Prescrição de fármacos inapropriados em idosos hospitalizados: análise da mortalidade e sobrevida
Ano de defesa: | 2023 |
---|---|
Autor(a) principal: | |
Orientador(a): | |
Banca de defesa: | , , , |
Tipo de documento: | Tese |
Tipo de acesso: | Acesso aberto |
Idioma: | por |
Instituição de defesa: |
Universidade Federal de Santa Maria
Centro de Ciências da Saúde |
Programa de Pós-Graduação: |
Programa de Pós-Graduação em Farmacologia
|
Departamento: |
Farmacologia
|
País: |
Brasil
|
Palavras-chave em Português: | |
Palavras-chave em Inglês: | |
Área do conhecimento CNPq: | |
Link de acesso: | http://repositorio.ufsm.br/handle/1/30480 |
Resumo: | Introduction: Elderly people (>60 years old) have a high prevalence of chronic noncommunicable diseases (DCNTs), often managed through the daily use of four or more drugs (polypharmacy). Furthermore, they may present biogerontological changes that affect the pharmacodynamics and pharmacokinetics of drugs. These situations increase the risk of adverse effects (especially geriatric syndromes), hospitalization, institutionalization and death. Therefore, several drugs are considered “potentially inappropriate medications” (MPIS) for the elderly, and these are prescribed daily in the elderly’s routine. However, the impact of the use of these drugs when used prior to hospitalization still needs to be clarified. Objective: To investigate the hospitalization profile and identify the impact of the use of inappropriate drugs prior to hospitalization on in-hospital mortality in the elderly. Methodology: Two complementary studies will be conducted. Study 1: It sought to evaluate the profile of elderly people upon admission, hospital evolution and outcome, as well as verify the association of the admission profile with the hospitalization outcome. A prospective cohort study was conducted. The variables analyzed for hospital admission were the sociodemographic profile and clinical-functional profile, as well as the evolution variables, the length of hospital stay and complications, and, as an outcome, hospital discharge or death. Study 2: approved by the Research Ethics Committee (CEP-UFSM, CAEE 48212915.50000.5346). It involved an epidemiological, prospective observational investigation in elderly people who sought emergency care and were hospitalized for various causes. Data were obtained through a structured interview that included instruments related to socioeconomic, cultural, lifestyle, health and previous daily use of MPISs and other drugs. Survival assessment was carried out up to 30 days after hospital discharge. Information on the clinical evolution of geriatric syndromes and survival was obtained via medical records. The drugs were pharmacologically categorized according to their action on the systems: nervous, cardiovascular, digestive, endocrine and osteo-muscular. The elderly were then grouped as MPIS users and non-users (control). The evolution of geriatric complications and the survival of the elderly were statistically analyzed using univariate tests and multivariate Cox regression. Results: In study 1, 493 elderly people were evaluated, with the majority of young elderly people, who lived alone, admitted to the hospital due to neoplasia. There was a positive association between death and age, Delirium, Charlson Comorbidity Index, Senior Risk Index, Frailty and calf circumference values. It was found that the elderly population that enters hospital emergency rooms presents multimorbidities, functional declines, frailty and greater exposure to adverse events during hospitalization, including death. In study 2, 318 patients aged ≥ 65 years were evaluated. The medications prescribed by these patients were recorded and the use of MPIS-ph was identified by the Brazilian consensus-based analysis of MPIS use. The impact of the use of MPIS-ph on the survival of hospitalized elderly people was determined through multivariate Cox regression analysis. Conclusions: The functional clinical profile, as well as pharmacological prescriptions, must be analyzed when creating care plans for elderly people entering in emergencies, as there are several variables that affect their outcomes. |
