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Risk factors and consequences of polypharmacy among elderly outpatients of a mental health service

This study aimed to investigate the presence of polypharmacy and inappropriate use of medications among subjects aged 60 or over assessed consecutively at an outpatient mental health service in the city of São Paulo, Brazil. The names of the medications, dosage, and length of time since their introduction were investigated for all subjects - this information was gathered from an interview with the patient and carer, and by reviewing the medical notes. Psychological and physical symptoms were assessed with a simplified version of the scale Saftee-Up. The inappropriate use of medication was recorded using the modified version of the Stuck criteria. A total of 184 consecutive patients were included in the study. The mean number of medications consumed was 2.46 - 41.3% of the subjects were receiving 3 or more daily drugs, 10.9% were consuming 5 or more different medications. Antidepressants (42.4%), antihypertensives (32.6%) and benzodiazepines (21.2%) were the drugs most frequently used in this sample of patients. Subjects using 3 or more medications had significantly higher Saftee-Up scores than those using 2 or less drugs (p=0.007). Logistic regression indicated that Saftee-Up scores were influenced by the number of clinical diagnoses (OR=1.85, p=0.030), but not by age (OR=0.99, p=0.732), sex (OR=0.67, p=0.317), number of psychiatric diagnoses (OR=0.77, p=0.533) and medications (OR=1.18, p=0.258). Thirty-four subjects (18.5%) were receiving at least one medication considered inappropriate. Psychiatrists should familiarize themselves with the international guidelines for drug use in later life and be actively involved in reducing the risks associated with polypharmacy and inappropriate use of medications in the elderly.

Aged; elderly; ageing; aging; polipharmacy; medication; drug; inappropriate use of medication; mental health; risk factor

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