Suely Rozenfeld

Prevalência, fatores associados e mau uso de medicamentos entre os idosos: uma revisão

Most elderly people use at least one medication, and about one-third use more than five drugs simultaneously. Many patients have no access to the drugs they most need, and others use unnecessary or dangerous drugs. The mean number of drugs used by the elderly, as quoted in different studies, varies from 2 to 5. Significant predictors for such misuse of medication are older age, female gender, precarious health conditions, and depression. Cardiovascular drugs, anti-rheumatics, and analgesics are the most frequently consumed therapeutic classes. Multiple use, prescription of contraindicated drugs, redundant use, and inadequate training of the health care team are associated with adverse drug effects and interactions. Better quality of prescriptions and research on drug use can bring benefits to people aged 60 years or older.

The assessment of adverse events in hospitals in Brazil

OBJECTIVE To evaluate the incidence of adverse events in Brazilian hospitals. DESIGN Retrospective cohort study based on patient record review. SETTING Three teaching hospitals in the State of Rio de Janeiro, Brazil. PARTICIPANTS Random sample (1103) of 27 350 adult patients admitted in 2003. Patients under 18 years old, psychiatric patients and patients whose length of stay was less than 24 hr were excluded, and obstetric cases were included. MAIN OUTCOME MEASURE(S) Incidence of patients with adverse events; proportion of preventable adverse events; number of adverse events per 100 patients and incidence density of adverse events per 100 patient-days. RESULTS The incidence of patients with adverse events was 7.6% (84 of 1103 patients). The overall proportion of preventable adverse events was 66.7% (56 of 84 patients). The incidence density was 0.8 adverse events per 100 patient-days (103 of 13,563 patient-days). The patients ward was the most frequent location of adverse events (48.5%). In regard to classification, surgical adverse events were the most frequent ones (35.2%). CONCLUSIONS The incidence of patients with adverse events at the three hospitals was similar to that in international studies. However, the proportion of preventable adverse events was much higher in the Brazilian hospitals.

Inappropriate medication use among the elderly: a systematic review of administrative databases

BackgroundInappropriate medication use (IMU) by elderly people is a public health problem associated with adverse effects on health. There are a number of methods for identifying IMU, some involving clinical judgment and others, consensually generated lists of drugs to be avoided. This review aims to describe studies that used information from insurance company and social security administrative databases to assess IMU among community-dwelling elderly and to present the risk factors most often associated with IMU.MethodsThe paper search was conducted in Medline and Embase, using descriptors combined with free terms in the title or abstract. The limits applied were: publication date from January 1990 to June 2010, species (human) and publication type (excluding editorials, letters and reviews). Excluded were: case studies; studies in hospitals, nursing homes, or hospital emergency departments; studies of specific drugs or groups of drugs; studies exclusively of subgroups of ill, frail elderly or rural populations. Additional studies were identified from reference lists. Data were selected and extracted after independent reading by two of the authors, with disagreements resolved by a third author. The primary outcome assessed was prevalence of IMU, defined as the proportion of elderly who received at least one inappropriate medication.ResultsOf the 628 studies, 19 met the inclusion criteria, 78.9% of them conducted in the USA. All papers included used explicit criteria of inappropriateness, most commonly Beers criteria (73.7%) in their three versions (1991, 1997 and 2002). Other methods used included Zhan, which is derived from on Beers criteria and was applied in 21% of the papers selected. The study found that prevalence of IMU ranged from 11.5% to 62.5%. Only 68.4% of the studies included examined inappropriate use-related factors, the most important being female sex, advanced age and larger number of drugs.ConclusionsThe results show that the prevalence of IMU among community-dwelling elderly is high and depends partly on the method used to evaluate improper use. Besides the diversity of methods, other factors, such as patient sex, age and number of drugs used concurrently, appear to have influenced the estimates of IMU.

