Skip to main content

Advertisement

SpringerLink
Log in

Potentially inappropriate medications for older adults in a primary healthcare unit in southern Brazil

  • Research Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background Potentially inappropriate medications for older adults are those that offer more risks than benefits for this population. Such medications found in older adults’ prescriptions across the world are associated with higher rates of comorbidities and hospitalizations, along with high expenditure on healthcare resources. Objectives To estimate the frequency of older adults using potentially inappropriate medications according to four different criteria, to identify factors associated with the use of such medicines and differences between the tools. Setting A primary healthcare unit linked to a university hospital in Porto Alegre, Brazil. Method This was a cross-sectional study conducted via data collection from the electronic medical records of 390 older adults. The information collected comprised sex, age, chronic diseases diagnosed and medications used. The dependent variable of the study was the use of at least one potentially inappropriate medication, according to the following criteria: Beers, Screening Tool of Older Persons’ Prescriptions (STOPP), Brazilian consensus and Anticholinergic Risk Scale (ARS). Main outcome measurement Prevalence of inappropriate medication, differences between the tools and associated factors. Results: The use of at least one potentially inappropriate medication was found in 55.1% of the sample according to the Beers criterion, 51.3% according to the Brazilian consensus, 42.6% according to STOPP and 23.6% according to ARS. It was also seen that 14.9% of the studied population was exposed to a very strong anticholinergic risk. Depending on which tools were used, the agreement observed between the criteria was considered high, moderate, or low. Regarding the four criteria, the use of potentially inappropriate medication is associated with polypharmacy, the diagnosis of three or more chronic diseases and the presence of neuropsychiatric and musculoskeletal diseases. Conclusion Among the older adult population studied, the prevalence of potentially anappropriate medication is high, according to the four different classification criteria used. As a more specific tool, the agreement between Anticholinergic Risk Scale and other criteria was lower, but it can be an important complement to other lists.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Paradella R. Número de idosos cresce 18% em 5 anos e ultrapassa 30 milhões em 2017. In: Agência de Notícias. Fundação Instituto Brasileiro de Geografia e Estatística (IBGE). 2018. https://agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/20980-numero-de-idosos-cresce-18-em-5-anos-e-ultrapassa-30-milhoes-em-2017. Accessed: 26 Oct 2019.

  2. Ministério da Saúde (BR). Política Nacional da Atenção Básica. Ministério da Saúde. 2012. https://189.28.128.100/dab/docs/publicacoes/geral/pnab.pdf. Accessed 26 Oct 2019.

  3. Samuel MJ. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63:2227–46.

    Article  Google Scholar 

  4. Hermes GB. Utilização de medicamentos potencialmente inapropriados por idosos brasileiros. In: Repositório Digital LUME. Universidade Federal do Rio Grande do SUL. 2017. https://lume.ufrgs.br/handle/10183/169698. Accessed 24 Oct 2019.

  5. Gorzoni ML, Fabbri RMA. Applicability of anticholinergic risk scale in hospitalized elderly persons. Rev Bras Geriatr Gerontol. 2017;20(1):123–8.

    Article  Google Scholar 

  6. Rodríguez-Blanco R, Álvarez-García M, Villalibre-Calderón C, Piña-Ferreras LD, Junquera-Alonso S, Alonso-Lorenzo JC. Evaluación de la actualización de los criterios STOPP-START en atención primaria. Semergen. 2019;45:180–6 (Spanish).

    Article  Google Scholar 

  7. Martins GA, Ribeiro AQ, Priore SE, Franceschini SCC, Acurcio FA. Uso de medicamentos potencialmente inadequados entre idosos do Município de Viçosa, Minas Gerais, Brasil: um inquérito de base populacional. Cad Saude Publica. 2015;31:2401–12 (Portuguese).

    Article  Google Scholar 

  8. Pardo-Cabello AJ, Manzano-Gamero V, Zamora-Pasadas M, Gutiérrez-Cabello F, Esteva-Fernández D, Luna-Del Castillo JD, et al. Potentially inappropriate prescribing according to STOPP-2 criteria among patients discharged from Internal Medicine: prevalence, involved drugs and economic cost. Arch Gerontol Geriatr. 2018;74:150–4.

    Article  Google Scholar 

  9. Pérez T, Moriarty F, Wallace E, McDowell R, Redmond P, Fahey T. Prevalence of potentially inappropriate prescribing in older people in primary care and its association with hospital admission: longitudinal study. BMJ. 2018;363:k4524.

    Article  Google Scholar 

  10. Kaufmann CP, Tremp R, Hersberger KE, Lampert ML. Inappropriate prescribing: a systematic overview of published assessment tools. Eur J Clin Pharmacol. 2014;70:1–11.

