The iatrogenic triad in a group of elderly women contracted to a health plan

Abstract

Objective: to study the main elements of the iatrogenic triad in a group of elderly women with a Chronic Non-Communicable Disease (CNCD) contracted to a health plan. Method: A cross-sectional and descriptive epidemiological study was carried out by analyzing 3,501 medical prescriptions of 725 elderly women aged ≥65 years. The medications were determined to be Potentially Inappropriate Medications (PIM) based on four instruments (AGS Beers 2015, PRISCUS List, EU(7)-PIM, Brazilian Consensus of PIM - CBPIM). In addition, the most prescribed drugs were assessed for possible Drug Interactions (DI) and classified according to degree of severity. Results: the present study revealed that 89.3% of the studied group used at least one element of the iatrogenic triad, and 44.9% of the sample were associated with the use of polypharmacy and PIM. A total of 48.0% were taking at least five continuous use medications. The main DI were omeprazole, simvastatin and levothyroxine, all of which are of significant severity and have potential drug-food interactions. A total of 35.1% of PIM were identified through the four criteria used, 26.6% were identified by the CBPIM, 25.8% by the EU(7)-PIM, and 24.6% and 6.6% by AGS Beers and PRISCUS, respectively. Conclusion: a high index of continuous use medications, PIM and potential DI were identified, mainly enzymatic inhibitors in a group of elderly women at risk due to their clinical characteristics. Old age was associated with the presence of all the elements of the iatrogenic triad. It was also noted that there were no significant differences between the criteria applied, except for the PRISCUS list.

Consenso brasileiro de medicamentos potencialmente inapropriados (CBMPI) associados a idade avançada, polifarmacia e multimorbidade circulatória / Brazilian consensus on potentially inappropriate medications (BCPIM) associated with advanced age, polypharmacy and cardiovascular multimorbidities

“…11 Therefore, it is believed that the presence of low socioeconomic conditions that restrain from the purchase of safer medications combined with lower educational levels are directly related to the use of medications that are less safe but more accessible to this group. 12 The high prevalence of PIM identified as non-selective irreversible COX inhibitors and proton pump inhibitors are consistent with the national literature 2,3,13 and justified for this group. Those medications are free and easily dispensed in Brazilian pharmacies under the restriction of medical prescriptions.…”

“…Medicalization involves risks to the health security of the elderly, because, if the risk is greater than the clinical benefits provided, when safer and more effective alternatives are available, it is considered to be potentially inappropriate for the individual. 1,2 Medicalization involves risks to the overall health of the elderly. This is based on the fact that if the risk is greater than the clinical benefits provided by the medication or when safer and more effective alternatives are available, that medication is considered to be potentially inappropriate for the individual.…”

Elderly individuals living by themselves: knowledge and measures to prevent the novel coronavirus

“…In this context, educational actions in the nursing field should be planned to reach elderly men living by themselves. In addition to educational practices within the healthcare network ( 44 ) , nurses’ competencies such as preventive actions and the early detection of infections by the novel coronavirus should be implemented during gerontological nursing consultations.…”

Atividade física como fator protetor para o extremo baixo peso em idosos assistidos por uma operadora de saúde

“…Além do citado, estes idosos pesquisados apresentam uma média geral de consumo diário de medicamentos/idosos superior ao encontrado na literatura nacional para idosos do mesmo setor de assistência à saúde. 16,17 A elevada utilização de fármacos em associação eleva o risco de desencadeamento de eventos adversos, tais como: intoxicação, prescrição em cascata e a tríade iatrogênica (definida como consumo de pelo menos um medicamento potencialmente inapropriado associado ao uso contínuo de polifarmácia e a presença de potenciais interações medicamentos e reações adversas). 16,17 O uso de múltiplos fármacos também pode interferir tanto na absorção de nutrientes quanto na ingesta de alimentos, podendo piorar o estado nutricional dos idosos.…”