Polypharmacy in the elderly: a review of the literature            /            Polifarmácia em idosos: uma revisão da literatura

Priscila de Paula Marques; Priscila Maria Stolses Bergamo Francisco; Maria José D´Elboux

doi:10.9789/2175-5361.rpcfo.v13.9709

Authors

Priscila de Paula Marques UNICAMP http://orcid.org/0000-0002-7954-4056
Priscila Maria Stolses Bergamo Francisco UNICAMP http://orcid.org/0000-0001-7361-9961
Maria José D´Elboux UNICAMP http://orcid.org/0000-0002-7973-3439

DOI:

https://doi.org/10.9789/2175-5361.rpcfo.v13.9709

Keywords:

Idoso, Envelhecimento, Polimedicação, Doença Crônica, Saúde do Idoso

Abstract

Objetivo: identificar na literatura científica, entre os anos de 2016 e 2018, estudos sobre a polifarmácia em idosos residentes na comunidade. Métodos: revisão integrativa, realizada nas bases de dados PUBMED, BVS/BIREME, SCOPUS, WEB OF SCIENSE, EMBASE, Cochrane Library e CINAHL. Resultados: dezesseis artigos foram selecionados para esta revisão. Quanto ao do uso de medicamentos por idosos residentes na comunidade, os estudos apresentaram a prevalência de uso, características e fatores associados à polifarmácia nos idosos; conhecimento adequado dos medicamentos prescritos; e uso dos medicamentos potencialmente inapropriados. Conclusão: a identificação do uso de medicamentos nos idosos aponta para a necessidade de melhor comunicação entre profissionais e pacientes, incentivar o autocuidado, minimizar o risco de complicações, prevenir iatrogenias e hospitalizações, assim como, reduzir a mortalidade em idosos por uso impróprio de medicamentos.

Downloads

Download data is not yet available.

Author Biographies

Priscila de Paula Marques, UNICAMP

Graduação em Enfermagem. Mestrado em Saúde Coletiva, Política e Gestão em Saúde. Doutoranda do Programa de Pós-Graduação em Gerontologia/ UNICAMP. Campinas- São Paulo- Brasil.

Priscila Maria Stolses Bergamo Francisco, UNICAMP

Bacharel em Estatística. Mestrado, Doutorado e Pós-Doutorado em Saúde Coletiva. Professora Doutora, no Departamento Saúde Coletiva/ UNICAMP. Campinas- São Paulo- Brasil.

Maria José D´Elboux, UNICAMP

Graduação em Enfermagem. Mestrado, Doutorado e Livre-docência em Enfermagem. Professora no Programa de Pós-Graduação em Gerontologia/ UNICAMP. Campinas- São Paulo- Brasil.

References

World Health Organization. World report on ageing and health [Internet]. Geneva: WHO; 2015 [acesso em 18 jun. 2020]. Available from: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1.

Kalache A. Envelhecimento populacional no Brasil: uma realidade nova. Cad. Saúde Pública (Online). [Internet]. 1987 [cited 2020 oct 23]; 3(3). Available from: https://doi.org/10.1590/S0102-311X1987000300001.

Miranda GMD, Mendes ACG, Silva ALA. Population aging in Brazil: current and future social challenges and consequences. Rev Bras Geriatr Gerontol [Internet] 2016 [cited 2020 jun 18]; 19(3). Available from: http://dx.doi.org/10.1590/1809-98232016019.150140.

Instituto Brasileiro de Geografia e Estatística [homepage na internet]. Pesquisa Nacional de Saúde, 2013: acesso e utilização dos serviços de saúde, acidentes e violências [acesso em 23 out 2020]. Disponível em: https://biblioteca.ibge.gov.br/pt/biblioteca-catalogo?view=detalhes&id=294074.

Leite MT, Pai SD, Quintana JM, Costa MC. Diseases chronicles do not encephalopathies in the elderly: knowledges and actions from community health agents. Rev. Pesqui. (Univ. Fed. Estado Rio J., Online). [Internet] 2015 [cited 2020 jun 18]; 7(2). Available from: http://dx.doi.org/10.9789/2175-5361.2015.v7i2.2263-2276.

Nascimento MM, Mambrini JV, Lima-Costa MF, Firmo JOA, Peixoto SW, Loyola Filho AI. Potentially inap-propriate medications: predictor for mortality in acohort of community-dwelling older adults. Eur. j. clin. pharmacol. [Internet]. 2017 [cited 2020 jun 18]; 73(5). Available from: https://doi.org/10.1007/s00228-017-2202-x.

