Polifarmácia em pessoas idosas: um estudo longitudinal na atenção primária à saúde

Abstract

Polypharmacy is frequent among the older adults, and it is considered a global public health problem. The prevalence and risks of polypharmacy, as well as the need for rational use of drugs, are widely studied topics. However, little is known about the development of polypharmacy among older adults over time. This lack of longitudinal and prospective evidence, especially in the Brazilian context, limits our understanding of the epidemiology of polypharmacy, and it may lead to underestimation of the impact of medication use among the older adults. Therefore, this thesis aimed to identify which changes occurred in the pattern of medication use by older adults living in the city of Coxilha, Rio Grande do Sul, Brazil, between 2010 and 2021. The specific objectives included verifying the incidence of polypharmacy in an old population, and comparing the prevalence and factors associated with polypharmacy in older people aged 60 to 70 years old, from two cohorts: cohort A (born between 1940 and 1950), interviewed in 2010, and cohort B (born between 1951 and 1961), interviewed in 2021. A census-based, dynamic cohort prospective longitudinal study was developed. The baseline occurred in 2010 and included all residents aged 60 years or old. The follow-up took place in 2021, when a new group of older people aged between 60 and 70 years was included in the study, corresponding to all residents of the city in this age group. Data collection took place through a household survey, using a structured questionnaire. For the data analysis, Poisson regression with robust variance was applied. The significance level adopted was 5%. Two scientific productions were developed in scientific article format. The first production, Chapter 3, presents the incidence and risk factors for polypharmacy over an 11-years period. The investigation revealed that 46.1% of the older adults made the transition to polypharmacy within 11 years. The highest number of health problems was a risk factor for polypharmacy (RR = 1.177; 95% CI 1.093 – 1.267). The second production, Chapter 4, compared the prevalence and factors associated with polypharmacy, in older adults aged 60 to 70 years, from two birth cohorts. Among the older adults in cohort A, 16.2% used polypharmacy, associated with negative self-rated health (PR = 3.295; 95% CI 1.215 – 8.936), older age (PR= 1.157; 1.053 – 1.270), and number of problems of health (PR= 1.238; 1.120 – 1.369). Among the older adults in cohort B, 40.4% used polypharmacy, which was associated with a great number of health problems (PR= 1.159; 1.111 – 1.208). These findings follow the trend observed in high-income countries and have implications for future practice in Primary Health Care, being able to guide the development and improvement of policies, actions, and services aimed at the older adults age group.