Prevalence and factors associated the use of potentially inappropriate medications by older adults in Rio Branco, Acre, Brazil: a population-based study

Rezende, Gustavo Rodrigues de; Amaral, Thatiana Lameira Maciel; Monteiro, Gina Torres Rego; Amaral, Cledir de Araújo; Vasconcellos, Maurício Teixeira Leite de; Souza, Jonas Gordilho

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Brasil

Revista Brasileira de Geriatria e Gerontologia

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Original Articles • Rev. bras. geriatr. gerontol. 24 (4) • 2021 • https://doi.org/10.1590/1981-22562022025.210165 copy

Prevalence and factors associated the use of potentially inappropriate medications by older adults in Rio Branco, Acre, Brazil: a population-based study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To verify the prevalence and analyze the factors associated with the use of potentially inappropriate medications (PIM) in the older adults in Rio Branco, Acre, Brazil.

Method

This is a cross-sectional population-based study. The dependent variable was the use of at least one PIM, according to the criteria of the Brazilian Consensus on Potentially Inappropriate Medicines for the older adults, regardless of clinical condition. In evaluating the association between the use of inappropriate medications and the independent variables, a crude and adjusted analysis was performed using logistic regression, using the hierarchical model by odds ratio (OR).

Results

The prevalence of using at least one PIM among the 1,016 participants was 25.9% (95%CI 22.3; 29.8), positively associated with female sex (OR=1.38; 95%CI 1.01; 1.90), dependence on instrumental activities of daily living (OR=1.37; 95%CI 1.02; 1.83), negative self-rated health (OR=1.54; 95%CI 1.12; 2.11), hospitalization in the last 12 months (OR=1.79; 95%CI 1.19; 2.69) and presence of more than three comorbidities (OR=2.56; 95%CI 1.97; 3.33). The most used subcategory was proton pump inhibitors by 11.3% (9.2; 13.8).

Conclusion

The prevalence of PIM use by elderly in this population was a quarter, being associated with female gender and health conditions. Awareness actions are necessary to guarantee the benefits of using medications.

Keywords
Potentially Inappropriate Medication List; Older Adults; Inappropriate Prescribing; Survey

Variables	Total		PIM		p-value ^a
Variables	Estimate (n)	% (95% CI)	Estimate (n)	% (95% CI)
Sex					0.213
Male	10,554	46.5 (43.4 – 49.7)	2,462	22.6 (18.0 – 27.9)
Female	12,862	53.5 (50.3 – 56.6)	3,597	28.7 (24.4 – 33.5)
Age (years)					0.048
60-69	13,383	57.2 (54.7 – 59.6)	3,383	25.3 (21.3 – 29.8)
70-79	6,698	28.6 (26.2 − 31.1)	1,569	23.4 (18.6 − 29.1)
80 and over	3,335	14.2 (12.2 − 16.6)	1,106	33.2 (25.9 – 41.3)
Skin color					0.416
Non white	17,802	76.0 (71.8 – 79.8)	4,500	25.3 (21.5 – 29.5)
White	5,614	24.0 (20.2 – 28.2)	1,558	27.8 (22.1 – 34.2)
Marital status^b					0.513
With partner	9,097	39.1 (35.8 – 42.6)	2,490	27.4 (21.1 – 34.7)
Without partner	14,161	60.9 (57.4 – 64.2)	3,545	25.0 (21.5 – 28.9)
Education^b					0.789
No education	17,471	75.2 (68.4 – 81.0)	4,520	25.9 (21.8 – 30.4)
Elementary School	1,963	8.5 (6.2 – 11.5)	477	24.3 (17.3 – 33.1)
High school	2,802	12.1 (9.1 – 15.8)	801	28.6 (19.1 – 40.4)
University education	987	4.2 (2.7 – 6.7)	216	21.9 (12.0 – 36.6)
Practice of physical activity^b					0.743
Yes	3,480	14.9 (11.9 – 18.4)	865	24.9 (17.9 – 33.5)
No	19,904	85.1 (81.6 – 88.1)	5,193	26.1 (22.5 – 30.0)
BMI^b					0.505
Eutrophic	8,449	38.3 (34.1 – 42.7)	1,998	23.7 (18.3 – 30.0)
Underweight	2,789	12.7 (10.5 – 15.2)	825	29.6 (20.8 – 40.1)
Obese	10,797	49.0 (44.0 – 54.1)	2,863	26.5 (21.8 – 31.8)
Smoking					0.374
Yes	4,163	17.8 (15.4 – 20.4)	980	23.5 (17.4 – 31.1)
No	19,253	82.2 (79.6 – 84.6)	5,078	26.4 (22.9 – 30.2)
IADL dependence degree					0.002
Independent	11,907	51.1 (46.7 – 55.5)	2,627	22.1 (18.6 – 26.0)
Dependent	11,402	48.9 (44.5 – 53.3)	3,432	30.1 (25.2 – 35.5)
BADL dependence degree					0.916
Independent	17,550	75.3 (70.4 – 79.6)	4,547	25.9 (22.5 – 29.6)
Dependent	5,759	24.7 (20.4 – 29.6)	1,512	26.3 (19.7 – 34.1)
Health self-assessment					0.001
Positive	8,598	36.7 (33.4 – 40.1)	1,726	20.1 (16.1 – 24.7)
Negative	14,818	63.3 (59.9 – 66.6)	4,333	29.2 (24.9 – 34.1)
Hospitalization in the last 12 months^b					<0.001
Yes	3,746	16.6 (14.5 – 18.8)	1,463	39.0 (31.5 – 47.2)
No	18,868	83.4 (81.2 – 85.5)	4,442	23.5 (19.8 – 27.7)
More than three comorbidities					<0.001
Yes	6,845	29.2 (25.9 – 32.8)	2,819	41.2 (35.8 – 46.7)
No	16,571	70.8 (67.2 – 74.1)	3,240	19.6 (16.1 – 23.6)
Signs and symptoms of depression GDS^b					0.002
Yes	7,546	32.5 (28.9 – 36.3)	2,409	31.9 (26.3 – 38.1)
No	17,601	67.5 (63.7 – 71.1)	4,389	15.7 (13.3 – 18.5)
Total	23,416	100.0	6,059	25.9 (22.3 – 29.8)

