Medicamentos potencialmente inapropriados utilizados por idosos da Estratégia de Saúde da Família de São João del-Rei

Abstract

Human aging affects the body's pharmacokinetic and pharmacodynamic responses, thus medication safety is of utmost importance emphasizing the use of Potentially Inappropriate Medications (PIM) for older people. Despite multiple studies evaluating clinical outcomes and economic impacts related to PIM use, there is a lack of longitudinal studies assessing the 2023 updated Beers criteria. This study examined the use and factors associated with PIM use by the elderly people into the community following the 2019 and 2023 Beers criteria and evaluated predictive value of these criteria in different clinical outcomes at one-year follow-up. It is a population-based longitudinal study one-year follow-up from 2017 to 2018 with 490 older adults under the Family Health Strategy in São João del-Rei, Brazil. The Beers criteria, versions 2019 and 2023, were used to identify PIM. Different health outcomes were assessed, such as cognition (as measured by Mini-Mental State Examination), sleep (evaluated using the Mini-Sleep questionnaire), mental health (assessed via the DASS-21), quality of life (gauged using the WHOQOL-Bref), successful aging (measured with the Successful Aging Scale) and life satisfaction (evaluated through the Life Satisfaction Scale). Generalized Estimating Equations were used to evaluate if the presence of PIM was longitudinally associated with diverse outcomes following the one-year follow-up period. A total of 255 (52%) of the elderly used at least 1 PIM. There were slight differences between two criteria (2019 and 2023) among elderly people into the community. The most common PIM were benzodiazepines, followed by Proton pump inhibitors and Sulfonylureas. We found that some sociodemographic factors (e.g. marital status and race) and clinical factors (e.g. difficulties in ADLs and number of diseases) were associated with the presence or number of PIM at baseline. In the longitudinal analysis, the presence of PIM exhibited associations with a spectrum of outcomes observed after one-year of follow up period. These outcomes included diminished physical quality of life, disrupted sleep patterns, compromised mental health (depression, stress and anxiety), successful aging and satisfaction with life. The conclusion is that the use of at least one PIM according to the Beers 2023 criteria was high and predictive of worse health outcomes. This underscores the imperative for healthcare professionals to exercise caution when prescribing a medications to their elderly patients.