Potentially inappropriate medication prescribed to elderly outpatients at a general medicine unit

Use of potentially inappropriate medications and adverse events in older outpatients with acute conditions

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 older adults: prevalence and physician knowledge

OBJECTIVE: To analyze the frequency, profile, and additional variables associated with the prescription of potentially inappropriate medications (PIM) to older adults in primary care, and evaluate physicians’ knowledge about these medications. METHODS: A cross-sectional study was conducted based on data from patient records for the period of January 2014 to December 2017 in a city located in the state of Minas Gerais. The frequency of PIM use was evaluated based on the 2019 Beers-Fick criteria. Physician knowledge was evaluated using a validated questionnaire as a primary data source. RESULTS: In a sample of 423 older adults, 75.89% (n = 321) used at least one PIM, the most common of which were medications used to treat central nervous system disorders (48.00%; n = 203). Most participants were female (62.41%; n = 264) and 70 years or older (69.50%; n = 294). When presented with clinical cases illustrating common situations in the management of older patients, 53.33% of physicians (n = 8) answered four or five questions correctly out of a possible seven; 13.33% (n = 2) answered six questions correctly; and 33.33% (n = 5) obtained three correct answers or fewer. CONCLUSIONS: These findings showed a high frequency of PIM use among older adults treated in Primary Health Care settings, with medications used in the treatment of central nervous system disorders. Our results highlight the importance of continuing education for health professionals and improved assessments of the medication available in the Unified Health System (Sistema Único de Saúde; SUS) for use in older adults, especially those taking multiple medications

Conhecimento de estudantes de medicina sobre medicamentos inapropriados para idosos

Objetivos: verificar e descrever o conhecimento de alunos de medicina sobre medicamentos inapropriados para idosos conforme os Critérios de Beers.Métodos: estudo transversal com a aplicação de questionários a 102 alunos matriculados do 9.º ao 11.º semestre do curso de Medicina da Universidade Luterana do Brasil – Canoas. Levantaram-se informações referentes ao conhecimento dos acadêmicos sobre medicamentos inapropriados para idosos frágeis ou com mais de 80 anos, com base na classificação do Critério de Beers.Resultados: 84,3% dos alunos pesquisados afirmaram ter conhecimento sobre medicamentos inapropriados para idosos, porém o percentual total de acertos foi de 20,2%. O maior número de acertos foi relacionado quanto à segurança do Diazepam (49%) e o menor percentual de acertos foi quanto ao medicamento Fluoxetina, com apenas 4,9% das respostas corretas. O maior percentual de respostas “Não Sei” foram relacionados em Oxibutinina (48%) e Ciclobenzaprina (37,3%). Os entrevistados que afirmaram não conhecer o tema e os indivíduos do sexo masculino apresentaram conhecimento significativamente maior com p=0,001.Conclusões: a maioria dos entrevistados afirmaram possuir conhecimento sobre o tema, porém a frequência de acertos foi baixa. O aprimoramento do ensino visando maior qualidade na prescrição e o uso racional de medicamentos é necessário para minimizar a iatrogenia em idosos

Factors associated with the use of potentially inappropriate medications by older adults in primary health care: An analysis comparing AGS Beers, EU(7)-PIM List , and Brazilian Consensus PIM criteria

BACKGROUND

Potentially inappropriate medications (PIM) for the older adults are those with an unfavorable risk-benefit ratio when more effective and safe therapeutic alternatives are available and is an important public health problem.

PURPOSE

To analyze the factors associated with the use of PIM by the older adults and to investigate the agreement of PIM use frequency using the 2015 American Geriatric Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults - 2015 AGS Beers Criteria, the Brazilian consensus on potentially inappropriate medication for older adults (BCPIM) and the European union list of potentially inappropriate medications - EU (7)-PIM List.

METHODS

This is a cross-sectional study conducted in two primary health care centers in southeastern Brazil. The 2015 AGS Beers Criteria, BCPIM, and EU (7)-PIM List were used for the classification of PIM. The association between PIM use and independent variables was assessed by multiple logistic regression. The level of agreement of PIM use among the three criteria was measured with the Cohen's kappa coefficient.

RESULTS

A total of 227 patients ≥60 years of age were included in the study. The frequency of PIM use was 53.7% for 2015 AGS Beers, 55.9% for BCPIM and 63.4% for the EU (7)-PIM List. The agreement between 2015 AGS Beers and BCPIM and between this and the EU (7)-PIM List was high, and moderate between the 2015 AGS Beers and the EU (7)-PIM List. Logistic regression showed association of PIM use with polypharmacy, self-reported neuropsychiatric and musculoskeletal diseases, age ≤70 years, preserved cognition and positive self-perception of health.

CONCLUSION

The frequency of PIM use by the older adults of health centers investigated is high. Strategies for improving the pharmacotherapy of the older adults in primary health care should be implemented.

Prescrição inadequada de medicamentos a idosos portadores de doenças crônicas em um plano de saúde no município de São Paulo, Brasil

INTRODUÇÃO: A polifarmácia e a prescrição de medicamentos inapropriados para idosos podem causar uma série de efeitos indesejados, comprometendo sua capacidade funcional. OBJETIVO: Verificação da presença de prescrição de medicamentos inapropriados em um grupo de idosos vinculados a um plano de saúde privado com cobertura na cidade de São Paulo-SP. METODOLOGIA: Estudo realizado mediante a análise de prescrições feitas a um grupo de idosos vinculados a um plano de saúde privado, todos portadores de doenças crônico-degenerativas e acompanhados por médicos de especialidades diversas, na capital do estado de São Paulo, durante os anos de 2012 e 2013. Os medicamentos foram examinados segundo os Critérios de Beers revisados pela American Geriatrics Society em 2012. RESULTADOS: Foram observadas prescrições feitas a 2.500 idosos com um total de 8.760 medicamentos. Destes, 2.926 33,4% foram considerados inapropriados para uso em idosos. Os fármacos mais prescritos foram os anti-inflamatórios não esteroides, seguidos por medicamentos cardiovasculares e de ação central. A maioria desses idosos não possui médico de referência, sendo acompanhados, em média, por quatro médicos de especialidades diferentes. CONCLUSÃO: O grupo pesquisado apresenta um número elevado de prescrições de medicamentos inapropriados para uso em idosos, os quais, somados às características próprias, fazem com que esse grupo se torne de alto risco para o aparecimento de iatrogenias. Utilizar critérios de fácil memorização para identificação desses medicamentos e, principalmente, rever a forma como o setor de saúde suplementar brasileiro atende a este segmento etário é de suma importância, a fim de preservar a qualidade de vida desses idosos.