Almeida NA, Reiners AAO, Azevedo RCS, Silva AMC, Cardoso JDC, Souza LC. Prevalence of and factors associated with polypharmacy among elderly persons resident in the community. Rev. bras. geriatr. gerontol. (Online). [Internet]. 2017 [cited 2020 jun 18]; 20(1). Available from: http://dx.doi.org/10.1590/1981-22562017020.160086.

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. paúde pública. [Internet]. 2016 [cited 2020 jun 18]; 50 (Supl 2). Available from: http://dx.doi.org/10.1590/s1518-8787.2016050006145.

Masnoon N, Shakib S, Kalisch-Ellet L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC geriatr. (Online). [Internet]. 2017 [cited 2020 jun 18]; 17(230). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5635569/.

Pereira KG, Peres MA, Iop D, Boing AC, Boing AF, Aziz M, et al. Polifarmácia em idosos: um estudo de base populacional. Rev. bras. epidemiol. [Internet]. 2017 [acesso em 18 de junho 2020]; 20(2). Disponível em: http://dx.doi.org/10.1590/1980-5497201700020013.

Tavares NUL, Costa KS, Mengue SS, Vieira MLFP, Malta DC, Silva Júnior JB. Uso de medicamentos para tratamento de doenças crônicas não transmissíveis no Brasil: resultados da Pesquisa Nacional de Saúde, 2013. Epidemiol. serv. saúde. [Internet]. 2015 [acesso em 18 de junho 2020]; 24(2). Disponível em: http://dx.doi.org/10.5123/S1679-49742015000200014.

Carvalho MFC, Romano-Lieber NS, Bergsten-Mendes G, Secoli SR, Ribeiro E, Lebrão ML, et al. Polifarmácia entre idosos no Município de São Paulo- Estudo SABE. Rev. bras. epidemiol. [Internet]. 2012 [acesso em 18 de junho 2020]; 15(4). Disponível em: https://www.scielosp.org/pdf/rbepid/2012.v15n4/817-827/pt.

Sousa LMM, Marques-Vieira CMA, Severino SSP, Antunes AV. A metodologia de revisão integrative da literature em enfermagem. Rev. invest. enf. [Internet]. 2017 [acesso em 18 de junho 2020]; 17(26). Disponível em: https://www.researchgate.net/publication/321319742_Metodologia_de_Revisao_Integrativa_da_Literatura_em_Enfermagem.

Soares CB, Hoga LAK, Peduzzi M, Sangaleti C, Yonekura T, Silva DRAD. Integrative review: concepts and methods used in nursing. Rev. Esc. Enferm. USP. [Internet]. 2014 [cited 2020 jun 18]; 48(2). Available from: http://www.scielo.br/pdf/reeusp/v48n2/pt_0080-6234-reeusp-48-02-335.pdf.

Souza MT, Silva MD, Carvalho R. Revisão integrativa: o que é e como fazer. Einstein. [Internet]. 2010 [acesso em 18 de junho 2020]; 8(1). Disponível em: http://www.scielo.br/pdf/eins/v8n1/pt_1679-4508-eins-8-1-0102.pdf.

Bala SS, Narayan SW, Nishtala PS. Potentially inappropriate medications in community-dwelling older adults undertaken as a comprehensive geriatric risk assessment. Eur. j. clin. pharmacol. [Internet]. 2018 [cited 2020 jun 18]; 74(5). Available from: https://doi.org/10.1007/s00228-018-2412-x.

Bosch-Lenders D, Maessen DW, Stoffers HE, Knottnerus JA, Winkens B, van den Akker M. Factors associated with appropriate knowledge of the indications for prescribed drugs among community-dwelling older patients with polypharmacy. Age ageing. [Internet]. 2016 [cited 2020 jun 18]; 45(3). Available from: https://pubmed.ncbi.nlm.nih.gov/27013501/

Costa CMFN, Silveira MR, Acurcio FDA, Guerra Jr AA, Guibu IA, Costa KS, et al. Use of medicines by patients of the primary health care of the Brazilian Unified Health System. Rev. Saúde Pública. [Internet]. 2017 [cited 2020 jun 18]; 51 Supl 2:S18. Available from: https://doi.org/10.11606/S1518-8787.2017051007144.