Drug utilization and polypharmacy among the elderly: a survey in Rio de Janeiro City, Brazil

OBJECTIVES To describe drug utilization by Brazilian retirees with an emphasis on inappropriate use. METHODS Cross-sectional study with a simple random sample of 800 retirees of the Brazilian Institute of Social Security, 60 years of age and older, residing in Rio de Janeiro City, through face-to-face interviews. RESULTS Medication use in the 15 days before the study was reported by 85% of the sample, with a mean of 3.7 products per person (standard deviation=2.9). About half the sample used one to four medications and a third used five or more. The highest number of drugs used per patient was 24. More women than men used multiple medications. There is a tendency toward positive association (P<0.001) between drug use and variables relating to disease and health care. This trend continues in the analysis by gender. Men who reported five or more diseases were five times more likely to use multiple drugs than men with up to two (zero, one, or two) diseases (prevalence ratio 5.21, 95% confidence interval=2.48-10.90). Women who reported five or more diseases were nearly four times more likely to use multiple drugs than women with up to two diseases (prevalence ratio 3.67, 95% confidence interval=2.24-6.02). Of the active substances used by the sample, 10% were considered inappropriate. CONCLUSIONS To improve drug therapy for the elderly, health practitioners can take measures to reduce unwarranted use of medication and to optimize the benefits from important drugs. Further studies should be conducted to adjust lists of medications inappropriate for the elderly to the situation in developing countries.

Epidemiologia de internações por doença falciforme no Brasil

OBJETIVO: A doenca falciforme e uma enfermidade hereditaria que afeta principalmente a populacao negra. O estudo teve por objetivo analisar as internacoes devido as complicacoes da doenca, com enfoque nos aspectos epidemiologicos e clinicos. METODOS: A populacao estudada foi constituida de 9.349 pacientes com diagnostico de doenca falciforme internados em hospitais da Bahia, Rio de Janeiro e Sao Paulo, no periodo de 2000 a 2002. Utilizaram-se os dados do Sistema de Internacoes Hospitalares do Sistema Unico de Saude. As variaveis respostas foram o obito e o tempo medio de permanencia hospitalar. As covariaveis foram o sexo, a idade, o tipo de admissao e a natureza juridica do hospital. As proporcoes foram comparadas utilizando-se o teste qui-quadrado ou de Fischer; e para as variaveis continuas, foi utilizado o teste Mann-Whitney ou Kruskall-Wallis. RESULTADOS: A mediana de idade variou de 11,0 a 12,0 anos e cerca de 70% das internacoes foram abaixo dos 20 anos. A mediana de dias de permanencia hospitalar variou com a idade e o tipo de admissao. O tipo de admissao mais frequente foi pela emergencia (65,6 a 90,8%). Foi observada maior letalidade hospitalar entre adultos. A mediana da idade do obito foi baixa (26,5 a 31,5 anos). CONCLUSOES: Os resultados confirmaram a alta morbidade na populacao jovem e evidenciaram predominância de obitos entre adultos jovens.

Adverse drug events in hospitals: a systematic review

The objective of this study was to evaluate studies on the occurrence of adverse drug events (ADEs) in hospitals in order to learn about their frequency and characteristics, comparing the methods for identifying them and the various definitions. A search was conducted on MEDLINE and identified studies published from 2000 to 2009. Inclusion criteria were: studies in populations not selected for specific diseases or drugs and ADEs that occurred during hospitalization. Twenty-nine studies were selected, displaying multiple sources of heterogeneity, including differences in the study populations, surveillance techniques, definitions of ADEs, and indicators. The proportion of patients with ADEs ranged from 1.6% to 41.4% of inpatients and the rates ranged from 1.7 to 51.8 events/100 admissions. A considerable share of these events could have been avoided. The findings show that ADEs in inpatients are a public health problem. However, further studies are needed to monitor these adverse events in order to effectively promote safe drug use.

Inquérito sobre uso de medicamentos por idosos aposentados, Belo Horizonte,MG

OBJETIVO: Caracterizar o uso de medicamentos por aposentados e pensionistas idosos, com enfase nas diferencas entre generos. METODOS: Inquerito domiciliar conduzido com amostra aleatoria simples de 667 individuos com 60 anos ou mais, residentes em Belo Horizonte, MG, em 2003. Os idosos foram entrevistados por farmaceuticos, utilizando questionario padronizado. Foram estimadas a prevalencia de uso e a media de medicamentos usados nos ultimos 15 dias anteriores a entrevista, as quais foram estratificadas de acordo com o genero segundo variaveis sociodemograficas e de saude. RESULTADOS: A prevalencia de uso de medicamentos foi de 90,1%, significativamente maior entre as mulheres (93,4%) do que entre os homens (84,3%). Mulheres utilizaram em media 4,6±3,2 produtos e homens 3,3±2,6 (p<0,001). Os principios ativos mais usados pelos idosos pertenciam aos sistemas cardiovascular, nervoso, e do trato alimentar e metabolismo. O consumo foi superior entre as mulheres nesses tres grupos, assim como as medias de uso de medicamentos segundo variaveis sociodemograficas e de saude selecionadas. CONCLUSOES: O estudo identificou uso mais intenso de medicamentos pelas mulheres, fato que as torna mais vulneraveis aos prejuizos de polifarmacia, como risco de interacoes e uso inadequado.

