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      Polifarmácia, medicamentos potencialmente inapropriados e a vulnerabilidade de pessoas idosas Translated title: Polypharmacy, potentially inappropriate medications, and the vulnerability of older adults

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          Abstract

          Resumo Objetivo Analisar a frequência de polifarmácia e prescrição de medicamentos potencialmente inapropriados (MPI) segundo os Critérios de Beers e CBMPI em pessoas idosas com vulnerabilidade clínico-funcional. Método Trata-se de um estudo transversal onde analisou-se os prontuários de 496 participantes com 60 anos ou mais, atendidos em primeira consulta em uma Policlínica Gerontológica. Os dados sociodemográficos, medicamentos, e o Índice de Vulnerabilidade Clínico Funcional 20 (IVCF-20) e quedas foram extraídos dos prontuários. A polifarmácia foi definida como o uso simultâneo de cinco ou mais medicamentos. Os participantes foram classificados em três grupos: robusto, em risco e vulnerável. Resultados A análise demonstrou que 69 (13,91%) dos participantes faziam uso de polifarmácia. Entre os usuários de polifarmácia, 40 (57,97%) faziam uso de pelo menos um MPI. Os MPIs mais encontrados foram a glibenclamida e o omeprazol, respectivamente. Pessoas idosas com vulnerabilidade apresentaram um risco três vezes maior de apresentar polifarmácia (RP 3,59; IC95% 2,109-6,092). Conclusão O uso de polifarmácia e MPI neste estudo estavam associados à vulnerabilidade da pessoa idosa, reforçando a necessidade de avaliação criteriosa de prescrições medicamentosas para essa população.

          Translated abstract

          Abstract Objective To analyze the frequency of polypharmacy and the prescription of Potentially Inappropriate Medications (PIM) according to the Beers Criteria and CBMPI in older adults with clinical-functional vulnerability. Method This is a cross-sectional study where the medical records of 496 participants aged 60 and older, seen in their first appointment at a Gerontological Polyclinic, were analyzed. Sociodemographic data, medications, the Clinical-Functional Vulnerability Index-20 (IVCF-20), and falls were extracted from the medical records. Polypharmacy was defined as the simultaneous use of five or more medications. Participants were classified into three groups: robust, at risk, and vulnerable. Results The analysis revealed that 69 (13.91%) participants were using polypharmacy. Among polypharmacy users, 40 (57.97%) were using at least one PIM. The most commonly found PIM were glibenclamide and omeprazole, respectively. Older adults with vulnerability were three times more likely to have polypharmacy (OR 3.59; 95% CI 2.109-6.092). Conclusion The use of polypharmacy and PIM in this study was associated with the vulnerability of older adults, emphasizing the need for a thorough evaluation of medication prescriptions for this population.

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          Most cited references30

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          Polypharmacy and Medication Management in Older Adults

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            Polifarmácia em idosos: um estudo de base populacional

            RESUMO: Objetivo: Investigar a polifarmácia em idosos residentes na área urbana de Florianópolis, Santa Catarina, Brasil, estimando a prevalência e os fatores a ela associados. Métodos: Foi realizado um estudo transversal de base populacional em uma amostra de 1.705 idosos, entre 2009 e 2010. A variável dependente foi polifarmácia (definida como “uso de cinco ou mais medicamentos”). Utilizaram-se variáveis sociodemográficas, uso de serviços de saúde e autoavaliação de saúde como exploratórias. Foram estimadas razões de prevalência (RP) por meio de análise multivariada utilizando-se da regressão de Poisson. Resultados: A média do uso de medicamentos por idosos foi de 3,8 (variando entre 0 e 28). A prevalência de polifarmácia foi de 32%, com intervalo de confiança de 95% (IC95%) 29,8 - 34,3. As características que apresentaram associação positiva com polifarmácia foram: sexo feminino (RP = 1,27; IC95% 1,03 - 1,57), aumento da idade (RP = 1,38; IC95% 1,08 - 1,77), autoavaliação de saúde negativa (RP = 1,99; IC95% 1,59 - 2,48) e realização de consulta médica nos últimos 3 meses anteriores à entrevista (RP = 1,89; IC95% 1,53 - 2,32). Os grupos de medicamentos mais utilizados pelos idosos na polifarmácia foram os indicados para o sistema cardiovascular, trato alimentar e metabolismo e sistema nervoso. Conclusão: O padrão de uso de medicamentos por idosos está dentro da média nacional. A prevalência de polifarmácia e as características a ela associadas foram semelhantes aos achados em outras regiões do Brasil.
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              Clinical-Functional Vulnerability Index-20 (IVCF-20): rapid recognition of frail older adults

