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Ferramentas de avaliação de medicamentos potencialmente inapropriados em idosos institucionalizados: um estudo comparativo
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Abstract(s)
Com o aumento da idade é previsível que surjam múltiplas patologias e, por conseguinte, um aumento do consumo de medicamentos. As diversas alterações fisiológicas, farmacocinéticas e farmacodinâmicas inerentes à idade, associadas à polimedicação e à fragilidade dos idosos, torna-os mais suscetíveis a problemas relacionados com medicamentos. Devido à necessidade constante de cuidados de saúde, a institucionalização torna-se uma necessidade. Estes indivíduos estão diversas vezes sujeitos ao consumo de medicamentos potencialmente inapropriados, medicamentos cujo risco de um evento adverso supera o benefício clínico, havendo risco aumentado de interações e reações adversas. De modo a identificar estes medicamentos utilizam-se métodos baseados em critérios implícitos e explícitos. São diversas as listas geradas por consenso, sendo a Lista Europeia (EU(7)-PIM) e os Critérios NORGEP dois exemplos.
O objetivo principal deste trabalho foi a comparação de duas ferramentas para identificação de medicamentos potencialmente inapropriados em idosos institucionalizados.
Foram analisados os perfis terapêuticos de 58 indivíduos (25 do sexo masculino e 33 do sexo feminino) com uma média de idades de 81,95 ± 11,80 anos, que consumiam, em média, 6,97 ± 3,11 medicamentos. Cerca de 81% (n=47) encontravam-se polimedicados e 86,20% (n=50) sujeitos a potenciais interações medicamentosas. A Lista EU(7)-PIM permitiu identificar uma média de 2,31 ± 1,76 MPI, enquanto os Critérios NORGEP identificaram uma média de 3,07 ± 2,16 critérios, por indivíduo, resultado estatisticamente significativo (Wpadronizado=2,639; p=0,008). Embora ainda não operacionalizados para Portugal, os Critérios NORGEP parecem ser passíveis de ser utilizados em pacientes idosos institucionalizados, sendo uma ferramenta sensível que poderá auxiliar os profissionais de saúde na identificação de medicamentos potencialmente inapropriados em utentes idosos institucionalizados.
As age increases, so does the prevalence of multiple illnesses and, thus, an increase in medication use is more likely. There are several physiological, pharmacokinetic, and pharmacodynamic changes inherent to ageing that are associated with polymedication and frailty in elders, making them more susceptible to medication-related problems. Due to the constant need for health care, entering an assisted living facility or nursing home can be necessary. Elderly, institutionalized, individuals are often subjected to the use of potentially inappropriate medications, of which the adverse events greatly outweigh clinical benefits and are associated with an increased risk of interaction between different medicines and adverse reactions. In order to identify these medicines, methods based on implicit and explicit criteria are used. There are several generally agreed lists of criteria, with the European List (EU(7)-PIM) and the NORGEP Criteria being two examples. The main objective of this thesis was to compare two tools for identifying potentially inappropriate medication among the elderly within nursing homes. The therapeutic profiles of 58 individuals (25 male and 33 female) with an average age of 81,95±11,80 years, who consumed, on average, 6,97 ± 3,11 medicines, were analysed. About 81% (n=47) were polymedicated and 86,20% (n=50) were subjected to potential interactions between medicines. The EU(7)-PIM List identified an average of 2,31±1,76 MPI, while the NORGEP Criteria identified an average of 3,07±2,16 criteria, per individual, a statistically significant result (Wstandardized=2,639; p=0,008). Although not yet adapted to be used in Portugal, the NORGEP Criteria seem to be appropriate in elderly patients in nursing homes, constituting a sensitive tool that may assist health professionals in identifying potentially inappropriate medicines administered to the elderly in nursing homes.
As age increases, so does the prevalence of multiple illnesses and, thus, an increase in medication use is more likely. There are several physiological, pharmacokinetic, and pharmacodynamic changes inherent to ageing that are associated with polymedication and frailty in elders, making them more susceptible to medication-related problems. Due to the constant need for health care, entering an assisted living facility or nursing home can be necessary. Elderly, institutionalized, individuals are often subjected to the use of potentially inappropriate medications, of which the adverse events greatly outweigh clinical benefits and are associated with an increased risk of interaction between different medicines and adverse reactions. In order to identify these medicines, methods based on implicit and explicit criteria are used. There are several generally agreed lists of criteria, with the European List (EU(7)-PIM) and the NORGEP Criteria being two examples. The main objective of this thesis was to compare two tools for identifying potentially inappropriate medication among the elderly within nursing homes. The therapeutic profiles of 58 individuals (25 male and 33 female) with an average age of 81,95±11,80 years, who consumed, on average, 6,97 ± 3,11 medicines, were analysed. About 81% (n=47) were polymedicated and 86,20% (n=50) were subjected to potential interactions between medicines. The EU(7)-PIM List identified an average of 2,31±1,76 MPI, while the NORGEP Criteria identified an average of 3,07±2,16 criteria, per individual, a statistically significant result (Wstandardized=2,639; p=0,008). Although not yet adapted to be used in Portugal, the NORGEP Criteria seem to be appropriate in elderly patients in nursing homes, constituting a sensitive tool that may assist health professionals in identifying potentially inappropriate medicines administered to the elderly in nursing homes.
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Keywords
Critérios NORGEP Idosos Institucionalização Lista EU(7)-PIM Medicamentos potencialmente inapropriados Polimedicação