    Article  Google Scholar 

  11. American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67(4):674–94.

    Article  Google Scholar 

  12. O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44:213–8.

    Article  Google Scholar 

  13. Oliveira MG, Amorim WW, Oliveira CRB, Coqueiro HL, Gusmão LC, Passos LC. Consenso brasileiro de medicamentos potencialmente inapropriados para idosos. Geriatr Gerontol Aging. 2016;10:168–81.

    Article  Google Scholar 

  14. Rudolph JL, Salow MJ, Angelini MC, McGlinchey RE. The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med. 2008;168:508–13.

    Article  Google Scholar 

  15. Almeida TA, Reis EA, Pinto IVL, Ceccato MGB, Silveira MR, Lima MG, et al. Factors associated with the use of potentially inappropriate medications by older adults in primary health care: an analysis comparing AGS Beers, EU(7)-PIM List, and Brazilian Consensus PIM criteria. Res Soc Adm Pharm. 2019;15(4):370–7.

    Article  Google Scholar 

  16. Oliveira MG, Amorim WW, de Jesus SR, Heine JM, Coqueiro HL, Passos LCS. A comparison of the beers and STOPP criteria for identifying the use of potentially inappropriate medications among elderly patients in primary care. J Eval Clin Pract. 2015;21:320–5.

    Article  Google Scholar 

  17. Oliveira MG, Amorim WW, De Jesus SR, Rodrigues VA, Passos LC. Factors associated with potentially inappropriate medication use by the elderly in the Brazilian primary care setting. Int J Clin Pharm. 2012;34:626–32.

    Article  Google Scholar 

  18. Ribas C, de Oliveira KR. Perfil dos medicamentos prescritos para idosos em uma Unidade Básica de Saúde do município de Ijuí-RS. Rev Bras Geriatr Gerontol. 2014;17:99–114 (Portuguese).

    Article  Google Scholar 

  19. Abramson J. WINPEPI (PEPI-for-Windows). In: Brixton health home. 2016. https://www.brixtonhealth.com/. Accessed 20 Mar 2020.

  20. The 2015 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2015 updated AGS beers criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63:2227–46.

    Article  Google Scholar 

  21. Pastor-Cano J, Aranda-García A, Gascón-Cánovas JJ, Sánchez-Ruiz JF, Rausell-Rausell VJ, Tobaruela-Soto M. Prescripción potencialmente inadecuada en mayores de 65 años según los criterios de Beers originales y su versión adaptada. Atención Primaria. 2018;50:106–13.

    Article  Google Scholar 

  22. Carvalho MFC, Romano-Lieber NS, Bergsten-Mendes G, Secoli SR, Ribeiro E, Lebrão ML, et al. Polypharmacy among the elderly in the city of São Paulo, Brazil-SABE. Rev Bras Epidemiol. 2012;15(4):817–27.

    Article  Google Scholar 

  23. Ramos LR, Tavares NUL, Bertoldi AD, Farias MR, Oliveira MA, Luiza VL, et al. Polypharmacy and polymorbidity in older adults in Brazil: a public health challenge. Rev Saúde Pública. 2016;50(suppl 2):9s.

    Article  Google Scholar 

  24. Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5:345–51.

    Article  Google Scholar 

  25. Maher RL, Hanlon JT, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014. https://doi.org/10.1517/14740338.2013.827660.

    Article  PubMed  Google Scholar 

  26. Köberlein J, Gottschall M, Czarnecki K, Thomas A, Bergmann A, Voigt K. General practitioners’ views on polypharmacy and its consequences for patient health care. BMC Fam Pract. 2013;14:119.

    Article  Google Scholar 

  27. Thillainadesan J, Gnjidic D, Green S, Hilmer SN. Impact of deprescribing interventions in older hospitalised patients on prescribing and clinical outcomes: a systematic review of randomised trials. Drugs Aging. 2018;35(4):303–19.

    Article  CAS  Google Scholar 

  28. Ailabouni NJ, Nishtala PS, Mangin D, Tordoff JM. Challenges and enablers of deprescribing: a general practitioner perspective. PLoS ONE. 2016;11(4):e0151066. https://doi.org/10.1371/journal.pone.0151066.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Boyd CM, Darer J, Boult C, Fried LP, Boult F, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294:716–24.

    Article  CAS  Google Scholar 

  30. Jean-Baptiste B, Corinne D, Marie-Margueritte D, François P. Potentially inappropriate medications (PIMs) and anticholinergic levels in the elderly: a population based study in a French region. Arch Gerontol Geriatr. 2014;59:630–5.

    Article  Google Scholar 

  31. Motter FR, Fritzen JS, Hilmer SN, Paniz ÉV, Paniz VMV. Potentially inappropriate medication in the elderly: a systematic review of validated explicit criteria. Eur J Clin Pharmacol. 2018;4(6):679–700.

