Polypharmacy, potentially inappropriate medications and associated factors among older adults with hypertension in primary care

Sangaleti, Carine Teles; Lentsck, Maicon Henrique; Silva, Dannyele Cristina da; Machado, Andrielli; Trincaus, Maria Regiane; Vieira, Maria Cristina Umpierrez; Pelazza, Bruno Bordin; Colombo, Fernanda Marciano Consolim

doi:10.1590/0034-7167-2022-0785

Carine Teles Sangaleti Corresponding author: Carine Teles Sangaleti E-mail: carineteles@unicentro.br

study/research conception or design

final review with critical and intellectual participation in the manuscript

Universidade Estadual do Centro-Oeste. Guarapuava, Paraná, Brazil

http://orcid.org/0000-0002-0696-325X

Maicon Henrique Lentsck

data analysis and/or interpretation

Universidade Estadual do Centro-Oeste. Guarapuava, Paraná, Brazil

http://orcid.org/0000-0002-8912-8902

Dannyele Cristina da Silva

study/research conception or design

final review with critical and intellectual participation in the manuscript

Universidade Estadual do Centro-Oeste. Guarapuava, Paraná, Brazil

http://orcid.org/0000-0003-1927-8435

Andrielli Machado

data analysis and/or interpretation

Hospital São Vicente de Paula. Guarapuava, Paraná, Brazil

http://orcid.org/0000-0002-7603-5555

Maria Regiane Trincaus

final review with critical and intellectual participation in the manuscript

Universidade Estadual do Centro-Oeste. Guarapuava, Paraná, Brazil

http://orcid.org/0000-0001-7481-2501

Maria Cristina Umpierrez Vieira

data analysis and/or interpretation

final review with critical and intellectual participation in the manuscript

Universidade Estadual do Centro-Oeste. Guarapuava, Paraná, Brazil

http://orcid.org/0000-0002-2173-4009

Bruno Bordin Pelazza

final review with critical and intellectual participation in the manuscript

Universidade Estadual do Centro-Oeste. Guarapuava, Paraná, Brazil

http://orcid.org/0000-0003-2245-6482

Fernanda Marciano Consolim Colombo

final review with critical and intellectual participation in the manuscript

Universidade de São Paulo, Faculdade de Medicina, Instituto do Coração, Unidade de Hipertensão. São Paulo, São Paulo, Brazil

http://orcid.org/0000-0003-3220-019X

Corresponding author: Carine Teles Sangaleti E-mail: carineteles@unicentro.br

EDITOR IN CHIEF: Álvaro Sousa

ASSOCIATE EDITOR: Carina Dessotte

Sleep quality	Mini Sleep Questionnaire (MSQ)	Adequate sleep: score 0-24 Altered sleep: score above 25
Cognitive assessment	Mini Mental State Examination (MMSE)	Normal – score equal to or greater than: 19.1 – illiterate older adults 23.4 – older adults with up to 3 years of education 24 – older adults with 3 to 7 years of education 28 – older adults with more than 7 years of education Altered - below the values mentioned above, considering the years of study
Depression	Geriatric Depression Scale (GDS)	Normal: score from 0-5 Altered: score from 6-15
Falls	Investigation of falls in the last 12 months	No – for no fall Yes – for older adults who fell within a 12-month period
Activity of Daily Living (ADL) assessment	Katz ADL Index	Normal – for older adults independent for all activities Altered: for older adults who have any need for support
Family functionality assessment	Family Apgar	0 to 4 = high family dysfunction 5 and 6 = moderate family dysfunction 7 to 10 = good family functionality
Fall risk assessment	Performance Oriented Mobility Assessment (POMA) score	Continuous variable scored from 22 (minimum) to 57 (maximum) The lower the score, the greater the risk of falls
Nutritional status assessment	Mini Nutritional Assessment (MAN)	The lower the value, the worse the nutritional status

Variables	Total	Polypharmacy				OR*	p value
	Total	Yes		No
	n	n	%	n	%
Sex							0.017**
Male	70	19	26.4	51	43.6	Ref.
Female	119	53	73.6	66	56.4	2.15
Age group							0.622
60 to 79 years	146	57	79.2	89	76.1	Ref.
80 years and older	43	15	20.8	28	23.9	0.83
Race/color							0.056**
White	111	36	50.0	75	64.1	Ref.
Non-white	78	36	50.0	42	35.9	1.78
Marital status							0.357
Married	80	27	37.5	53	45.3	Ref.
Singled	10	5	6.9	5	4.3	1.96
Widowed	71	25	34.7	46	39.0	1.06
Divorced	22	12	16.7	120	8.5	2.35
Living together	6	3	4.2	3	2.6	1.96
Number of children							0.132**
0 to 5	105	35	48.6	77	59.8	Ref.
6 and more	84	37	51.4	47	40.2	1.57
Income							0.256
1 wage	31	9	12.5	22	18.8	Ref.
2 to 4 wages	158	63	87.5	95	81.2	1.62
Education							0.563
Illiterate	61	24	33.3	37	31.6	1.62
Incomplete elementary school	78	33	45.8	45	38.5	1.83
Complete elementary school	29	9	12.5	20	17.1	1.12
Incomplete high school	21	6	8.3	15	12.8	Ref.
House							0.111**
Masonry	74	23	31.9	51	43.6	Ref.
Others	115	49	68.1	66	56.4	1.64

