Use of potentially inappropriate medications by older adults in Primary Health Care: cross-sectional study

Coelho, Claudia Oliveira; Silva, Silvia Lanziotti Azevedo da; Pereira, Daniele Sirineu; Campos, Estela Márcia Saraiva

doi:10.1590/1981-22562023026.230129.en

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Revista Brasileira de Geriatria e Gerontologia

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Original Articles • Rev. bras. geriatr. gerontol. 26 • 2023 • https://doi.org/10.1590/1981-22562023026.230129.en copy

Use of potentially inappropriate medications by older adults in Primary Health Care: cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To verify the prevalence of potentially inappropriate medications (PIM) in use and possible associated factors in older adults and the agreement between two assessment tool in Primary Health Care (PHC) contex

Methods

Cross-sectional study. The prevalence of older adults in use of PIM and associated factors were estimated. First of all was calculated the frequency of drugs, among those used, considered PIM. Classification as PIM was based on the 2019 Beers Criteria and the 2016 Brazilian Consensus on Potentially Inappropriate Medications 2016 (BCPIM) for the older adults. The agreement between the two classifications was also evaluated. Multivariate logistic regression models were estimated. Association was evaluated by Odds Ratio (OR). Kappa was calculated for agreement between both classifications.

Results

The prevalence of older adults using MPI was 32.9%, according to Beers Criteria and 27.6% according to the BCPIM. The reports of diabetes (OR=1.96), depression (OR=2.25) and polypharmacy (OR=4.11) were associated (p<0.001) with the use of inappropriate medication, according to the Beers Criteria. Older adults who were very satisfied with their own health were less likely to use inappropriate medication both according to the Beers Criteria (OR=0.02) and the BCPIM (OR=0.09). Agreement between classifications was considered good (k=0.75, p<0.001).

Conclusion

Reports of diabetes and depression, polypharmacy and negative self-rated health and satisfaction were associated with PIM’s use. The associations were similar between the two classifications, indicating that both are relevant in identifying PIM use in older adults in the context of PHC.

Keywords
Older Adults; Medication Prescription; Primary Health Care

Variable	Mean (±standard-deviation)	Frequency n(%)*
Sociodemographic Variables
Age	70.80 (± 6.71)
Age Group
60 – 75 years / >75 years		385 (77.6%) / 111 (22.4%)
Sex
Female/Male		309 (62.3%) / 187 (37.7%)
Education (Years)	3.67 (± 3.32)
Abilty to read and write
Yes/No		330 (66.5%) / 166 (33.5%)
Marital Status
Married/Unmarried**		327 (66.4%)/169 (33.6%)
Color/Race
White/ Non-White***		315 (63.5%)/154 (36.5%)
Paid Work
No/Yes		405 (81.7%)/91 (18.3%)
Own Income
Yes/No		266 (53.6%)/230 (46.4%)
Retired
Yes/No		355 (71.6%)/141 (28.4%)
Pensioner
No/Yes		391 (78.8%)/105 (21.2%)
Money enought for expanses
Yes/No		274 (55.3%)/222 (44.7%)
Family Income (salaries)	2.24 (± 1.44)
Own Residence
Yes/No		444 (89.5%)/52 (10.5%)
Number of people living home	2.74 (± 1.27)
Life Habits/Clinical Conditions
Cigarettes
Does not Smoke/Smoke****		415 (88.4%)/54 (11.6%)
Alcohol Consumption
Does not drink/Drink*****		392 (79.0%)/104 (21.0%)
Occurrence of falls
No/Yes		362 (73.1%)/135 (26.9%)
Functional Capacity	7.59 (± 1.14)
Health self – assessment
General Health Self-assessment
Good/More or less/Bad		265(53.5%)/213(42.9%)/18(3.6%)
Compared Health Self-assessment
Good/More or less/Bad		374(75.4%)/100(20.2%)/22(4.4%)
Own Health Satisfaction
Very/More or less/Little		381(76.8%)/103(20.8%)/12(2.4%)
Compared Health Satisfaction
Very/More or less/Little		405(81.7%)/80(16.1%)/11(2.2%)

Variable	Mean (±standard-deviation)	Frequency n(%)*
Morbidities
Arterial Hypertension
Yes/No		383 (77.2%)/113 (22.8%)
Stroke
No/Yes		466 (94.0%)/30 (6.0%)
Diabetes
No/Yes		302 (60.9%)/194 (39.1%)
Parkinson’s Disease
No/Yes		486 (98.0%)/10 (2.0%)
Seizures
No/Yes		480 (96.8%)/ 16 (3.2%)
Depression
No/Yes		393 (79.2%)/ 103 (20.8%)
Vertigo
No/Yes		316 (63.7%)/ 180 (36.3%)
Urinary Incontinence
No/Yes		389 (78.4%)/ 107 (21.6%)
Fecal Incontinence
No/Yes		489 (98.6%)/ 7(1.4%)
Osteoporosis
No/Yes		404 (81.5%)/ 92 (18.5%)
Arthritis
No/Yes		402 (81.0%)/ 94 (19.0%)
Osteoarthritis
No/Yes		395 (79.6%)/ 101 (20.4%)
Heart Disease
No/Yes		365 (73.6%)/ 131 (26.4%)
Number of Comorbidities	3.81 (± 2.40)
Medication
Number of Medication Used	3.96 (± 2.68)
Polypharmacy
No/Yes		313 (63.1%)/183 (36.9%)
Benzodiazepines
No/Yes		450 (88.9%)/ 46 (11.1%)
Diuretics
No/Yes		289 (58.4%) /207 (41.6%)
Antiarrhythmics
No/Yes		445 (89.9%)/ 51(10.1%)
Psychotropics
No/Yes		445 (89.9%)/ 51 (10.1%)

