Fatores associados ao uso de psicotrópicos por idosos residentes no Município de São Paulo

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 common mental disorders and use of psychiatric drugs in cancer outpatients

BACKGROUND

Considering the high incidence of cancer in Brazil and worldwide, the high prevalence and relevance of Common Mental Disorders (CMD) in the treatment of cancer patients, and the use of psychiatric drugs without reliably proven effectiveness, studies that contemplate this topic are needed to understand and provide rationale for the treatment of CMD in these individuals.

OBJECTIVES

This study identified prevalence and factors associated with Common Mental Disorders (CMD) and psychotropic use in cancer outpatients.

METHOD

This is a cross-sectional study with descriptive correlational design. It was developed in the chemotherapy sector of a hospital specialized in cancer. The tools used were: Self Reporting Questionnaire (SRQ-20) and structured questionnaires.

FINDINGS

Among 403 respondents, CMD prevalence was 31.5% and psychotropic use was 25.8%. CMD were associated with gender, education, family income, psychotropic use and cancer surgery. Psychotropic use was associated with gender, employment status, cancer surgery, treatment period and other physical health conditions. Logistic regressions showed CMD were associated with gender and other physical health conditions; psychotropic use was associated with gender, employment status and other conditions.

Sleep disturbances in older adults are associated to female sex, pain and urinary incontinence

OBJECTIVES

The prevalence of sleep problems in elderly, such as insomnia, is a relevant issue in our society. Poor sleep quality is viewed by many as an inevitable result of aging. In this context, this study aimed to estimate the prevalence and associated factors of sleeping disturbances in elderly men and women (60 years and older).

METHODS

The present study is part of SABE Study (Health, Well-being and Aging), a cohort conducted in São Paulo, Brazil. The sample included in the present cross-sectional study comprised 1,334 elderly people aged 60 years or older. Sleep disturbances were assessed based on responses of study participants on whether they had experienced any sleep disturbance in the past month.

RESULTS

Among the elderly assessed, 44.9% had overall sleep disturbances, which were more frequent in women (51.5%) and in 75 to 79 years old (48.2%). According to the regression analysis, the variables gender, joint diseases, as well as nocturia and urinary incontinence, were associated with sleep disorders. Increase in sleep disturbances was found not to be linearly age-dependent.

CONCLUSIONS

Gender, pain, urinary and nocturia incontinence were factors associated with sleep disorders. Thus, we might conclude that the absence of sleep disturbances in older adults depends on gender and health status.

Elderly people with mental disorders: experiencing the use of psychotropic medicines

OBJECTIVE

To interpret the experience of the elderly with mental disorder in the use of psychotropic medicines.

METHOD

Qualitative study in the interpretative modality, supported by the Grounded Theory. It was carried out from interviews with 16 elderly people with mental disorder and six relatives, totaling 22 participants.

RESULTS

In the experience of the use of psychotropic medicines, the elderly with mental disorders become aware of their condition, attribute meaning and establish strategies for the correct use. On the other hand, they express their dissatisfaction with being dependent on psychotropic medicines to live without symptoms, face their side effects and do not always use them correctly.

CONCLUSION

The use of psychotropic medicines is a priority in the life of the elderly and, in view of the fragilities found, it is necessary a continuous monitoring of health professionals.

Antidepressant use and the components of the frailty syndrome

Abstract Objective: to evaluate the effects of antidepressant use on components of frailty. Methods: a cross-sectional and analytical study comparing groups of users and non-users of antidepressants was carried out in a municipal region in the south of Brazil. The research was linked to the matrix study "Health of Elderly Persons in Primary Care". The sample was selected through access to the database of the matrix study from which two groups were extracted: users (n=87) and non-users (n=114) of antidepressants. After selection of the groups, data collection was carried out between June and September 2016 in the homes of the elderly, and included information on sociodemographic characteristics, use of medications and the evaluation of frailty. Pearson's Chi-square hypothesis test was used to verify the association between the groups and the Odds Ratio (OR) was used to calculate risk. Results: The prevalence of frailty was 62.7% and was associated with the group that used antidepressants. Among the components of frailty an association between the user group and fatigue, low gait speed and unintentional weight loss was found. A greater risk of frailty among elderly persons using tricyclic antidepressants and antidepressants potentially inappropriate for the elderly was identified. Conclusions: an association between frailty and antidepressant use was found. These results indicate the need for the clinical evaluation of the risks and benefits of prescribing antidepressants for the elderly; and reveal that when treatment begins, the monitoring and assessment of geriatric characteristics are required to ensure the safety and quality of life of the elderly.