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2023-11-10T18:27:51Z2023-11-10T18:27:51Z2023-09-29http://repositorio.ufsm.br/handle/1/30480Introduction: Elderly people (>60 years old) have a high prevalence of chronic noncommunicable diseases (DCNTs), often managed through the daily use of four or more drugs (polypharmacy). Furthermore, they may present biogerontological changes that affect the pharmacodynamics and pharmacokinetics of drugs. These situations increase the risk of adverse effects (especially geriatric syndromes), hospitalization, institutionalization and death. Therefore, several drugs are considered “potentially inappropriate medications” (MPIS) for the elderly, and these are prescribed daily in the elderly’s routine. However, the impact of the use of these drugs when used prior to hospitalization still needs to be clarified. Objective: To investigate the hospitalization profile and identify the impact of the use of inappropriate drugs prior to hospitalization on in-hospital mortality in the elderly. Methodology: Two complementary studies will be conducted. Study 1: It sought to evaluate the profile of elderly people upon admission, hospital evolution and outcome, as well as verify the association of the admission profile with the hospitalization outcome. A prospective cohort study was conducted. The variables analyzed for hospital admission were the sociodemographic profile and clinical-functional profile, as well as the evolution variables, the length of hospital stay and complications, and, as an outcome, hospital discharge or death. Study 2: approved by the Research Ethics Committee (CEP-UFSM, CAEE 48212915.50000.5346). It involved an epidemiological, prospective observational investigation in elderly people who sought emergency care and were hospitalized for various causes. Data were obtained through a structured interview that included instruments related to socioeconomic, cultural, lifestyle, health and previous daily use of MPISs and other drugs. Survival assessment was carried out up to 30 days after hospital discharge. Information on the clinical evolution of geriatric syndromes and survival was obtained via medical records. The drugs were pharmacologically categorized according to their action on the systems: nervous, cardiovascular, digestive, endocrine and osteo-muscular. The elderly were then grouped as MPIS users and non-users (control). The evolution of geriatric complications and the survival of the elderly were statistically analyzed using univariate tests and multivariate Cox regression. Results: In study 1, 493 elderly people were evaluated, with the majority of young elderly people, who lived alone, admitted to the hospital due to neoplasia. There was a positive association between death and age, Delirium, Charlson Comorbidity Index, Senior Risk Index, Frailty and calf circumference values. It was found that the elderly population that enters hospital emergency rooms presents multimorbidities, functional declines, frailty and greater exposure to adverse events during hospitalization, including death. In study 2, 318 patients aged ≥ 65 years were evaluated. The medications prescribed by these patients were recorded and the use of MPIS-ph was identified by the Brazilian consensus-based analysis of MPIS use. The impact of the use of MPIS-ph on the survival of hospitalized elderly people was determined through multivariate Cox regression analysis. Conclusions: The functional clinical profile, as well as pharmacological prescriptions, must be analyzed when creating care plans for elderly people entering in emergencies, as there are several variables that affect their outcomes.Introdução: Idosos (>60 anos) têm alta prevalência de doenças crônicas nãotransmissíveis (DCNTs), muitas vezes manejadas através do uso diário de quatro ou mais fármacos (polifarmácia). Ainda, podem apresentar alterações biogerontológicas que afetam a farmacodinâmica e farmacocinética dos fármacos. Estas situações aumentam o risco de efeitos adversos (em especial síndromes geriátricas), hospitalização, institucionalização e morte. Desta forma, diversos fármacos são considerados “medicamentos potencialmente inapropriados” (MPIs) para idosos, e estes são prescritos diariamente na rotina de idosos. Entretanto, o impacto do uso destes fármacos quando utilizados previamente a hospitalização, ainda precisa ser esclarecido. Objetivo: Investigar o perfil de internação e identificar o impacto do uso prévio de fármacos inapropriados a internação na mortalidade intra-hospitalar de idosos. Metodologia: Dois estudos complementares serão conduzidos. Estudo 1: Buscou avaliar o perfil de idosos na admissão, evolução hospitalar e desfecho, como também verificar a associação do perfil da admissão com o desfecho da internação. Foi conduzido um estudo de coorte prospectiva. As variáveis analisadas da admissão hospitalar foram o perfil sociodemográfico e perfil clínico-funcional, já as variáveis da evolução, o tempo de internação hospitalar e complicações, e, como desfecho, a alta hospitalar ou o óbito. Estudo 2: aprovado pelo Comitê de Ética em Pesquisa (CEPUFSM, CAEE 48212915.50000.5346). Envolveu uma investigação epidemiológica, prospectiva observacional em idosos que procuraram atendimento de emergência e foram hospitalizados por diversas causas. A obtenção dos dados, foi realizada por entrevista estruturada que incluiu instrumentos relacionados a indicadores socioeconômicos, culturais, estilo de vida, saúde e uso prévio diário de MPIs e outros fármacos. A avaliação da sobrevivência foi feita até 30 dias após a alta hospitalar. Informações da evolução clínica de síndromes geriátricas e de sobrevivência foram obtidas via prontuários. Os fármacos foram farmacologicamente categorizados segundo a sua atuação nos sistemas: nervoso, cardiovascular, digestório, endócrino e ósteo-muscular. Os idosos foram então agrupados como usuários de MPISs e não usuários (controle). A evolução de complicações geriátricas e a sobrevivência dos idosos foram estatisticamente analisadas por testes univariados e pela regressão multivariada de Cox. Resultados: No estudo 1, foram avaliados 493 idosos, com maioria de idosos jovens, que moravam sozinhos, admitidos no hospital devido a neoplasia. Houve associação positiva do óbito com a idade, Delirium, índice de Comorbidades de Charlson, Índice de risco sênior, Fragilidade e valores da circunferência de panturrilha. Verificou-se que a população idosa que ingressa em emergência hospitalar apresenta multimorbidades, declínios funcionais, fragilidade e maior exposição a eventos adversos durante a internação, entre eles o óbito. No estudo 2, foram avaliados 318 pacientes com idade ≥ 65 anos. Os medicamentos que possuíam prescrição por esses pacientes foram registrados e o uso de MPIsph(Medicamentos potencialmente inapropriados prévios a internação) foi identificado pela análise brasileira baseada em consenso de uso de MPIs. O impacto do uso de MPIs-ph na sobrevida de idosos hospitalizados foi determinado por meio da análise multivariada de regressão de Cox. Conclusões: O perfil clínico funcional, assim como de prescrições farmacológicas devem ser analisados na construção dos planos de cuidados dos idosos que ingressam nas emergências, visto que diversas são as variáveis que interferem nos desfechos destes.Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPqporUniversidade Federal de Santa MariaCentro de Ciências da SaúdePrograma de Pós-Graduação em FarmacologiaUFSMBrasilFarmacologiaAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessMedicamentos potencialmente inapropriadosSíndromes geriátricasHospitalizaçãoPotentially inappropriate medicationsGeriatric syndromesHospitalizationCNPQ::CIENCIAS BIOLOGICAS::FARMACOLOGIAPrescrição de fármacos inapropriados em idosos hospitalizados: análise da mortalidade e sobrevidainfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisCruz, Ivana Beatrice Mânica dahttp://lattes.cnpq.br/3426369324110716Azolin, Verônica FarinaLemos, Luiz Fernando CuozzoSchwanke , Carla Helena AugustinBarbisan, Fernandahttp://lattes.cnpq.br/1885218080678884Flores, Thamara Graziela2010000000006006006006006006006000b5fcfe0-b017-4163-80e2-17c110fbcf01b89732d7-10e5-4b09-b7af-64ce89e2a62c17cadbc3-0d89-49fa-ac8d-ff1a3a79d3f54e898b48-614d-4758-8161-a0ef9bfaf07ab4feebf3-5154-4590-9362-0ac5c3d2f47f18d12ea7-8686-489d-ac2e-dbbbd9af9280reponame:Biblioteca Digital de Teses e Dissertações do UFSMinstname:Universidade Federal de Santa Maria (UFSM)instacron:UFSMORIGINALTES_PPGFARMACOLOGIA_2023_FLORES_THAMARA.pdfTES_PPGFARMACOLOGIA_2023_FLORES_THAMARA.pdfTese de doutoradoapplication/pdf10256667http://repositorio.ufsm.br/bitstream/1/30480/1/TES_PPGFARMACOLOGIA_2023_FLORES_THAMARA.pdf778b4e0d700269f1c070409f4055d205MD51CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; 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dc.title.por.fl_str_mv |