              ABSTRACT OBJECTIVE To evaluate the adequacy of the Clinical-Functional Vulnerability Index-20, a rapid triage instrument to test vulnerability in Brazilian older adults, for the use in primary health care. METHODS The study included convenience sample of 397 patients aged older than or equal to 60 years attended at Centro de Referência para o Idoso (Reference Center for Older Adults) and of 52 older adults the same age attended at the community. The results of the questionnaire, consisting of 20 questions, were compared with those of the Comprehensive Geriatric Assessment, considered a reference for identifying frail older adults. Spearman’s correlation was evaluated in the Clinical-Functional Vulnerability Index-20 with the Comprehensive Geriatric Assessment; the validity was verified by the area under the ROC curve; reliability was estimated by the percentage of agreement among evaluators and by the kappa coefficient, both with quadratic weighted. The cut-off point was obtained based on the higher accuracy criterion. Cronbach’s alpha, a measure of internal consistency, was estimated. RESULTS The Spearman’s correlation coefficient was high and positive for both groups (0.792 for older adults attended at the Reference Center and 0.305 for older adults from the community [p < 0.001]). The area under the ROC curve for older adults attended at the Reference Center was substantial (0.903). The cut-off point obtained was six, and older adults with scores in Clinical-Functional Vulnerability Index-20 above that value had strong possibility of being frail. For older adults from the community, the quadratic weighted agreement among evaluators was 99.5%, and the global quadratic weighted kappa coefficient was 0.94. Cronbach’s alpha was high for older adults attended at the Reference Center (0.861) and those attended at the community (0.740). CONCLUSIONS The Clinical-Functional Vulnerability Index-20 questionnaire, in the sample examined, turned out to be positively correlated with the Comprehensive Geriatric Assessment, in addition to the results indicating a high degree of validity and reliability. Thus, the Clinical-Functional Vulnerability Index-20 proves to be viable as a triage instrument in the primary health care that identifies frail older adults (older adults at risk of weakening and frail older adults).
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                Author and article information

                Journal
                rbgg
                Revista Brasileira de Geriatria e Gerontologia
                Rev. bras. geriatr. gerontol.
                Universidade do Estado do Rio Janeiro (Rio de Janeiro, RJ, Brazil )
                1809-9823
                1981-2256
                2024
                : 27
                : e230191
                Affiliations
                [5] Manaus Amazonas orgnameUniversidade Federal do Amazonas orgdiv1Faculdade de Educação Física e Fisioterapia Brazil
                [2] Manaus AM orgnameFundação Universidade Aberta da Terceira Idade (FUnATI) Brasil
                [4] Coari Amazonas orgnameUniversidade Federal do Amazonas orgdiv1Instituto de Saúde e Biotecnologia (ISB) Brazil
                [3] Manaus Amazonas orgnameUniversidade Federal do Amazonas orgdiv1Instituto de Ciências Exatas Brazil
                [1] Manaus Amazonas orgnameUniversidade Federal do Amazonas orgdiv1Faculdade de Educação Física e Fisioterapia (FEFF) Brazil
                Article
                S1809-98232024000100210 S1809-9823(24)02700000210
                10.1590/1981-22562024027.230191.pt
                c9ef2018-9e6e-4186-b430-f1af0d030ede

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 10 January 2024
                : 10 August 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 0
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                SciELO Brazil

                Categories
                Artigos Originais

                Vulnerability,Polypharmacy,Potentially Inappropriate Medications,Older Adults,Polifarmácia,Medicamentos Potencialmente Inapropriados,Vulnerabilidade,Idosos

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