Potentially inappropriate prescriptions for elderly people taking antidepressant: comparative tools

Background

The use of psychotropic drugs by elderly people is widely spread around the world, given that prevalence of inappropriate medication is frequent. Strictly speaking, in Brazil, the vulnerable population of elderly people is more likely to use Potentially Inappropriate Psychotropic (PIP) due to the impact of social-economic characteristics, to the Brazilian Public Health System, and to the lack of patient monitoring. However, neither the use pattern nor the prevalence rate of PIP have been studied in Brazil so far. The objectives of this study were to determine the prevalence of PIP in elderly outpatients taking antidepressants, and to compare the performance of two different tools (Beers, STOPP).

Methods

This cross-sectional study involved all the aged outpatients (≥ 60 years of age) taking antidepressants attended by the public health system in a city of the State of São Paulo, Brazil. Data were obtained from a pharmacy database and medical records. All psychotropic drugs evaluated included: antidepressants, antipsychotics, anti-epileptics and benzodiazepines. STOPP and Beers criteria were applied to detect PIP.

Results

One thousand one hundred forty prescriptions from 174 outpatients were subjected to two different screening tools. The average patient age was 67 (interquartile range 63–74) and the median number of drugs used was 3.0 (interquartile 2–4) per patient. The overall prevalence of PIP was 121 (69.5%). The levels of PIP observed according to tools were 39.6% (STOPP) and 29.9% (Beers).The long-term use of benzodiazepines was the most common PIP recognized, and the one which contributed more significantly to higher levels of PIP than other medications.

Conclusions

The prevalence of PIP was high among the elderly. STOPP criteria identified more PIP than Beers criteria. Knowledge of PIP prevalence should gear efforts to reduce the level of inappropriate prescriptions and may provide the need for developing national criteria.

Prevalence of and factors associated with benzodiazepine use in community-resident elderly persons

Abstract Objective: to assess the prevalence of and factors associated with the use of benzodiazepines in elderly persons living in the community. Method: a cross-sectional study was conducted through a household survey of 423 elderly persons from Juiz de Fora, Minas Gerais, Brazil. To analyze the factors associated with the outcome, the Poisson regression model was used, based on the theoretical model of determination with hierarchical blocks. The variables were adjusted within each block, with those with a 5% significance level remaining in the final model. Result: The prevalence of benzodiazepine use was 18.3% (95% CI 15.2 to 21.6). Most benzodiazepines used had a long-elimination half-life (59.2%) and use was considered long in 85.5% of users. Among benzodiazepine users 38.4% also used antidepressants. The use of these drugs was associated with the presence of self-reported mental and behavioral disorders, polypharmacy and medical visits in the last three months. Conclusion: The use of benzodiazepines was considered high among the elderly. The reduction in the prescription of these drugs should be assessed individually, considering the physiological alterations of the elderly and the adverse effects of drugs, in order to minimize incorrect prescriptions.

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

RESUMO: Objetivo: Investigar a prevalência e os fatores associados ao uso de psicofármacos entre idosos. Métodos: O estudo, realizado em 2003, baseou-se no Inquérito de Saúde da Região Metropolitana de Belo Horizonte (RMBH). Participaram do estudo 1.635 idosos (60 anos ou mais) residentes nos municípios da RMBH, selecionados por meio de amostra probabilística complexa. Modelos de regressão logística foram utilizados para identificar os fatores associados ao uso de psicofármacos, considerando o nível de significância de 5,0%. Resultados: A prevalência de uso de psicofármacos foi de 13,4%, sendo 8,3% para uso de benzodiazepínicos e 5,0% para antidepressivos. Os fatores independentemente associados ao uso de psicofármacos foram sexo feminino (OR = 2,20; IC95% 1,49 - 3,27), relato de diagnóstico médico para depressão (OR = 6,42; IC95% 4,31 - 9,55), ter realizado 5 ou mais consultas médicas nos últimos 12 meses (OR = 2,15; IC95% 1,32 - 3,53) e afiliação a plano de privado saúde (OR = 2,69; IC95% 1,86 - 3,88). Conclusão: A prevalência observada foi semelhante ao verificado entre idosos brasileiros e o padrão de associações detectado foi consistente com o observado em populações idosas de países de maior renda, sendo o relato de diagnóstico médico para depressão o fator mais fortemente associado ao uso de psicofármacos.

