Keywords
Hospitalization
Potentially inappropriate medications
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Abstract
Objective: This study evaluated medication prescription for frail elderly patients treated in a geriatric service of a university hospital, focusing on the identification of potentially inappropriate medications (PIMs) and medication-related problems (MRPs). Methods: A descriptive, cross-sectional, and retrospective study was conducted from April 2023 to March 2024 with 99 elderly patients at a university hospital in Maranhão. The Beers Criteria AGS 2023 was used to classify PIMs, and MRPs were classified according to the Granada Consensus. Data collection was carried out in medical records and statistical analysis in Microsoft Excel and R Studio program. Pearson's chi-square test (p<0.05) was used to assess the association between frailty and PIM use. Results: The use of PIMs had a high prevalence (91.84%). The most prescribed PIMs were for the central nervous system (43.16%) and gastrointestinal system (40%). There was no statistical difference between frailty and PIM use. Eighty patients (80.81%) had at least one MRP. Conclusion: This study showed a high prevalence of PIMs and MRPs, demonstrating the importance of a multidisciplinary geriatric approach, with emphasis on optimizing drug therapy and reducing associated risks.
References
ALVES CO, et al. Beers criteria-based assessment of medication use in hospitalized elderly patients in southern Brazil. J Family Med Prim Care. 2014;3(3):260-265.
ALVES MKL, et al. Evidence of association between the use of drugs and community-dwelling older people frailty: a cross-sectional study. Sao Paulo Med J. 2020 Nov-Dec;138(6):465-474.
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;1‐30.
ANDRADE CP, et al. Perfil do uso de medicamentos por idosos da Estratégia Saúde da Família de Porto Alegre. Revista Saúde (Sta. Maria). 2019; 45 (2).
ANDRADE RC, et al. Polifarmácia, medicamentos potencialmente inapropriados e a vulnerabilidade de pessoas idosas. Revista Brasileira de Geriatria e Gerontologia, v. 27, 1 jan. 2024.
AKANDE‐SHOLABI W, FAFEMI A. Potentially inappropriate medication use in the elderly: physicians’ and hospital pharmacists knowledge, practice, confidence, and barriers. Journal of Pharmaceutical Health Care and Sciences, v. 8, n. 1, 9 dez. 2022.
BANDEIRA VAC, et al. Uso de antidepressivo e os componentes da síndrome de fragilidade. Revista Brasileira de Geriatria e Gerontologia, Rio de Janeiro, 2018; 21(1): 7-15.
CAMARGOS MCS, GONZAGA MR. Viver mais e melhor? Estimativas de expectativa de vida saudável para a população brasileira. Cadernos de Saúde Pública, v. 31, n. 7, p. 1460–1472, jul. 2015.
CARNEIRO JA, et al. Prevalência e fatores associados à fragilidade em idosos não institucionalizados. Revista Brasileira De Enfermagem, v. 69, n. 3, p. 435–442, 1 jun. 2016.
COSTA SAL, et al. Efeitos do uso prolongado de Inibidores de Bomba de Prótons em idosos. Brazilian Journal of Health Review, Curitiba, v.4, n.2, p.4248-4265 mar./apr.2021.
COMITÉ DE CONSENSO. Tercer Consenso de Granada sobre problemas relacionados con medicamentos (PRM) y resultados negativos asociados a la medicación (RNM). Ars Pharm. 2007;48(1):5-17.
CUENTRO VS, et al. Prescrições medicamentosas de pacientes atendidos no ambulatório de geriatria de um hospital universitário: estudo transversal descritivo. Ciência & Saúde Coletiva, v. 19, n. 8, p. 3355–3364, ago. 2014.
FALLER JW, et al. Instruments for the detection of frailty syndrome in older adults: A systematic review. PLOS ONE, v. 14, n. 4, p. e0216166–e0216166, 29 abr. 2019.
FAISAL S, et al. Prevalence and Predictors of Excessive Polypharmacy in Geriatric Inpatients: A Retrospective Cross-Sectional Study in Indonesia. J Prim Care Community Health. 2023; 14:21501319231178595.
FRIED LP, et al. Frailty in Older Adults: Evidence for a Phenotype. The Journals of Gerontology, v. 56, n. 3, p. M146–M157, 1 mar. 2001.
GUTIÉRREZ-VALENCIA M, et al. The relationship between frailty and polypharmacy in older people: A systematic review. British Journal of Clinical Pharmacology, v. 84, n. 7, p. 1432–1444, 3 maio 2018.
HAILU BY, et al. Drug related problems in admitted geriatric patients: the impact of clinical pharmacist interventions. BMC Geriatr. 2020 Jan 13;20(1):13.
