Uso de medicamentos potencialmente inapropriados em instituições de longa permanência para idosos: revisão integrativa

Abstract

Objective: To analyze the prevalence of potentially inappropriate medication (PIM) use in long-term care facilities for the elderly (ILPIs). Introduction: The elderly are vulnerable to drug-related problems, mainly due to pharmacodynamic and pharmacokinetic changes, typical of aging. In this sense, PIM for the elderly stands out, which, despite being associated with negative outcomes, continue to be prescribed and used without caution in ILPIs. Method: An integrative literature review was used to obtain articles from relevant online databases, with the guiding question: “What is the prevalence of the use of potentially inappropriate medications for the elderly in long-stay institutions?”. The search and selection process of the studies followed the PRISMA 2020 recommendations. The eligibility criteria were observational and experimental studies, in English and Portuguese, carried out in the last 10 years with elderly patients ≥ 60 years and studies of the prevalence of PIM use in elderly residents in ILPIs. Results: The final sample consisted of 11 articles, of which six (54.54%) were published in Brazil, two (18.18%) in Malaysia and one in Australia, Ireland and Spain, respectively. The main type of study was cross-sectional with 10 (90.90%) articles, published between 2012 and 2019, with the predominant year 2012 (36.36%). The mean prevalence of PIM use was 43.86% (7.8%-80%), with a higher relationship with females (58.5%) and polypharmacy (58.7%). Discussion: The observed results indicate a high and worrying prevalence of PIM among institutionalized elderly people. It is essential to propose and implement strategies aimed at reducing the use of these drugs. Educational interventions, deprescription and computerization of prescription systems stood out. Such strategies proved to be effective and viable. The nursing team, in this sense, stands out for being the last barrier before using the medication. Therefore, the identification of such drugs and the discussion, with the prescriber and other members of the health team, becomes of great value in the process of reviewing the prescription and reducing the use of PIM. Conclusion: The results of this study highlight the importance of sensitizing health professionals to the rational use of medicines and greater safety of the proposed pharmacotherapy for the elderly population. Implications for research, policy and practice: Future research on this topic is needed to reinforce the need to reduce inappropriate prescriptions and the importance of rational drug use for residents in LTCIs.