Garfinkel D. Poly-de-prescribing to treat polypharmacy: efficacy and safety. Ther. adv. drug. saf. [Internet]. 2018 [cited 2020 jun 18]; 9(1). Available from: https://doi.org/10.1177%2F2042098617736192.

Kirchmayer U, Mayer F, Basso M, De Cristofaro R, Mores N, Cappai G, et al. Polypharmacy in the elderly: A population based cross-sectional study in Lazio, Italy. Eur geriatr. med. [Internet] 2016 [cited 2020 jun 18]; 7(5). Available from: http://dx.doi.org/10.1016/j.eurger.2016.05.008.

Lim LM, McStea M, Chung WW, Azmi NN, Aziz SAA, Alwi S, et al. Prevalence, risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multi-ethnic Malaysia. PLoS ONE. [Internet]. 2017 [cited 2020 jun 18]; 12(3). Available from: https://pubmed.ncbi.nlm.nih.gov/28273128/.

Mayer S, Vogler S, Simon J, Österle A. Exploring determinants of polypharmacy in the elderly population in Austria. Value in health regional issues (Online). [Internet]. 2016 [cited 2020 jun 18]; 19(7). Available from: https://doi.org/10.1016/j.jval.2016.09.607.

Midão L, Giardini A, Menditto E, Kardas P, Costa E. Polypharmacy prevalence among older adults based on the Survey of Health, Aging and Retirement in Europe. Arch. gerontol. geriatr. [Internet]. 2018 [cited 2020 jun 18]; 78. Available from: https://doi.org/10.1016/j.archger.2018.06.018.

Miller GE, Sarpong EM, Davidoff AJ, Yang EY, Brandt NJ, Fick DM. Determinants of Potentially Inappropriate Medication Use among Community-Dwelling Older Adults. Health serv. res. [Internet]. 2017 [cited 2020 jun 18]; 52(4). Available from: https://doi.org/10.1111/1475-6773.12562.

Montiel-Luque A, Nunez-Montenegro AJ, Martin-Aurioles E, Canca-Sanchez JC, Toro-Toro MC, Gonzalez-Correa JA, et al. Medication-related factors associated with health-related quality of life in patients older than 65 years with polypharmacy. PLoS One. [Internet]. 2017 [cited 2020 jun 18]; 12(2). Available from: https://dx.doi.org/10.1371%2Fjournal.pone.0171320.

Nascimento RCRM, Álvares J, Guerra AA Jr, Gomes IC, Silveira MR, Costa EA, et al. Polypharmacy: A challenge for the primary health care of the Brazilian Unified Health System. Rev. Saúde Pública. [Internet]. 2017 [cited 2020 jun 18]; 51Supl2:S19. Available from: https://doi.org/10.11606/S1518-8787.2017051007136.

Nascimento RCRM, Guerra AA Jr, Alvares J, Gomes IC, Godman B, Bennie M, et al. Statin use in Brazil: findings and implications. Curr. med. rese. and opin. [Internet] 2018 [cited 2020 jun 18]; 34(10). Available from: https://doi.org/10.1080/03007995.2018.1451312.

Neoh CF, Long CM, Lim SM, Ramasamy K, Shahar S, Majeed ABA. Medication use and adherence among multi-ethnic community-dwelling older adults in Malaysia. Geriatr. gerontol. int. [Internet]. 2017 [cited 2020 jun 18]; 17(8). Available from: https://doi.org/10.1111/ggi.12849.

Niclos G, Olivar T, Rodilla V. A cross-sectional evaluation of the prevalence and detection of predictors of polypharmacy amongst adult in Spain. Int. j pharm. Pract. [Internet]. 2018 [cited 2020 jun 18]; 26(3). Available from: https://doi.org/10.1111/ijpp.12386.

Rieckert A, Trampisch US, Klaaben-Mielke R, Drewelow E, Esmail A, Johansson T, et al. Polypharmacy in older patients with chronic diseases: a cross-sectional analysis of factors associated with excessive polypharmacy. BMC fam. pract. [Internet]. 2018 [cited 2020 jun 18]; 19. Available from: https://doi.org/10.1186/s12875-018-0795-5.