IBGE. Censo Demográfico 2022: alfabetização: resultados do universo. Rio de Janeiro: IBGE, 2024.
MASCARELO A, et al. Prevalence and factors associated with excessive polypharmacy in institutionalized older people in southern Brazil. Revista Brasileira de Geriatria e Gerontologia. 2021;24(2): e 21002.
MELO LA, LIMA KC. Prevalência e fatores associados a multimorbidades em idosos brasileiros. Ciência & Saúde Coletiva, 25(10): 3869-3877, 2020.
MOREIRA FSM et al. Uso de medicamentos potencialmente inapropriados em idosos institucionalizados: prevalência e fatores associados. Ciência & Saúde Coletiva, 25(6):2073-2082, 2020.
MORLEY JE, et al. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012 Jul;16(7):601-8.
MORIN L, et al. A epidemiologia da polifarmácia em adultos mais velhos: estudo de coorte prospectivo baseado em registro. Clin Epidemiol. 2018;10:289-298.
MOURA E, et al. Síndrome da fragilidade e fatores associados em idosos residentes em instituições de longa permanência. Saúde em Debate, v. 42, n. 117, p. 468–480, 1 jun. 2018.
MUHLACK DC, et al. The associations of geriatric syndromes and other patient characteristics with the current and future use of potentially inappropriate medications in a large cohort study. Eur J Clin Pharmacol 74, 1633–1644 (2018).
PAGNO AR, et al. Drug therapy, potential interactions and iatrogenesis as factors related to frailty in the elderly. Rev. bras. geriatr. gerontol. (Online), p. 588–596, 2018.
PEREIRA DS, et al. Qualidade de vida e situação de saúde de idosos: um estudo de base populacional no Sertão Central do Ceará. Revista Brasileira de Geriatria e Gerontologia, Rio de Janeio, 2015; 18(4):893-908
PEREIRA MLC, et al. Delirium em idosos hospitalizados: prevalência, fatores de risco e desfechos clínicos. Brazilian Journal of Health Review, Curitiba, v. 7, n. 3, p. 01-11, may/jun., 2024.
PRAMOTESIRI P, et al. Drug Related Problems among Older Inpatients at a Tertiary Care Setting. J Clin Med. 2024 Mar 13;13(6):1638.
RANKIN A, et al. Interventions to improve the appropriate use of polypharmacy for older people. The Cochrane library, v. 2018, n. 9, 3 set. 2018.
ROSA ASKC, et al. Identificação de prescrição inapropriada em ambulatório de Geriatria utilizando os Critérios Stopp e Start. Revista Brasileira de Geriatria e Gerontologia, Rio de Janeiro, 2016; 19(5):871-878.
SANTANA DA, et al. Prevalência de comorbidades em idosas frágeis, pré-frágeis e robustas. Conexões, Campinas, SP, v. 22, n. 00, p. e024011, 2024.
SCHNEIDER R, et al. Drug prescription patterns, polypharmacy and potentially inappropriate medication in Swiss nursing homes: a descriptive analysis based on claims data. Swiss Med Wkly. 2019; 149:w20126.
SEFERA B, et al. Drug-related problems and its predictors among hospitalized heart failure patients at Jimma Medical Center, South West Ethiopia: prospective interventional study. BMC Cardiovasc Disord. 2022; 22(1):418.
SILVA DCG, et al. Potentially inappropriate medication use among older hospitalized patients in a brazilian general hospital. infarma, v. 28, n. 1, p. 27–32, 31 mar. 2016.
SILVA AF, et al. Problemas relacionados aos medicamentos em idosos fragilizados da Zona da Mata Mineira, Brasil. Revista Brasileira de Geriatria e Gerontologia, v. 16, n. 4, p. 691–704, dez. 2013.
SILVA JBVB, et al. Perfil clínico de longevos em uma unidade de terapia intensiva. Acta Paulista de Enfermagem, v. 31, p. 39–45, 2018.
TAN JL, et al. Age-Related Changes in Hepatic Function: An Update on Implications for Drug Therapy. Drugs Aging. 2015; 32(12):999-1008.
TEFERA GM, et al. Drug Therapy Problems and the Role of Clinical Pharmacist in Surgery Ward: Prospective Observational and Interventional Study. Drug Healthc Patient Saf. 2020; 12:71-83.
THANAPLUETIWONG S, et al. Association between Drug Therapy and Risk of Incident Frailty: A Systematic Review. Ann Geriatr Med Res. 2024 Sep;28(3):247-256.