Relevância clínica das potenciais interações medicamentosas em idosos institucionalizados
Autor(a) principal: | |
---|---|
Data de Publicação: | 2022 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Biblioteca de teses e dissertações da Universidade de Passo Fundo (BDTD UPF) |
Texto Completo: | http://tede.upf.br:8080/jspui/handle/tede/2240 |
Resumo: | The number of institutionalized people has grown in recent times due to several factors, whether personal, economic, social or the sum of both, however, advanced age, cognitive and functional decline and the condition of multimorbidity are factors that influence institutionalization, among these is the use of polypharmacy. The elderly are vulnerable to adverse drug-related events, including drug interactions. The general objective of this study was to classify the potential drug interactions in institutionalized elderly people using antihypertensive drugs according to the severity and type of interaction, in addition to the specific objectives, which are: I. To verify the prevalence of potential drug interactions according to severity and type of interaction. II. Describe the type and mechanism of potential clinically relevant drug interactions between the most prescribed drugs. Cross-sectional study carried out with individuals aged 60 years or over, of both sexes, residing in Long Stay Institutions for the Elderly (ILPI) in municipalities in southern Brazil. The total population residing in these institutions was 479 elderly people. Data collection was carried out through a structured questionnaire, covering sociodemographic variables, variables related to health in general and medications used. For this study, the database was consulted and individuals using antihypertensive drugs were selected. The severity of potential drug interactions, the level of documentation/scientific evidence and the mechanism of action involved were defined according to the Drug-Reax® System software, developed by Thomson MicromedexTM and accessed on the Capes journal portal. The study included 257 institutionalized elderly people who used antihypertensive drugs, most of whom were long-lived, female, widowed, educated and with multimorbidity. The most prevalent health problems were urinary and fecal incontinence and dementia. The study points out the distribution of potential drug interactions according to severity, being, Major 87.1%; Moderate 82.8%; Lower 21.1%. Contraindicated 3,4 Of the prescriptions analyzed for 257 institutionalized elderly people who use antihypertensive drugs, 232 (90.3%) of the elderly had at least one DI. It can also be observed that in relation to polypharmacy, it was identified that among the prescriptions evaluated, 83.7% of them had polypharmacy and 66.9% had excessive polypharmacy. Therefore, it is necessary for the health team to know the potential for seriousness of interactions, in the medications in use, so as not to compromise patient safety, and many of them can be monitored and avoided. |
id |
UPF-1_5263411c0548fa5f6d9ceb3610cf1a78 |
---|---|
oai_identifier_str |
oai:tede.upf.br:tede/2240 |
network_acronym_str |
UPF-1 |
network_name_str |
Biblioteca de teses e dissertações da Universidade de Passo Fundo (BDTD UPF) |
repository_id_str |
|
spelling |
Portella, Marilene Rodrigues261.379.250-72http://lattes.cnpq.br/5139810903269611Hahn, Siomara Regina493.829.770-15http://lattes.cnpq.br/8757164546962882028.353.370-67http://lattes.cnpq.br/0293275769955320Flores, Rennã Dall Puppo2022-06-07T18:01:08Z2022-03-25FLORES, Rennã Dall Puppo. Relevância clínica das potenciais interações medicamentosas em idosos institucionalizados. 2022 63 f. Dissertação (Mestrado em Envelhecimento Humano) - Universidade de Passo Fundo, Passo Fundo, RS, 2022http://tede.upf.br:8080/jspui/handle/tede/2240The number of institutionalized people has grown in recent times due to several factors, whether personal, economic, social or the sum of both, however, advanced age, cognitive and functional decline and the condition of multimorbidity are factors that influence institutionalization, among these is the use of polypharmacy. The elderly are vulnerable to adverse drug-related events, including drug interactions. The general objective of this study was to classify the potential drug interactions in institutionalized elderly people using antihypertensive drugs according to the severity and type of interaction, in addition to the specific objectives, which are: I. To verify the prevalence of potential drug interactions according to severity and type of interaction. II. Describe the type and mechanism of potential clinically relevant drug interactions between the most prescribed drugs. Cross-sectional study carried out with individuals aged 60 years or over, of both sexes, residing in Long Stay Institutions for the Elderly (ILPI) in municipalities in southern Brazil. The total population residing in these institutions was 479 elderly people. Data collection was carried out through a structured questionnaire, covering sociodemographic variables, variables related to health in general and medications used. For this study, the database was consulted and individuals using antihypertensive drugs were selected. The severity of potential drug interactions, the level of documentation/scientific evidence and the mechanism of action involved were defined according to the Drug-Reax® System software, developed by Thomson MicromedexTM and accessed on the Capes journal portal. The study included 257 institutionalized elderly people who used antihypertensive drugs, most of whom were long-lived, female, widowed, educated and with multimorbidity. The most prevalent health problems were urinary and fecal incontinence and dementia. The study points out the distribution of potential drug interactions according to severity, being, Major 