Uso de medicamentos potencialmente inapropriados entre idosos institucionalizados: um estudo longitudinal

Abstract

The main obectives of this work were to verify the prevalence of Potentially Inappropriate Medication (PIM) use amog older people living in long term instituition and associated factors, as well as to evaluate the changes in the occurrence of PIM use over time. The first stage of the study (Study 1) follows a cross-sectional design and used baseline data from the study "Human Aging and Health: the reality of the institutionalized elderly in the city of Natal/RN", which aims to assess health/institutionalized elderly in the city of Natal/RN. The collection was performed based on the data collected in 10 Long Term Care (LTC) in the city of Natal, RN. Inappropriate medications were classified according to the 2015 American Geriatric Society (AGS) Beers Criteria for Potentially Inappropriate Medication Use in Older Adults - 2015. Sociodemographic variables, related to LTC and health conditions, were analyzed. For the univariate and multivariate analyzes between the main variable (use of one or more PIM according to the 2015 AGS/Beers criteria ) and the other variables, the Poisson regression was used with a robust estimator. The study population consisted of 321 elderly people, of whom 304 used medications, and the prevalence of PIM was 54.6% (95% CI: 48.9-60.2). Multivariate analysis revealed that PIM was associated with polypharmacy and dementia, and the most frequent PIM groups were antipsychotic, benzodiazepine and sulfonylureas. The second part of the study (Study 2) followed a 24- month longitudinal follow-up with 6-month follow-up intervals (waves). The variables and the AGS/Beers criteria adopted in Study 1 were maintained. The prevalence of PIM use was high in the 4 waves, and 63.4% (95% CI: 57,6-69,1) in the wave 1, 62.9% (95% CI: 56.8- 68.9) in wave 2, 69.2% (95% CI: 63.1-75.3) in wave 3 and 65.9% (95% CI: 59.4-72.4) in wave 4. Among the PIM classes analyzed, antipsychotics (39,1%), benzodiazepines (30,7%) and proton pump inhibitors (7,6%) were the most frequently identified in all waves. The study revealed the maintenance of the high prevalence of PIM among the elderly of the LTC, setting the need to adopt indicators on the use of these medicines and the implementation of strategies that make pharmacotherapy safer and more adequate for older adults.