Prescrição de benzodiazepínicos para adultos e idosos de um ambulatório de saúde mental

Resumo Foi objetivo deste estudo comparar as prescrições de benzodiazepínicos (bzd) em adultos e idosos quanto aos indicadores do uso apropriado. Estudo transversal de coleta de dados de pacientes atendidos no Ambulatório Municipal de Saúde Mental de Sorocaba/SP, entre março e novembro de 2013. Foram utilizados indicadores de uso apropriado: medicamento apropriado, com adequada posologia e duração de uso; como também, o uso de apenas um bzd, como ansiolítico por menos de 3 meses, no tratamento da depressão com antidepressivo, uso por menos de 2 meses se associado ao antidepressivo e o não uso de bzd de longa ação em idoso. Dos 330 participantes, a maioria era mulheres, com histórico familiar de transtorno mental e uso de bzd, não realizava acompanhamento com psicólogo e fazia uso de outros psicotrópicos e de polifarmácia (p > 0,05). A minoria das prescrições tinha indicação de uso do bzd (37,5% para idosos e 32,4% para adultos) (p > 0,05). Apenas 5,8% das prescrições para idosos e 1,9% para adultos eram racionais (p > 0,05). O uso crônico foi observado em todos os adultos e idosos com transtornos depressivos e ansiosos (p > 0,05). Uma minoria das prescrições de bzd para adultos e idosos era apropriada.

Benzodiazepine use and associated factors in elderly in the city of Dourados, MS, Brazil

ABSTRACT Objective The use of benzodiazepines (BZD) and associated factors in the elderly of Dourados, MS, Brazil was investigated. Methods This is a cross-sectional population-based study using a multistage sampling design. Participants were 1,022 individuals aged ≥ 60 years. Measurements socioeconomic status, schooling, demographic aspects, marital status, physical activity, hospitalizations, self-rated health, use of alcohol beverages and smoking were assessed by standard questionnaire. The drugs used were obtained by checking the prescription or package and classified according to the Anatomical Therapeutic Chemical Index. Chi-square test, Chi-square for linear tendency, Fisher's exact test and Poisson regression were used to assess association between variables. Results The prevalence of use of BZD was 6.5% (CI95%: 5.1-8.2%). The oldest group (PR: 1.60 for 70-79 years and PR: 1.79 for ≥ 80 years), non-use of alcohol (PR: 4.14) and use of antidepressants (PR: 8.73) were the statistically associated characteristics. Conclusions The prevalence of use of BZD in the study population was low, similar to findings of more recent Brazilian studies and lower than those obtained in international studies. The prevalence of use of BZD increased with aging and use of antidepressants.

PSICOFÁRMACOS E PSICOTERAPIA COM IDOSOS

O presente artigo se propõe a averiguar a relação entre o uso de psicofármacos e o processo psicoterápico de idosos atendidos em um serviço-escola no Vale do Rio Pardo/RS, durante o período de 1997 a 2011. Trata-se de uma pesquisa documental, baseada em uma abordagem descritiva, desenvolvida a partir da análise de 73 prontuários dos usuários com idade a partir de 60 anos. A pesquisa faz parte de um projeto mais amplo que abrange pesquisas similares em todas as outras faixas etárias (inferiores a 60 anos). Ela mostra que a maior procura pelo tratamento se dá entre as mulheres, e que o principal motivo de procura pelo tratamento está relacionado à tristeza/pessimismo. Revela um número expressivo de medicação psicotrópica entre os idosos pesquisados, inclusive com a utilização de mais de um psicofármaco para uma mesma pessoa, o que reforça os estudos que apontam o aumento da medicação psicofarmacológica na sociedade.