Prescrição de fármacos inapropriados em idosos hospitalizados: análise da mortalidade e sobrevida |
title |
Prescrição de fármacos inapropriados em idosos hospitalizados: análise da mortalidade e sobrevida |
spellingShingle |
Prescrição de fármacos inapropriados em idosos hospitalizados: análise da mortalidade e sobrevida Flores, Thamara Graziela Medicamentos potencialmente inapropriados Síndromes geriátricas Hospitalização Potentially inappropriate medications Geriatric syndromes Hospitalization CNPQ::CIENCIAS BIOLOGICAS::FARMACOLOGIA |
title_short |
Prescrição de fármacos inapropriados em idosos hospitalizados: análise da mortalidade e sobrevida |
title_full |
Prescrição de fármacos inapropriados em idosos hospitalizados: análise da mortalidade e sobrevida |
title_fullStr |
Prescrição de fármacos inapropriados em idosos hospitalizados: análise da mortalidade e sobrevida |
title_full_unstemmed |
Prescrição de fármacos inapropriados em idosos hospitalizados: análise da mortalidade e sobrevida |
title_sort |
Prescrição de fármacos inapropriados em idosos hospitalizados: análise da mortalidade e sobrevida |
author |
Flores, Thamara Graziela |
author_facet |
Flores, Thamara Graziela |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Cruz, Ivana Beatrice Mânica da |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/3426369324110716 |
dc.contributor.referee1.fl_str_mv |
Azolin, Verônica Farina |
dc.contributor.referee2.fl_str_mv |
Lemos, Luiz Fernando Cuozzo |
dc.contributor.referee3.fl_str_mv |
Schwanke , Carla Helena Augustin |
dc.contributor.referee4.fl_str_mv |
Barbisan, Fernanda |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/1885218080678884 |
dc.contributor.author.fl_str_mv |
Flores, Thamara Graziela |
contributor_str_mv |
Cruz, Ivana Beatrice Mânica da Azolin, Verônica Farina Lemos, Luiz Fernando Cuozzo Schwanke , Carla Helena Augustin Barbisan, Fernanda |
dc.subject.por.fl_str_mv |
Medicamentos potencialmente inapropriados Síndromes geriátricas Hospitalização |
topic |
Medicamentos potencialmente inapropriados Síndromes geriátricas Hospitalização Potentially inappropriate medications Geriatric syndromes Hospitalization CNPQ::CIENCIAS BIOLOGICAS::FARMACOLOGIA |
dc.subject.eng.fl_str_mv |
Potentially inappropriate medications Geriatric syndromes Hospitalization |
dc.subject.cnpq.fl_str_mv |
CNPQ::CIENCIAS BIOLOGICAS::FARMACOLOGIA |
description |
Introduction: Elderly people (>60 years old) have a high prevalence of chronic noncommunicable diseases (DCNTs), often managed through the daily use of four or more drugs (polypharmacy). Furthermore, they may present biogerontological changes that affect the pharmacodynamics and pharmacokinetics of drugs. These situations increase the risk of adverse effects (especially geriatric syndromes), hospitalization, institutionalization and death. Therefore, several drugs are considered “potentially inappropriate medications” (MPIS) for the elderly, and these are prescribed daily in the elderly’s routine. However, the impact of the use of these drugs when used prior to hospitalization still needs to be clarified. Objective: To investigate the hospitalization profile and identify the impact of the use of inappropriate drugs prior to hospitalization on in-hospital mortality in the elderly. Methodology: Two complementary studies will be conducted. Study 1: It sought to evaluate the profile of elderly people upon admission, hospital evolution and outcome, as well as verify the association of the admission profile with the hospitalization outcome. A prospective cohort study