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Identificação de potenciais complexidades terapêuticas no doente idoso institucionalizado : o exemplo do idoso com demência
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Abstract(s)
Introdução: Os idosos institucionalizados e com demência têm maior risco de apresentar complexidade terapêutica, que inclui fenómenos como Medicamentos Potencialmente Inadequados (MPI), interações medicamentosas clinicamente relevantes (crDDI), e a utilização de medicamentos com elevado risco de efeitos anticolinérgicos.
Objetivo: Avaliar a prevalência de complexidade terapêutica, MPI, crDDI e medicação com elevado risco de efeitos anticolinérgicos e estudar fatores preditores para um elevado risco de experienciar complexidade terapêutica.
Métodos: Foi realizado um estudo transversal com recurso a dados secundários provenientes de residências seniores (2015-2019). A prevalência de complexidade terapêutica foi definida como o residente apresentar pelo menos um dos seguintes fenómenos: MPI (identificados através dos Critérios de Beers de 2019 e dos critérios EU(7)PIM – operacionalizada em 2021 para Portugal); crDDI (através do Drug Interaction Checker – Medscape -, e Resumo de Características do Medicamento – RCM); e índex anticolinérgico (calculado através da escala ACB). Os fatores preditores foram identificados com recurso a uma regressão logística.
Resultados: Dos participantes cerca de 34,0% (n=79) apresentavam demência, sendo que 79,7% (n=63) eram do sexo feminino com uma média de idade de 84±6,8 anos. A prevalência de MPI foi de cerca de 96,2% (n=76) e 86,1% (n=68) com recurso aos critérios de Beers de 2019 e EU(7)PIM, respetivamente. A prevalência de crDDI foi de 44,2% (n=34), enquanto a prevalência de medicamentos com elevado risco de efeitos anticolinérgico foi de 62,3% (n=48). Os fatores preditivos de elevado risco de complexidade terapêutica foram o número de crDDI (OR 4,50; 95% CI 2,29-8,81), idade superior a 85 anos (OR 3,33; 95% CI 1,02-10,92) e o score ACB obtido (OR 2,64; 95% CI 1,69-4,14).
Conclusão: Concluiu-se que idosos com demência têm uma prevalência superior de complexidade terapêutica, nomeadamente MPI, crDDI e medicamentos com elevado score anticolinérgico-. Verificou-se que a idade avançada, o número de crDDI e o score ACB constituem fatores preditores para um risco elevado de experienciar complexidade terapêutica.
Background: The elderly institucionalised with dementia have a increase risk of medication complexities, which may include Potentially Inappropriate Medications (PIMs), clinically relevant drug-drug interactions (crDDI), and the use of medications with high anticholinergic burden. Main goals: We aimed to evaluate the prevalence of medication complexities, PIMs, crDDIs, medications with high anticholinergic score and to study predictors for a high risk of experiencing therapeutic complexity. Methods: A cross-sectional study was undertaken using secondary data from nursing homes (2015-2019). The prevalence of medication complexities was defined as the resident having at least one of the following phenomena: PIMs (identified using the 2019 update of Beers criteria e List EU (7) PIM)- operationalized in 2021 for Potugal); crDDI (identified using the Drug Interaction Checker – Medscape -, and the Summary of Product Characteristics – SmPC); and anticholinergic burden (calculated using ACB scale). The predictive factors were identified with logistic regression. Results: Of the participants 34.0% (n=79) had dementia and 79.7% (n=63) were female gender with a mean age of 84±6.8 years old. The prevalence of PIM was 96.2% (n=76) and 86.1% (n=68) with the Beers Criteria and the EU(7)PIM List, respectively. The prevalence of crDDIs was 44.2% (n=34), while the prevalence of medications with high anticholinergic burden was 62.3% (n=48). The predictive factors were the number of crDDIs (OR 4.50; 95% CI 2.29-8.81), advanced age (OR 3.33; 95% CI 1.02-10.92) and ACB score (OR 2.64; 95% CI 1.69-4.14). Conclusions: We found that patients with dementia have a higher prevalence of medication complexities, namely medications with high anticholinergic index, PIMs and crDDIs. It was found that advanced age, the number of crDDIs and the ACB score ar predictive factors for a high risk of experiencing medication complexity.
Background: The elderly institucionalised with dementia have a increase risk of medication complexities, which may include Potentially Inappropriate Medications (PIMs), clinically relevant drug-drug interactions (crDDI), and the use of medications with high anticholinergic burden. Main goals: We aimed to evaluate the prevalence of medication complexities, PIMs, crDDIs, medications with high anticholinergic score and to study predictors for a high risk of experiencing therapeutic complexity. Methods: A cross-sectional study was undertaken using secondary data from nursing homes (2015-2019). The prevalence of medication complexities was defined as the resident having at least one of the following phenomena: PIMs (identified using the 2019 update of Beers criteria e List EU (7) PIM)- operationalized in 2021 for Potugal); crDDI (identified using the Drug Interaction Checker – Medscape -, and the Summary of Product Characteristics – SmPC); and anticholinergic burden (calculated using ACB scale). The predictive factors were identified with logistic regression. Results: Of the participants 34.0% (n=79) had dementia and 79.7% (n=63) were female gender with a mean age of 84±6.8 years old. The prevalence of PIM was 96.2% (n=76) and 86.1% (n=68) with the Beers Criteria and the EU(7)PIM List, respectively. The prevalence of crDDIs was 44.2% (n=34), while the prevalence of medications with high anticholinergic burden was 62.3% (n=48). The predictive factors were the number of crDDIs (OR 4.50; 95% CI 2.29-8.81), advanced age (OR 3.33; 95% CI 1.02-10.92) and ACB score (OR 2.64; 95% CI 1.69-4.14). Conclusions: We found that patients with dementia have a higher prevalence of medication complexities, namely medications with high anticholinergic index, PIMs and crDDIs. It was found that advanced age, the number of crDDIs and the ACB score ar predictive factors for a high risk of experiencing medication complexity.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Polimedicação Demência Idosos Residências séniores