Adequação medicamentosa aos Critérios de Beers e condução do tratamento medicamentoso por idosos atendidos em um ambulatório de geriatria do interior de Minas Gerais

Abstract

Polypharmacy and prescribing medicines considered potentially inappropriate for elderly, associated with the driving mode of drug treatment instituted can trigger adverse drug reactions (ADR) and expose a vulnerable age group at greatest risk. The use of standardized lists of potentially inappropriate medication (PIM), as the 2012 AGS Beers Criteria, are an effective means of ascertaining the consumption pattern of these medicines and assist in safer care. The objective of this research was to evaluate the inappropriate prescription of medicines for elderly individuals and the consumption mode of medications, including selfmedication, PIM consumption without prescription, possible occurrences of drug interactions with nutrients and disease and the presence of signs and symptoms characteristic of ADR; in Geriatrics outpatient clinic of Federal University of Triangulo Mineiro (UFTM). Observational, descriptive and quantitative study, composed of part retrospective and prospective part. Held with seniors who started the monitoring in Geriatrics outpatient clinic of UFTM in the period from January 01,2013 to June 30, 2015 having performed at least two queries and residing in the urban area of Uberaba. The first stage of the research was conducted through the collection of data in medical records. The second stage consisted of home interview including socio-demographic data, health profile and lumefantrine, practice of self-medication, food consumption concomitant medication and symptoms and signs of ADR. Data were entered and tabulated for statistical analyses descriptives and exploratory, comparatives and test of hypotheses. There were in this study 54 elderly, female predominance (61,1%), age of 80 to 89 years (38,9%), between 1 to 5 years schooling (46,3%), widowed (51,9%), income of a minimum wage (66,7%), living with children and/or grandchildren (53,7%), showing four to six associated Comorbidities (44,4%) being the most prevalent hypertension (72,2%), involvement by a deficiency (37%) , having featured a hearing (38,9%). In relation to the drug profile, the majority mentioned has received guidance (94,4%), does not require help to take the medications (55,6%), had the main oblivion difficulty (62,5%), and consume the remedies in appropriate hours (51,9%). In the first query,the hit 40,7% of elderly polypharmacy and 55,6% were in use at least one PIM. In the second query 50% of elderly were on polypharmacy and 51,9% had indication of consumption of PIM. The cardiovascular system has been the main target of drugs in both queries (25,4% and 26,8%) and Pain Therapeutics category was the most hit by the PIM prescribed (54,4%). There was no drug appropriateness with the treatment evolution. The elderly were doing selfmedication (79,6%), being prevalent the use of analgesics (66,7%), family members and acquaintances was the main reason for the practice (44,2%), and 52,3% used PIM without prescription. Out of the total, 46,3% made use of herbal remedies, mostly teas (92%), and did not use vitamin supplements (68,5%). In relation to interactions, 66,7% ingested drugs only with water, 90,8% used at least one of the foods that make interaction with medications, especially the coffee (70,4%), and the dementia associated with the consumption of medications that can interact with the medical condition reached 41,7% of seniors who had this condition. All the elderly (100%) presented some of the symptoms and signs of ADR, including difficulties with memory (65%) and social isolation (61,1%); half of older people (50%) reported other different symptoms and 42,6% related the ADR to the use of specific drugs. The results allow to understand the profile of the elderly and drug treatment established by attending outpatient clinic. The high prevalence of prescription of PIM and self-medication reflect the need to undertake further studies addressing these themes. In this way, they will contribute to possible adaptations of governmental plans and domestic distribution of free sale, and for the development of tools to aid and assist in the requirements towards the reality experienced in our country.