Avaliação de hiperpolifarmácia e prescrição de medicamentos potencialmente inapropriados na sobrevida de pessoas idosas longevas hospitalizadas

• Ano de defesa: 2025
• Autor(a) principal: Vargas, Diva Bernardes
• Orientador(a): Miranda, Alexandre Franco
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Católica de Brasília
• Programa de Pós-Graduação: Programa Stricto Sensu em Gerontologia
• Departamento: Escola de Saúde e Medicina
• País: Brasil
• Palavras-chave em Português: Idoso de 80 anos ou mais; Polimedicação; Prescrição inadequada
• Palavras-chave em Inglês: Aged 80 and over; Polypharmacy; Inappropriate prescription
• Área do conhecimento CNPq: CNPQ::CIENCIAS DA SAUDE
• Link de acesso: https://bdtd.ucb.br:8443/jspui/handle/tede/3649

Introduction: The global increase in life expectancy and the growing elderly population have led to a higher prevalence of multimorbidities, consequently increasing medication use. However, some prescribed medications are classified as potentially inappropriate medications (PIMs) for older adults, as their risks often outweigh the benefits. Objectives: This study aims to analyze the profile of hyperpolypharmacy and PIM prescription among hospitalized elderly patients, considering factors such as sex, age, pre-existing diseases, polypharmacy, glomerular filtration rate (eGFR), and PIM use. Additionally, we evaluated the survival rates in this population based on hyperpolypharmacy, sex, and age, comparing hospitalized elderly patients who received ≤3 PIMs with those who received >3 PIMs. Materials and Methods: This prospective study was conducted in a high-complexity hospital, analyzing 123 medical records of hospitalized elderly patients. Data collected included health profile, number of prescribed medications, PIM use, eGFR, and multimorbidities. Continuous variables were compared using Student’s t-test, while categorical variables were analyzed using the chi-square test. Survival analysis was performed using Kaplan-Meier curves, and the Cox regression model was applied to calculate hazard ratios. Survival curves were compared between patients receiving ≤3 PIMs and those receiving >3 PIMs. Statistical analyses were conducted using IBM SPSS (v.26) and MedCalc (v.23.0.9). Results: The results were divided into Article 1, Article 2 and Results 3. The mean age of participants was 87.2 ± 5.5 years, with 45% being male. Multimorbidities were highly prevalent (93%), and hyperpolypharmacy was observed in 72% of cases, with rapid-acting insulin being the most frequently prescribed PIM. The average length of hospital stay was 15 days, with pneumonia (26%) being the leading cause of hospitalization. Patients aged 85 years or older had lower survival rates, and women exhibited a 3.48-fold higher risk of death compared to men. Advancing age increased the mortality risk by 3.83-fold, while hyperpolypharmacy was associated with a nine fold increase in in-hospital mortality. However, no significant difference in survival was observed between patients receiving ≤3 PIMs and those receiving >3 PIMs. Conclusions: Hospitalized oldest-old patients exhibited a high prevalence of multimorbidities, with pneumonia being the most common reason for admission. Polypharmacy, hyperpolypharmacy, and PIM use were widespread, with hyperpolypharmacy emerging as a key determinant of reduced survival. Although survival curves suggested a worsening prognosis with an increasing number of PIMs, statistical significance was not demonstrated. Regular medication reviews are essential to improving health outcomes in this vulnerable population.