    Article  Google Scholar 

  32. Miquel MDC, Cuervo MS, Silveira ED, Machuca IS, González-Blazquez S, Errasquin BM, et al. Potentially inappropriate drug prescription in older subjects across health care settings. Eur Geriatr Med. 2010;1:9–14.

    Article  Google Scholar 

  33. Fox C, Richardson K, Maidment ID, Savva GM, Matthews FE, Smithard D, et al. Anticholinergic medication use and cognitive impairment in the older population: the medical research council cognitive function and ageing study. J Am Geriatr Soc. 2011;59:1477–83.

    Article  Google Scholar 

  34. Bhattacharya R, Chatterjee S, Carnahan RM, Aparasu RR. Prevalence and predictors of anticholinergic agents in elderly outpatients with dementia. Am J Geriatr Pharmacother. 2011;9:434–41.

    Article  CAS  Google Scholar 

  35. Wilson NM, Hilmer SN, March LM, Cameron ID, Lord SR, Seibel MJ, et al. Associations between drug burden index and falls in older people in residential aged care. J Am Geriatr Soc. 2011;59:875–80.

    Article  Google Scholar 

  36. Magin PJ, Morgan S, Tapley A, McCowan C, Parkinson L, Henderson KM, et al. Anticholinergic medicines in an older primary care population: a cross-sectional analysis of medicines’ levels of anticholinergic activity and clinical indications. J Clin Pharm Ther. 2016;41:486–92.

    Article  CAS  Google Scholar 

  37. Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults. Arch Intern Med. 2010;170(18):1648–54.

    Article  Google Scholar 

  38. Lutz BH, Miranda VIA, Bertoldi AD. Potentially inappropriate medications among older adults in Pelotas, Southern Brazil. Rev Saude Publica. 2017;51:52.

    Article  Google Scholar 

  39. Davies EA, O’Mahony MS. Adverse drug reactions in special populations: the elderly. Br J Clin Pharmacol. 2015;80:796–807.

    Article  CAS  Google Scholar 

  40. Moreno G, Mangione CM, Kimbro L, Vaisberg E, American Geriatrics Society Expert Panel on Care of Older Adults with Diabetes Mellitus. Guidelines abstracted from the American Geriatrics Society guidelines for improving the care of older adults with diabetes mellitus: 2013 update. J Am Geriatr Soc. 2013;61(11):2020–6.

    Article  Google Scholar 

  41. Prefeitura Municipal de Saúde (BR). REMUME - Relação Municipal de Medicamentos Essenciais. In: Prefeitura Municipal de Porto Alegre. 2018. https://lproweb.procempa.com.br/pmpa/prefpoa/sms/usu_doc/remume_arquivo_110518.pdf. Accessed 26 Oct 2019.

  42. Fried TR, Niehoff KM, Street RL, Charpentier PA, Rajeevan N, Miller PL, et al. Effect of the tool to reduce inappropriate medications on medication communication and deprescribing. J Am Geriatr Soc. 2017;65:2265–71.

    Article  Google Scholar 

  43. Boghossian TA, Rashid FJ, Thompson W, Welch V, Moayyedi P, Rojas‐Fernandez C, et al. Deprescribing versus continuation of chronic proton pump inhibitor use in adults. Cochrane Database Syst Rev. 2017;3(3):CD011969. https://doi.org/10.1002/14651858.CD011969.pub2.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank the health professionals of the Unidade Básica de Saúde Santa Cecília, Porto Alegre/Brazil.

Funding

This study was not funded by any institution.

Author information

Authors and Affiliations

  1. Programa de Pós-Graduação em Assistência Farmacêutica, School of Pharmacy, Anexo I da Faculdade de Farmácia, Federal University of Rio Grande do Sul, R. São Luís, 150 - Santana, Porto Alegre, RS, 90620-170, Brazil

    Taiane Santos Garcia & Isabela Heineck

  2. Graduate Program in Medical Sciences: Endocrinology, Clinical Pharmacy Section, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Bairro Santa Cecília, Porto Alegre, 90035-903, Brazil

    Bruno Simas da Rocha

  3. Department of Statistics, Institute of Mathematics and Statistics, Federal University of Rio Grande do Sul, Av. Bento Gonçalves, 9500 Prédio 43-111, Bairro Agronomia, Porto Alegre, 91509-900, Brazil

    Stela Maris De Jezus Castro

Authors
  1. Taiane Santos Garcia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bruno Simas da Rocha
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stela Maris De Jezus Castro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Isabela Heineck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Taiane Santos Garcia.

Ethics declarations

Conflicts of interest

The authors have no conflicts of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Santos Garcia, T., Simas da Rocha, B., De Jezus Castro, S.M. et al. Potentially inappropriate medications for older adults in a primary healthcare unit in southern Brazil. Int J Clin Pharm 42, 911–922 (2020). https://doi.org/10.1007/s11096-020-01048-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-020-01048-7

Keywords

Search

Navigation