Utilização de medicamentos potencialmente inadequados por idosos de um ambulatório de Onco-Hematologia

Abstract

Increased life expectancy of the population contributes to the increased incidence of cancer in the older people. Elderly with cancer use drugs of supportive therapy and for treatment of comorbidities, beyonds the anticancer drugs. It is necessary to assess whether the medications are appropriate to the older patients characteristics. Medications can be defined as potentially inappropriate for older people when the risks of adverse events outweigh the clinical benefits, particularly when safer alternatives exist. The aim of this study was to determine the frequency and the factors associated with the use of potentially inappropriate medications by older adults with cancer at an onco-hematology ambulatory of a teaching hospital in Belo Horizonte. Patients aged 60 years or older (n=160) undergoing parenteral antineoplastic chemotherapy from May to December 2015 and treated with one or more medications were interviewed. Data on the medications, comorbidities, oncological diagnosis, and functional status were recorded. Elderly functionality was determined using The Vulnerable Elders Survey (VES-13). Potentially inappropriate medications were determined using the 2015 Beers Criteria and considering the following categories: potentially inappropriate medications to be avoided by older adults and medications to be used with caution in older adults. Logistic regression was used to determine the factors associated with the use of potentially inappropriate medications. A total of 78 (48.1%) older adults used at least one potentially inappropriate medications. The most used potentially inappropriate medications to be avoided by older adults were proton pump inhibitors (33.3%), antiemetic (10.5%), long-acting benzodiazepines (10.5%), and antidepressants (7.6%). Antineoplastic agents (carboplatin, cisplatin, cyclophosphamide and vincristine), serotonin reuptake inhibitors, and tricyclic antidepressant should be used with caution. Multivariate analysis indicated that potentially inappropriate medications were associated with the use of five or more medications (odds ratio, 3.14; 95% confidence interval, 1.46.6), adjusted by the number of medications, number of comorbidities, depression, and arthritis/arthrosis. The frequency of use of potentially inappropriate medications by older adults at the investigated ambulatory was high. Polypharmacy presented a positive association with the use of potentially inappropriate medications.