Variables	Total	Polypharmacy				OR*	p value
	Total	Yes		No
	n	n	%	n	%
Chronic diseases							<0.001**
No	28	1	1.4	27	23.1	21.3
Yes	161	71	98.6	90	76.9	Ref.
Sleep classification							0.001**
Normal	102	28	38.9	74	63.2	Ref.
Altered	87	44	61.1	43	36.8	2.70
MMSE							0.079**
Normal	119	51	70.8	68	58.1	Ref.
Altered	70	21	29.2	49	41.9	0.57
GDS							0.010**
Normal	131	42	58.3	89	63.2	Ref.
Altered	58	30	41.7	28	36.8	2.27
Falls							0.031**
Yes	108	34	47.2	74	63.2	1.92
No	81	38	52.8	43	36.8	Ref.
ADL score							0.382
Normal	157	62	86.1	95	81.2	Ref.
Altered	32	10	13.9	22	18.8	0.69
Caregiver							0.658
Without	141	55	76.4	86	73.5	0.85
With	48	17	23.6	31	26.5	Ref.
Family Apgar							0.800
Highly functional	148	58	80.6	90	76.9	Ref.
Moderately functional	19	6	8.3	13	11.1	0.98
Severely dysfunctional	22	8	11.1	14	12.0	0.88
Beers							< 0.001**
Yes	147	40	55.6	95	81.2	Ref.
No	72	32	44.4	22	18.8	3.45
Continuous variables		Mean	SD	Mean	SD		p value
POMA score		18.2	7.536	20.7	6.801	0.95	0.019**
MAN score		11.1	2.389	11.4	2.444	0.984	0.322

Variables	OR* (IC95%)	p value
Beers	2.69 (1.29-5.62)	0.008
Altered sleep	2.07 (1.00-4.29)	0.048
Non-white race/color	2.22 (1.08-4.55)	0.029

Variables	Total	Beers		Non-Beers		OR*	p value
Variables	n	n	%	n	%	OR*	p value
Chronic diseases							0.070**
No	28	4	7.4	24	14.8	2.70
Yes	161	50	92.6	111	85.2	Ref.
Sleep classification							0.021**
Normal	102	22	40.7	80	59.3	Ref.
Altered	87	32	59.3	55	40.7	2.11
MMSE							0.095**
Normal	119	39	72.2	80	59.3	Ref.
Altered	70	15	27.8	55	40.7	0.55
GDS							0.397
Normal	131	35	64.8	96	71.1	Ref.
Altered	58	19	35.2	39	28.9	1.33
Falls							0.114**
Sim	108	26	48.1	82	60.7	1.66
No	81	28	51.9	53	39.3	Ref.
ADL score							0.425
Normal	157	43	79.6	114	84.4	Ref.
Altered	32	11	20.4	21	15.6	1.38
Caregiver							0.020**
Without	141	34	47.2	107	91.5	2.24
With	48	20	27.8	28	23.9	Ref.
Family Apgar							<0.001**
Highly functional	148	32	59.3	116	85.9	Ref.
Moderately functional	19	8	14.8	11	8.1	2.63
Severely dysfunctional	22	14	25.9	8	5.9	6.34
Polypharmacy							<0.001**
Yes	147	22	40.7	95	70.4	Ref.
No	72	32	59.3	40	29.6	3.45
Continuous variables		Mean	SD	Mean	SD		p value
POMA score		18.0	7.431	20.5	6.892	0.95	0.039**
Mini nutritional score		10.8	2.546	11.5	2.353	0.88	0.084**
Overall nutritional score		12.5	2.448	13.2	2.451	0.85	0.062**

Variables	OR* (95%CI)	p value
Polypharmacy	3.92 (1.77-8.69)	0.001
Family Apgar
Moderately functional	4.73 (1.50-14.92)	0.008
Severely dysfunctional	13.79 (4.07-46.75)	<0.001
Without caregiver	3.74 (1.61-8.70)	0.002
MMSE score	0.43 (0.18-0.98)	0.047

[1] Corresponding author: Carine Teles Sangaleti E-mail: carineteles@unicentro.br

Brasil

Brasil

Polypharmacy, potentially inappropriate medications and associated factors among older adults with hypertension in primary care

Polifarmacia, medicamentos potencialmente inapropiados y factores asociados entre adultos mayores con hipertensión en atención primaria

ABSTRACT

Objective:

Methods:

Results:

Conclusions: