Polypharmacy, inappropriate medication use and associated factors among brazilian older adults

Constantino, Juliana Lima; Bozzi, Ronielly Pereira; Souza, Gustavo Pinheiro Machado Motta de; Marchesi, Renan; Jorge, Antonio José Lagoeiro; Correia, Dayse Mary da Silva; Rosa, Maria Luiza Garcia; Giordani, Fabíola; Baltar, Valéria Troncoso

doi:10.1590/1414-462X202028030245

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ORIGINAL ARTICLE • Cad. saúde colet. 28 (3) • Jul-Set 2020 • https://doi.org/10.1590/1414-462X202028030245 copy

Polypharmacy, inappropriate medication use and associated factors among brazilian older adults

Polifarmácia, uso de medicamento inapropriado e fatores associados em idosos brasileiros

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Population aging is still an important worldwide phenomenon. Elderly people suffer from multiple chronic diseases that require the use of several drugs, and this demographic scenario fosters the increased prescription of multiple drugs, or Polypharmacy (PP) and Potentially Inappropriate Medication (PIM).

Objective

This study aimed to identify the prevalence rates and associated factors of PP and PIM in Brazilian older adults.

Method

The prevalence of PIM use and PP was estimated in a sample of 222 patients enrolled in the Family Health Program in Niterói, Brazil. Logistic regression models were used to analyze the data. Age and sex were kept in the models as potential confounding factors.

Results

PP and PIM use presented prevalence rates of 23.9 and 24.8%, respectively. PP was associated with body mass index, coronary heart disease, diabetes mellitus, and a number of comorbidities, whereas PIM use was associated with PP.

Conclusion

The prevalence rates of PP and PIM use found were lower than those reported in previous studies. This could be a result of differences in availability of drugs or prescribing habits. Multiple chronic diseases were associated with PP. These results suggest that more care should be taken in prescribing for the elderly population.

Keywords:
drug therapy; epidemiology; older adults

Drug class	Medication use frequency	Prevalence of use of PIM %
Antihypertensive	195	10.8
Diuretics	117	0.0
Beta-blockers	51	2.0
ACEIs	109	0.0
ARBs	39	0.0
CCBs	44	45.5
Nitrates	10	0.0
Antiarrhythmics	5	100.0
Digitalis	5	100.0
Vasodilators	13	76.9
Anti-diabetics	58	0.0
Statins	63	0.0
Hypolipidemic agents	5	0.0
Analgesics	4	0.0
Anti-inflammatory	13	23.1
Corticosteroids	8	0.0
Antidepressants/Anxiolytics	27	55.6
PPIs/H2 blockers	39	0.0
Anticonvulsants	3	0.0
Anticoagulants	3	0.0
Antiplatelet agents	49	2.0
Thyroid hormone	8	0.0
Total	222	24.8

	Unadjusted Regression			Adjusted Regression
	OR	CI(95%)	p-value	OR	CI(95%)	p-value
Gender (male/female)	1.48	[0.74; 2.94]	0.265	1.34	[0.65; 2.73]	0.426
Age (years)	0.99	[0.95; 1.03]	0.740	1.00	[0.96; 1.04]	0.994
BMI Classification (WHO)			0.417
Overweight/Under or Normal	1.4	[0.63; 3.08]	0.410
Obese/Under or Normal	1.7	[0.77; 3.92]	0.186
Obesity (Y/N)*	2.31	[1.03; 5.17]	0.042
Skin Color (non-white/white)	1.21	[0.65; 2.28]	0.546
Per capita family income	1.00	[0.99; 1.00]	0.441
Private Health Insurance (Y/N)*	0.73	[0.31; 1.70]	0.466
Marital Status (with/without partner)	0.75	[0.40; 1.39]	0.355
Current Smoking Status (Y/N)*	1.22	[0.66; 2.26]	0.528
Polypharmacy (Y/N)*	4.14	[2.12; 8.07]	<0.001
COPD (Y/N)*	0.59	[0.13; 2.79]	0.508
Coronary Heart Disease (Y/N)*	2.04	[0.95; 4.39]	0.068
Depression (Y/N)*	1.18	[0.56; 2.49]	0.668
Dyslipidemia (Y/N)*	1.10	[0.60; 2.03]	0.755
Hypertension (Y/N)* ^&	3.00	[0.67; 13.44]	0.150
Diabetes (Y/N)*	2.81	[1.50; 5.25]	0.001
Heart Stroke (Y/N)^* * Y/N = Yes/No;	2.99	[1.09; 8.18]	0.033
Number of morbidities	1.60	[1.17; 2.20]	0.001
Poliparmacy (S/N)*	4,14	[2.12; 8.07]	<0.001	4.05	[2.07; 7.93]	<0.001

	Unadjusted Regression			Adjusted Regression
	OR	CI(95%)	p-value	OR	CI(95%)	p-value
Gender (male/female)	1.57	[0.78; 3.16]	0.211	1.08	[0.43; 2.71]	0.874
Age (years)	0.98	[0.94; 1.02]	0.287	1,00	[0.94; 1.06]	0.969
BMI Classification (WHO)			0.002			0.014
Overweight/Under or Normal	5.76	[1.89; 17.54]	0.002	6.52	[1.81; 23.56]	0.004
Obese/Under or Normal	7.38	[2.38; 22.82]	0.001	5.72	[1.51; 21.60]	0.010
Obesity (Y/N)*	3.43	[1.54; 7.63]	0.002
Skin Color (non-white/white)	1.73	[0.90; 3.36]	0.103
Per capita family income	1.00	[0.99; 1.00]	0.233
Private Health Insurance (Y/N)*	1.51	[0.70; 3.24]	0.293
Marital Status (with/without partner)	0.83	[0.45; 1.56]	0.568
Current Smoking Status (Y/N)*	0.66	[0.35; 1.24]	0.195
COPD (Y/N)*	0.28	[0.04; 2.19]	0.223
Coronary Heart Disease (Y/N)*	6.22	[2.89; 13.41]	<0.001	8.80	[3.32; 23.33]	<0.001
Depression (Y/N)*	1.45	[0.69; 3.02]	0.326
Dyslipidemia (Y/N)*	2.83	[1.46; 5.48]	0.002
Diabetes (Y/N)*	6.01	[3.07; 11.77]	<0.001	3.15	[1.28; 7.77]	0.013
Heart Stroke (Y/N)^* * Y/N = Yes/No;	7.12	[2.49; 20.35]	<0.001
Number of morbidities	3.06	[2.08; 4.50]	<0.001	2.14	[1.31; 3.49]	0.002

Instituto de Estudos em Saúde Coletiva da Universidade Federal do Rio de Janeiro Avenida Horácio Macedo, S/N, CEP: 21941-598, Tel.: (55 21) 3938 9494 - Rio de Janeiro - RJ - Brazil
E-mail: cadernos@iesc.ufrj.br

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[1] Correspondence: Juliana Lima Constantino. E-mail: jlconstantino@id.uff.br