tricyclic Antidepressant (TCA) (OR 0.30, 95% CI 0.12-0.75; P = 0.010), LABZD (OR 33.72, 95% CI 11.27-100.85; P = < 0.001), atypical antipsychotics (OR 22.35, 95% CI 5.31-93.99; P = < 0.001) use were most common predictors for PIP medication prescribing.

CONCLUSION

The study suggests that the Beer criteria detects more PIP medication than the STOPP criteria.

Benzodiazepine deprescription strategies in chronic users: a systematic review

BACKGROUND

As long-term use of benzodiazepines increases, adverse effects also become more frequent, especially in elderly adults. Due the potential of causing dependence, poor patient adherence and a lack of awareness of side effects, deprescription is challenging.

OBJECTIVE

This study aimed to identify what are the effective approaches to motivate and promote deprescription of benzodiazepines.

METHODS

We used MeSH terms to search in five databases that were MEDLINE, Cochrane CENTRAL, LILACS, SCIELO and Science Direct. Then, we selected articles accordingly to inclusion and exclusion criteria. Risk of bias assessment for randomized controlled trials and prospective interventional studies was made using RoB 2.0 and ROBINS-I tools, respectively. For cohort studies, we used the clarity group by McMaster University tool.

RESULTS

Database search retrieved 412 results, and 11 studies were selected for analysis. Interventions focusing on patient education to improve community awareness about deprescription presented better discontinuation rates and more potential on motivating discussions about deprescribing with physicians. Interventions based on counselling by different health professionals were not well evaluated as they presented four of six studies as high, serious or critical risk of bias.

CONCLUSIONS

Although the comparison of different strategies was impaired by the high risk of bias in some studies, patient education focused interventions presented good results. Future studies should consider doing a follow-up of 6 months or longer with evaluation of withdrawal symptoms and sleep patterns, inclusion of young adults on the sample and some form of cognitive evaluation that might influence the results of the intervention.

Increased use of benzodiazepines among older adults: Bambuí Project

BACKGROUND

Benzodiazepines are the most widely used psychoactive drugs, despite the risks associated with their prolonged use, especially among older adults.

OBJECTIVE

To investigate the use of benzodiazepines among community-dwelling people aged ≥ 75 years.

METHODS

The study was conducted among members of the baseline (in 1997) and survivors (in 2012) of the Bambuí Project cohort. The prevalence of benzodiazepine use was estimated separately for each year, and the comparison between them was performed using the Poisson regression model with robust variance.

RESULTS

The prevalence of benzodiazepine use was higher in 2012 (33.9%) compared to 1997 (24.9%). After multiple adjustments, the difference in prevalence did not remain significant in study population (PR = 1.25; 95%CI 0.99 - 1.60), unlike that observed in the female stratum (PR = 1.38; 95%CI 1.04 - 1.84). Clonazepam was the strongest-growing drug between the two years (PR = 4.94; 95%CI 2.54 - 9.62).

CONCLUSION

This study showed an important increase in benzodiazepine use in an older adult population. These results are concerning as these drugs are contraindicated for use in older adults, mainly if used chronically, and are available in the national list of essential medicines. Health professionals should be aware of the risks involved in its use regarding this population.

Factors associated with the use of potentially inappropriate medication by elderly patients prescribed at hospital discharge

Objective

To analyze the frequency of use of potentially inappropriate medication prescribed to elderly at hospital discharge from a public hospital, considering the Brazilian Consensus on Potentially Inappropriate Medication for Elderly, and to identify the associated factors.

Methods

Patients aged ≥60 years, admitted in clinical and geriatric units of a public hospital were invited to participate in the study. The information about the use of medicines was collected from the patient’s electronic record and through telephone contact. The Brazilian Consensus on Potentially Inappropriate Medication for Elderly was used to classify the medication, regardless of the clinical condition.

Results

A total of 255 elders were included in this study. The frequency of use of potentially inappropriate medication by elderly was 58.4%. The potentially inappropriate medication use in elderly was positively associated with the presence of depression (odds ratio of 2.208) and polypharmacy (odds ratio of 2.495). The hospitalization in a geriatric unit showed an inverse association with the potentially inappropriate medication use in elderly (odds ratio of 0.513).

Conclusion

The frequency of potentially inappropriate medication prescription to elderly upon hospital discharge was high. The presence of depression and polypharmacy were directly associated with use of potentially inappropriate medication in the elderly. Admission to the geriatric clinic has become a protection factor for the use of potentially inappropriate medication in elderly. Strategies to improve the elderly pharmacotherapy should implemented aiming at healthcare quality and safety in the transition of care.

Removal of pharmaceutically active compounds from synthetic and real aqueous mixtures and simultaneous disinfection by supported TiO2/UV-A, H2O2/UV-A, and TiO2/H2O2/UV-A processes

Pharmaceutically active compounds are carried into aquatic bodies along with domestic sewage, industrial and agricultural wastewater discharges. Psychotropic drugs, which can be toxic to the biota, have been detected in natural waters in different parts of the world. Conventional water treatments, such as activated sludge, do not properly remove these recalcitrant substances, so the development of processes able to eliminate these compounds becomes very important. Advanced oxidation processes are considered clean technologies, capable of achieving high rates of organic compounds degradation, and can be an efficient alternative to conventional treatments. In this study, the degradation of alprazolam, clonazepam, diazepam, lorazepam, and carbamazepine was evaluated through TiO₂/UV-A, H₂O₂/UV-A, and TiO₂/H₂O₂/UV-A, using sunlight and artificial irradiation. While using TiO₂ in suspension, best results were found at [TiO₂] = 0.1 g L^-1. H₂O₂/UV-A displayed better results under acidic conditions, achieving from 60 to 80% of removal. When WWTP was used, degradation decreased around 50% for both processes, TiO₂/UV-A and H₂O₂/UV-A, indicating a strong matrix effect. The combination of both processes was shown to be an adequate approach, since removal increased up to 90%. H₂O₂/UV-A was used for disinfecting the aqueous matrices, while mineralization was obtained by TiO₂-photocatalysis.

Self-medication and adherence to drug treatment: assessment of participants of the Universidade do Envelhecer (the University of Aging) program

Abstract Objectives : to evaluate the use of medication (for continuous use and self-medication) and adherence to treatment among elderly and non-elderly participants of the Universidade do Envelhecer (UniSer). Method : an observational, quantitative and cross-sectional study, using the interview technique, was carried out at UniSer with 215 subjects. A structured instrument was used for the collection of sociodemographic variables and self-medication data. The 1986 Morisky-Green-Levine Scale (MGL) and the Brief Medication Questionnaire (BMQ) regimen screening tool were used to assess adherence. Descriptive analyzes of the data were performed, and the chi-squared Test and Fisher’s Exact Test were applied to evaluate the association between variables of interest. Results : of the participants, 127 (59.1%) were elderly (< 60 years old), of whom 81.9% were women. Regarding self-medication, 22.9% of elderly and 21.7% of non-elderly persons practiced it in the previous seven days (p=0.848), even if they considered it dangerous (p=0.472). A total of 45.8% of the elderly and 55.6% of the non-elderly irrationally self-medicated within the analyzed period, while 76.4% of the elderly and 64.8% of the non-elderly used medications of continuous use (p=0.063). A total of 78.8% of the elderly and 76.1% of the non-elderly were not adherent to treatment (p=0.719) according to the MGL scale, while the BMQ Regimen Screen found that 36.7% of the elderly and 41.1% of the non-elderly were not adherent (p=0.595). Conclusion : these findings demonstrate that there were no significant differences between the groups studied and health education actions should be carried out with an emphasis on guidelines on adherence and the rational use of medicines.