POLYPHARMACY IN ELDERLY PATIENTS: MEDICATION ADHERENCEIntroduction: In recent decades, the number of elderly people has increased significantly in western societies, resulting in a high prevalence of chronic diseases and, therefore, in increased polypharmacy. In addition, established therapies are frequently complex, many times leading to therapeutic incompliance, which comprises a frequent therapeutic-related problem that may prejudice the treatment outcome. Objectives: To evaluate the levels of adherence to therapy in people over 60 years who evidence polypharmacy, identifying the factors affecting adherence levels. Methodology: Population-based, transversal and exploratory study, by questionnaire application. Sample: 51 polymedicated individuals (minimum four prescribed medicines) from a daily center located in the city of Olhão, with minimum age of 60 years. Diagnostic of, at least, one pathology treated since a minimum of six months. Assessed variables: social-demographic data, administration difficulties and amount of medicines administered daily. Results: The sample was composed of approximately 70% female and 30% male, with ages between 64 and 98 years (mean of 80 years). It was observed that all the individuals were adherent to therapy, although with different adherence levels, 94% of the whole sample being completely or very adherent to the therapy. Amongst all the studied variables, it was found that only marital status and oblivion, as a problem associated to therapy administration, affected adherence levels.The results allowed concluding that, with high probability, the fact that the elderly people were at a daily centre, led to higher therapeutic adherence.

This work proposes the design of nanoparticles based on locus bean gum (LBG) and chitosan to be used as oral immunoadjuvant for vaccination purposes. LBG-based nanoparticles were prepared by mild polyelectrolyte complexation between chitosan (CS) and a synthesized LBG sulfate derivative (LBGS). Morphological characterization suggested that nanoparticles present a solid and compact structure with spherical-like shape. Sizes around 180-200nm and a positive surface charge between +9mV and +14mV were obtained. CS/LBGS nanoparticles did not affect cell viability of Caco-2 cells after 3h and 24h of exposure when tested at concentrations up to 1.0mg/mL. Two model antigens (a particulate acellular extract HE of Salmonella enterica serovar Enteritidis, and ovalbumin as soluble antigen) were associated to CS/LBGS nanoparticles with efficiencies around 26% for ovalbumin and 32% for HE, which resulted in loading capacities up to 12%. The process did not affect the antigenicity of the associated antigens. BALB/c mice were orally immunized with ovalbumin-loaded nanoparticles (100μg), and results indicate an adjuvant effect of the CS/LBGS nanoparticles, eliciting a balanced Th1/Th2 immune response. Thus, CS/LBGS nanoparticles are promising as antigen mucosal delivery strategy, with particular interest for oral administration.

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