was conducted. The variables analyzed for hospital admission were the sociodemographic profile and clinical-functional profile, as well as the evolution variables, the length of hospital stay and complications, and, as an outcome, hospital discharge or death. Study 2: approved by the Research Ethics Committee (CEP-UFSM, CAEE 48212915.50000.5346). It involved an epidemiological, prospective observational investigation in elderly people who sought emergency care and were hospitalized for various causes. Data were obtained through a structured interview that included instruments related to socioeconomic, cultural, lifestyle, health and previous daily use of MPISs and other drugs. Survival assessment was carried out up to 30 days after hospital discharge. Information on the clinical evolution of geriatric syndromes and survival was obtained via medical records. The drugs were pharmacologically categorized according to their action on the systems: nervous, cardiovascular, digestive, endocrine and osteo-muscular. The elderly were then grouped as MPIS users and non-users (control). The evolution of geriatric complications and the survival of the elderly were statistically analyzed using univariate tests and multivariate Cox regression. Results: In study 1, 493 elderly people were evaluated, with the majority of young elderly people, who lived alone, admitted to the hospital due to neoplasia. There was a positive association between death and age, Delirium, Charlson Comorbidity Index, Senior Risk Index, Frailty and calf circumference values. It was found that the elderly population that enters hospital emergency rooms presents multimorbidities, functional declines, frailty and greater exposure to adverse events during hospitalization, including death. In study 2, 318 patients aged ≥ 65 years were evaluated. The medications prescribed by these patients were recorded and the use of MPIS-ph was identified by the Brazilian consensus-based analysis of MPIS use. The impact of the use of MPIS-ph on the survival of hospitalized elderly people was determined through multivariate Cox regression analysis. Conclusions: The functional clinical profile, as well as pharmacological prescriptions, must be analyzed when creating care plans for elderly people entering in emergencies, as there are several variables that affect their outcomes. |
publishDate |
2023 |
dc.date.accessioned.fl_str_mv |
2023-11-10T18:27:51Z |
dc.date.available.fl_str_mv |
2023-11-10T18:27:51Z |
dc.date.issued.fl_str_mv |
2023-09-29 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
format |
doctoralThesis |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://repositorio.ufsm.br/handle/1/30480 |
url |
http://repositorio.ufsm.br/handle/1/30480 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.cnpq.fl_str_mv |
201000000000 |
dc.relation.confidence.fl_str_mv |
600 600 600 600 600 600 600 |
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dc.rights.driver.fl_str_mv |
Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ |
eu_rights_str_mv |
openAccess |
dc.publisher.none.fl_str_mv |
Universidade Federal de Santa Maria Centro de Ciências da Saúde |
dc.publisher.program.fl_str_mv |
Programa de Pós-Graduação em Farmacologia |
dc.publisher.initials.fl_str_mv |
UFSM |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
Farmacologia |
publisher.none.fl_str_mv |
Universidade Federal de Santa Maria Centro de Ciências da Saúde |
dc.source.none.fl_str_mv |
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Biblioteca Digital de Teses e Dissertações do UFSM |
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http://repositorio.ufsm.br/bitstream/1/30480/1/TES_PPGFARMACOLOGIA_2023_FLORES_THAMARA.pdf http://repositorio.ufsm.br/bitstream/1/30480/2/license_rdf http://repositorio.ufsm.br/bitstream/1/30480/3/license.txt |
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MD5 MD5 MD5 |
repository.name.fl_str_mv |
Biblioteca Digital de Teses e Dissertações do UFSM - Universidade Federal de Santa Maria (UFSM) |
repository.mail.fl_str_mv |
atendimento.sib@ufsm.br||tedebc@gmail.com |
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1793240058874036224 |