Variables	OR_Brute (95%CI)	p-value	OR_Adjusted (95%CI)	p-value
Distal level^a
Sex		0.049		0.046
Male	1		1
Female	1.38 (1.00 – 1.91)		1.38 (1.01 – 1.90)
Age (years)		0.049		0.065
60-69	1		1
70-79	0.90 (0.69 – 1.19)		0.90 (0.69 – 1.18)
80 and over	1.47 (0.99 – 2.17)		1.47 (0.99 – 2.17)
Intermediate level^b
IADL dependence degree		0.002		0.015
Independent	1		1
Dependent	1.52 (1.17 – 1.97)		1.39 (1.07 – 1.81)
Health self-assessment		0.001		0.011
Positive	1		1
Negative	1.65 (1.23 – 2.21)		1.50 (1.10 – 2.04)
Signs and symptoms of depression GDS^b		0.002		0.053
No	1		1
Yes	1.54 (1.18 – 2.03)		1.31 (0.99 – 1.73)
Proximal level^c
Hospitalization in the last 12 months		<0.001		0.007
No	1		1
Yes	2.08 (1.42 – 3.05)		1.79 (1.19 – 2.69)
More than three comorbidities		<0.001		<0.001
No	1		1
Yes	2.88 (2.23 – 3.72)		2.56 (1.97 – 3.33)

Category	N	% (95%CI)
Gastrointestinal system	2,684	11.5 (9.4 – 14.0)
Proton pump inhibitors (omeprazole, pantoprazole, esomeprazole)	2,647	11.3 (9.2 – 13.8)
Gastrointestinal antispasmodics (scopolamine)	52	0.2 (0.1 – 1.0)
Metoclopramide	93	0.4 (0.1 – 1.1)
Mineral oil (orally)	18	0.1 (0.0 – 0.6)
Central nervous system and psychotropic medications	1,795	7.7 (5.8 – 10.0)
First-generation antihistamines (bronpheniramine, cyproheptadine, chlorpheniramine, dexchlorpheniramine, dimenhydrinate, doxylamine, meclizine, promethazine)	319	1.4 (0.8 – 2.4)
First-generation (chlorpromazine, haloperidol, levomepromazine) and second-generation (quetiapine, risperidone) antipsychotics for behavioral problems in dementia	261	1.1 (0.6 – 2.0)
Barbiturates (phenobarbital)	129	0.6 (0.2 – 1.4)
Benzodiazepines (alprazolam, bromazepam, clonazepam, cloxazolam, diazepam, flunitrazepam, lorazepam, midazolam, nitrazepam)	1,163	5.0 (3.5 – 6.9)
Tertiary tricyclic antidepressants (amitriptyline, imipramine, nortriptyline, maprotiline) alone or in combination	338	1.4 (0.8 – 2.5)
Cardiovascular system	1,104	4.7 (3.5 – 6.3)
Alpha-1 blockers for the treatment of hypertension (doxazosin)	117	0.5 (0.2 – 1.2)
Centrally acting alpha agonists for routine treatment of hypertension (methyldopa)	128	0.5 (0.2 – 1.7)
Class Ia, Ic, III antiarrhythmic drugs (amiodarone)	84	0.4 (0.1 – 0.9)
Aspirin at a dose > 150 mg/day	291	1.2 (0.6 – 2.4)
Digoxin > 0.125 mg/day	243	1.0 (0.6 – 1.8)
Loop diuretics (furosemide) as first-line monotherapy for hypertension	55	0.2 (0.1 – 0.7)
Nifedipine, immediate-release capsule	267	1.1 (0.7 – 1.9)
Endocrine system	1,335	5.7 (4.3 – 7.5)
Estrogens (with or without progesterones). Avoid oral forms and transdermal patches	24	0.1 (0.0 – 0.8)
Glibenclamide	1,311	5.6 (4.2 – 7.4)
Musculoskeletal system	331	1.4 (0.9 – 2.3)
Muscle relaxants (carisoprodol, cyclobenzaprine, orphenadrine)	331	1.4 (0.2 – 2.3)
Several	18	0.1 (0.0 – 0.6)
Theophylline as monotherapy for chronic obstructive pulmonary disease	18	0.1 (0.0 – 0.6)

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[1] Correspondence Thatiana Lameira Maciel Amaral E-mail: thatianalameira27@gmail.com

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Prevalence and factors associated the use of potentially inappropriate medications by older adults in Rio Branco, Acre, Brazil: a population-based study

Abstract

﻿Objective

Method

Results

Conclusion

Objective