Use of PIM for older adults	Beers Critetia (2019)	BCPIM (2016)	Kappa
No	333 (67.1%)	359 (72.4%)	k = 0.75 (0.68-0.81) p < 0.001 Very Good*
Yes	163 (32.9%)	137 (27.6%)	k = 0.75 (0.68-0.81) p < 0.001 Very Good*

	Crude Models				Ajusted Models**
Independent Variables	Beers Criteria		BCPIM		Beers Criteria		BCPIM
	Odds Ratio	IC95%	Odds Ratio	IC95%	Odds Ratio	IC95%	Odds Ratio	IC95%
Age >75 years	0.87	0.55 – 1.37	1.08	0.67 – 1.71
Sex Male	0.60	0.40 – 0.90*	0.78	0.51 – 1.17	0.99	0.58 – 1.12
Arterial Hypertension Yes	1.65	1.03 – 2.69*	2.04	1.22 – 3.55*	0.88	0.50 – 1.54	1.17	0.65 – 2.16
Stroke Yes	1.02	0.44 – 2.19	1.31	0.48 – 2.46
Diabetes Yes	2.93	1,99 – 4,33*	1.89	1.27 – 2.83*	1.96	1.24 – 3.09*	1.83	0.68 – 1.80
Parkinson’s Disease Yes	0.87	0.18 – 3.18	1.76	0.44 – 6.29
Seizures Yes	2.72	0.99 – 7.74	2.09	0.73 – 5.73
Depression Yes	2.87	1.84 – 4.49*	2.53	1.60 – 3.99*	2.25	1.30 – 3.92*	1.83	1.04 – 3.20*
Vertigo Yes	1.25	0.85 – 1.84	1.61	1.08 – 2.42*			0.95	0.56 – 1.58
Urinary Incontinence Yes	1.29	0.82 – 2.01	1.29	0.80 – 2.04
Fecal Incontinence Yes	0.81	0.11 – 3.82	0.43	0.02 – 2.56
Osteoporosis Yes	1.11	0.68 – 1.78	1.18	0.71 – 1.92
Arthritis Yes	1.19	0.74 – 1.90	1.37	0.83 – 2.21
Osteoarthritis Yes	1.11	0.68 – 1.78	1.18	0.71 – 1.92
Heart Disease Yes	2.05	1.36 – 3.10*	2.38	1.55 – 3.64*	1.24	0.72 – 2.10	1.29	0.75 – 2.19
Morbidities >5	2.21	1.49 – 3.26*	2.28	1.52 – 3.42*	0.71	0.40 – 1.24	0.91	0.50 – 1.63
Polypharmacy Yes	4.58	3.08 – 6.87*	4.55	3.03 – 6.95*	4.11	2.50 – 6.85*	4.23	2.52 – 7.21*
Functional Capacity 7/8 ADL	1.04	0.56 – 1.99	0.87	0.47 – 1.70
Occurrence of Falls Yes	1.73	1.14 – 2.61*	1.65	1.07 – 2.52*	1.41	0.87 – 2.28	1.23	0.74 – 2.02
Own Health Self-assessment More or less	0.38	0.13 – 1.10	0.15	0.04 – 0.43*	0.86	0.25 – 2.89	0.22	0.04 – 0.93*
Own Health Self-assessment Good	0.23	0.08 – 0.62*	0.11	0.03 - 0.32*	0.77	0.21 – 2.70	0.21	0.03 – 0.97*
ComparedHealth Self-assessment More or less	0.58	0.22 – 1.49	0.40	0.15 – 1.05			1.22	0.33 – 5.07
Compared Health Self-assessment Goof	0.44	0.44 – 1.06	0.35	0.14 – 0.84*			2.02	0.55 – 8.53
Mais ou menos satisfeito com a saúde	0.17	0.03 – 0.64*	0.15	0.03 – 0.56*	0.44	0.07 – 2.36	0.32	0.05 – 1.75
Very satisfied with own health	0.14	0.03 – 0.51*	0.11	0.02 – 0.37*	1.00	0.16 – 5.69	0.56	0.08 – 3.26
More or less satisfied with compared health	0.06	0.01 – 0.37*	0.22	0.04 – 0.84*	0.06	0.01 – 0.43*	0.22	0.03 – 1.19
Very satisfied with compared health	0.04	0.01 – 0.22*	0.12	0.02 – 0.42*	0.02	0.01 – 0.19*	0.09	0.01 – 0.50*
Hosmer-Lamashow					p = 0.690		p = 0.260

Criteria	Number of Medication
Beers Criteria	No: 245 (84.8%)
Beers Criteria	Yes: 44 (15.2%)
BCPIM	No: 241 (83.4%)
BCPIM	Yes: 48 (16.6%)
Classification Agreement	No: 16 (5.5%)
Classification Agreement	Yes: 273 (94.5%)

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[1] Correspondence Silvia Lanziotti Azevedo da Silva silviafisiojf@yahoo.com.br

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Use of potentially inappropriate medications by older adults in Primary Health Care: cross-sectional study

Abstract

﻿Objective

﻿Methods

Results

Conclusion

Objective

Methods