Triagem auditiva em idosos: comparacão entre auto-relato e audiometria

Despite its high prevalence in the aged, hearing loss has been poorly investigated. Audiometry is the gold standard for evaluation of hearing loss, but large-scale use of the procedure involves operational difficulties. Thus, self-report may be an alternative. AIM: To determine if a single global question is valid for use in epidemiologic research. STUDY DESIGN: Systematic review. MATERIAL AND METHOD: A search of the medical literature from 1990 to 2004 was performed using MEDLINE and LILACS. The references of the articles identified in the electronic search were also reviewed. STUDY SELECTION AND DATA EXTRACTION: The articles that compared the results obtained with self-report to a single global question with those obtained by pure tone audiometry were selected. Data about the prevalence of hearing loss, and sensitivity, specificity and predictive values were extracted. DATA SYNTHESIS: Ten longitudinal studies were included. A single global question seems to be an acceptable indicator of hearing loss, sensitive and reasonably specific, mainly if the hearing loss is identified as the tone average that includes frequencies up to 2 or 4 kHz, at 40 dBHL level, in the best ear. CONCLUSION: A single global question shows good performance in identifying older persons with hearing loss and can be recommended for an epidemiologic study if audiometric measurements cannot be performed.

O uso prolongado de benzodiazepínicos em mulheres de um centro de convivência para idosos

While experts recommend caution against long-term benzodiazepine use in the elderly, survey data suggests that the use of benzodiazepine increase with age. The patterns of benzodiazepine use and factors associated with long-term use in population at risk were studied with a standarlized questionnaire applied to 634 women over 60, who attended a daycare center for older people in Rio de Janeiro between May, 1992 and December, 1995. Prevalence of benzodiazepine use in the last 15 days was 21.3% (CI 95% 18.1-24.5), and prevalence of daily use for 12 or more months was 7.4% (CI 95% 5.4-9.4). In a multivaried analysis the amount of drugs being consumed displayed an important and progressive association with long-term benzodiazepine use, with OR = 2.77 (CI 95% 1.17-6.57) for those who take from four to six drugs, and OR = 7.62 (CI 95% 3.18-18.26) for those who take more than seven drugs. Insomnia (OR = 8.87 CI 95% 2.53-31.06) and chronic headache (OR = 3.53 CI 95% 1.82-6.89) have also been associated with this pattern of use.

Malnutrition mortality in the elderly, southeast Brazil, 1980-1997

OBJECTIVE To assess the frequency of nutritional disturbances as cause of death in elderly. METHODS Female and male subjects aged 60 years and more were selected from municipalities of the southeastern region between 1980 and 1997. Data was collected from death certificates provided by the Death Data System (1980-1998) and the population size was estimated using data provided by the Center for Regional Development and Planning (Cedeplar). Death categorization was performed using the ICD-9 (260 to 263.9) for the period 1980 to 1995 and ICD-10 (E40 to E46) for recent years. RESULTS In Brazil, between 1980 and 1997, there were 36,955 deaths associated to malnutrition among elderly. The southeast region concentrates the largest number of deaths, 23,968 (64.9%). In the state of São Paulo, there were 11,067 deaths caused by malnutrition in elderly and in the state of Rio de Janeiro, 7,763. These two regions are responsible for the highest values observed for the region. There are higher death proportions and mortality rates among subjects aged 70 years and more than in subjects of any sex of the age group 60 to 69 years. CONCLUSION The preliminary results of the study raise some issues as follows: the role of malnutrition as an associated cause of death; the trend of increased number of deaths for malnutrition among elderly people; distinctive death characteristics among states in the same geographic region. Statistical analysis such as time series analysis might explain better these issues. There is a need to further study the role of malnutrition among elderly aged 60 years and more to establish adequate intervention programs.