Polifarmácia na população idosa brasileira e os fatores associados: estudo de base nacional

Abstract

Introduction: Polypharmacy is characterized by the simultaneous use of five or more medicines, with or without a prescription. This condition is considered to be one of the main causes of health complications in the elderly worldwide. It is important to investigate polypharmacy and functionality in the elderly, as well as the chronic diseases that routinely affect the public in question, using consolidated and relevant data at a national level. Objective: To analyze the prevalence of polypharmacy and associated factors in the Brazilian elderly population, based on the National Health Survey (PNS) - 2019. Material and methods: This is an observational, cross-sectional, quantitative and exploratory study, using public domain secondary data from the latest population-based survey, entitled PNS, carried out in 2019-2020. The study population consisted of elderly people from all over Brazil, living in households, who used continuous medication (n=31,633). Polypharmacy was used as the dependent variable, while Chronic Non-Communicable Diseases (CNCD) and the health of individuals aged 60 and over were used as independent variables, in relation to difficulties in carrying out Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL). Descriptive analyses with absolute and relative frequencies, prevalence ratios and statistical tests such as chi-square and binary logistic regression were carried out. Results: The sample was mostly made up of males (60.7%), with an average age of 70.8 years (±8.3), married (50.5%), white (45.3%), literate (77.2%), with completed high school (60.7%) and an average monthly income of R$1,928.59 (±3,564.90). The prevalence of polypharmacy was 23.8% (n=7534). All the NCDs assessed were associated with polypharmacy (p<0.05), and individuals with NCDs were more likely to use polypharmacy when compared to individuals without NCDs. The NCDs that had the greatest impact on polypharmacy were heart disease such as infarction, angina, heart failure or other (OR=5.93; 95%CI=4.85-7.24), stroke (OR=2.55; 95%CI=1.85-3.52), and diabetes (OR=2.48; 95%CI=2.07-2.97). The IADLs that were associated with polypharmacy were: going out using transportation (OR=1.52; 95%CI=1.35- 1.72), shopping (OR=1.21; 95%CI=1.09-1.34) and taking medication (OR=1.42; 95%CI=1.29- 1.57), while the BADLs were: sitting down (OR=1.27; 95%CI=1.15-1.40) and dressing alone (OR=1.54; 95%CI=1.25-1.89), i.e. elderly people who had difficulties in performing the aforementioned IADLs and BADLs were more likely to use polypharmacy when compared to those who did not have these functional difficulties (p<0.001). Conclusion: The prevalence of polypharmacy was high and was related to NCDs and the functionality of elderly people in the five regions of Brazil, with a negative impact. This highlights the need for public policies focused on the de-prescription or appropriate prescription of medicines, with a view to reducing or preventing polypharmacy and its associated risks.