Kantor ED, Rehm CD, Haas JS, Chan AT, Giovannucci EL. Trends in Prescription Drug Use among Adults in the United States from 1999–2012. JAMA. [Internet]. 2015 [cited 2020 jun 18]; 314(17). Available from: https://doi.org/10.1001/jama.2015.13766.

Silveira EA, Dalastra L, Pagotto V. Polypharmacy, chronic diseases and nutritional markers in community-dwelling older. Rev. bras. epidemiol. [Internet]. 2014 [cited 2020 jun 18]; 17(4). Available from: http://dx.doi.org/10.1590/1809-4503201400040002.

Morin L, Johnell K, Laroche ML, Fastbom J, Wastesson JW. The epidemiology of polypharmacy in older adults: register-based prospective cohort study. J. clin. epidemiol. [Internet]. 2018 [cited 2020 jun 18]; 10. Available from: https://dx.doi.org/10.2147%2FCLEP.S153458.

Cantlay A, Glyn T, Barton N. Polypharmacy in the elderly. InnovAiT. [Internet]. 2016 [cited 2020 jun 18]; 9(2). Available from: https://doi.org/10.1177%2F1755738015614038.

Guenette L, Moisan J. Elderly people’s knowledge of the purpose of their medicines. Am. j. geriatr. pharmacother. [Internet]. 2011 [cited 2020 jun 18]; 9(1). Available from: https://doi.org/10.1016/j.amjopharm.2011.02.007.

Kovacevic SV, Miljkovic B, Vucicevic K, Culafic M, Kovacevic M, Golubovic B, et al. Elderly polypharmacy patients’ needs and concerns regarding medication assessed using the structured patient-pharmacist consultation model. Patient educ. couns. [Internet]. 2017 [cited 2020 jun 18]; 100(9). Available from: https://doi.org/10.1016/j.pec.2017.05.001.

Fastbom J, Johnell K. National indicators for quality of drug therapy in older persons: the Swedish experience from the first 10 years. Drugs aging. [Internet]. 2015 [cited 2020 jun 18]; 32(3). Available from: https://doi.org/10.1007/s40266-015-0242-4

Cooper JA, Cadogan CA, Patterson SM, Kerse N, Bradley MC, Ryan C, et al. Interventions to improve the appropriate use of polypharmacy in older people: a Cochrane systematic review. BMJ Open. [Internet]. 2015 [cited 2020 jun 18]; 5:e009235. Available from: http://dx.doi.org/10.1136/bmjopen-2015-009235.

Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert opin drug saf. [Internet] 2014 [cited 2020 jun 18]; 13(1). Available from: https://dx.doi.org/10.1517%2F14740338.2013.827660.

Vrdoljak D, Borovac JA. Medication in the elderly-considerations and therapy prescription guidelines. Acta med. acad. [Internet]. 2015 [cited 2020 jun 18]; 44(2). Available from: https://dx.doi.org/10.5644/ama2006-124.142.

Sönnichsen A, Trampisch US, Rieckert A, Piccoliori G, Vögele A, Flamm M, et al. Polypharmacy in chronic diseases- Reduction of Inappropriate Medication and Adverse drug events in older populations by electronic Decision Support (PRIMA-eDS): study protocol for a randomized controlled trial. Trials. [Internet]. 2016 [cited 2020 jun 18]; 17:57. Available from: https://doi.org/10.1186/s13063-016-1177-8.

Orihuela MG. La evidencia científica y la intervención farmacológica preventiva en geriatría scientific evidence and preventive pharmacological intervention in geriatrics. Rev. cuba. med. gen. integr. [Internet]. 2012 [cited 2020 jun 18]; 28(4). Available from: http://scielo.sld.cu/pdf/mgi/v28n4/mgi17412.pdf.

Kaufmann CP, Tremp R, Hersberger KE, Lampert ML. Inappropriate prescribing: a systematic overview of published assessment tools. Eur. j. clin. pharmacol. [Internet]. 2014 [cited 2020 jun 18]; 70(1). Available from: https://link.springer.com/article/10.1007%2Fs00228-013-1575-8.

Dimitrow MS, Airaksinen MS, Kivelä SL, Lyles A, Leikola SNS. Comparison of prescribing criteria to evaluate the appropriateness of drug treatment in individuals aged 65 and older: a systematic review. J. am. geriatr. soc. [Internet]. 2011 [cited 2020 jun 18]; 59(8). Available from: https://doi.org/10.1111/j.1532-5415.2011.03497.x.