87.1%; Moderate 82.8%; Lower 21.1%. Contraindicated 3,4 Of the prescriptions analyzed for 257 institutionalized elderly people who use antihypertensive drugs, 232 (90.3%) of the elderly had at least one DI. It can also be observed that in relation to polypharmacy, it was identified that among the prescriptions evaluated, 83.7% of them had polypharmacy and 66.9% had excessive polypharmacy. Therefore, it is necessary for the health team to know the potential for seriousness of interactions, in the medications in use, so as not to compromise patient safety, and many of them can be monitored and avoided.O número de pessoas institucionalizadas cresce nos últimos tempos devido a vários fatores, sejam eles de ordem pessoal, econômica, social ou soma de ambas, entretanto, a idade avançada, declínio cognitivo e funcional e a condição de multimorbidade são fatores que influenciam na institucionalização, dentre esses encontra-se o uso da polifarmácia. Os idosos são vulneráveis a eventos adversos relacionados aos medicamentos, entre os quais, as interações medicamentosas. Este estudo teve como objetivo geral classificar as potenciais interações medicamentosas em idosos institucionalizados em uso de anti-hipertensivo de acordo com a gravidade e tipo de interação, além dos objetivos específicos, que são: I. Verificar a prevalência das potenciais interações medicamentosas de acordo com a gravidade e o tipo de interação. II. Descrever o tipo e o mecanismo dos potenciais interações medicamentosas clinicamente relevantes entre os medicamentos mais prescritos. Estudo de corte transversal realizado com indivíduos com idade igual ou superior a 60 anos, de ambos os sexos, residentes em Instituições de Longa Permanência para Idosos (ILPI) em municípios do sul do Brasil. A população total residente nessas instituições era de 479 pessoas idosas. A coleta de dados foi realizada por meio de um questionário estruturado, contemplando as variáveis sociodemográficas, as variáveis relacionadas à saúde em geral e medicamentos utilizados. Para este estudo, foi consultado o banco de dados e selecionados os indivíduos em uso de medicamentos anti-hipertensivos. A gravidade das potenciais interações medicamentosas, o nível de documentação/evidência científica e o mecanismo de ação envolvido foram definidos de acordo com o software Drug-Reax® System, desenvolvido por Thomson MicromedexTM e com acesso no portal de periódicos Capes. O estudo incluiu 257 idosos institucionalizados que faziam uso de anti-hipertensivo, destes a maioria era de longevos, do sexo feminino, viúvos, escolarizados e com multimorbidade. Os problemas de saúde mais prevalentes foram incontinência urinária, fecal e demência. O estudo aponta a distribuição das potenciais interações medicamentosas segundo a severidade, sendo, Maior 87,1%; Moderada 82,8%; Menor 21,1%. Contraindiciada 3,4 Das prescrições analisadas dos 257 idosos institucionalizados que fazem uso de anti-hipertensivo, 232 (90,3%) dos idosos apresentaram pelo menos uma IM. Pode-se observar ainda que em relação a polifarmácia foi identificado que dentre as prescrições avaliadas 83,7% delas apresentavam polifarmácia e 66,9% apresentavam polifarmácia excessiva. Portanto, faz-se necessário a equipe de saúde conhecer o potencial de gravidade das interações, nas medicações em uso, para não comprometer a segurança dos pacientes e, muitas delas podem ser monitoradas e evitadas.Submitted by Jucelei Domingues (jucelei@upf.br) on 2022-06-07T18:01:08Z No. of bitstreams: 1 2022RennaDallPuppoFlores.pdf: 1534868 bytes, checksum: 19f961dfeb2d96841203aef00509e051 (MD5)Made available in DSpace on 2022-06-07T18:01:08Z (GMT). No. of bitstreams: 1 2022RennaDallPuppoFlores.pdf: 1534868 bytes, checksum: 19f961dfeb2d96841203aef00509e051 (MD5) Previous issue date: 2022-03-25application/pdfporUniversidade de Passo FundoPrograma de Pós-Graduação em Envelhecimento HumanoUPFBrasilFaculdade de Educação Física e Fisioterapia – FEFFEnvelhecimentoIdosos - Assistência em instituiçõesMedicamentos - InteraçõesSAUDE COLETIVA::SAUDE PUBLICARelevância clínica das potenciais interações medicamentosas em idosos institucionalizadosinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesis-9132566411690049154500500600-65308596723982726413112649244584600979info:eu-repo/semantics/openAccessreponame:Biblioteca de teses e dissertações da Universidade de Passo Fundo (BDTD UPF)instname:Universidade de Passo Fundo (UPF)instacron:UPFLICENSElicense.txtlicense.txttext/plain; charset=utf-82053http://tede.upf.br:8080/jspui/bitstream/tede/2240/1/license.txt1ea0bfd7af108792edd8df732bb777fcMD51ORIGINAL2022RennaDallPuppoFlores.pdf2022RennaDallPuppoFlores.pdfapplication/pdf1534868http://tede.upf.br:8080/jspui/bitstream/tede/2240/2/2022RennaDallPuppoFlores.pdf19f961dfeb2d96841203aef00509e051MD52tede/22402022-06-07 15:01:08.668oai:tede.upf.br: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Biblioteca Digital de Teses e DissertaçõesPUBhttp://tede.upf.br/oai/requestbiblio@upf.br || bio@upf.br || cas@upf.br || car@upf.br || lve@upf.br || sar@upf.br || sol@upf.br || upfmundi@upf.br || jucelei@upf.bropendoar:2022-06-07T18:01:08Biblioteca de teses e dissertações da Universidade de Passo Fundo (BDTD UPF) - Universidade de Passo Fundo (UPF)false |
dc.title.por.fl_str_mv |
Relevância clínica das potenciais interações medicamentosas em idosos institucionalizados |
title |
Relevância clínica das potenciais interações medicamentosas em idosos institucionalizados |
spellingShingle |
Relevância clínica das potenciais interações medicamentosas em idosos institucionalizados Flores, Rennã Dall Puppo Envelhecimento Idosos - Assistência em instituições Medicamentos - Interações SAUDE COLETIVA::SAUDE PUBLICA |
title_short |
Relevância clínica das potenciais interações medicamentosas em idosos institucionalizados |
title_full |
Relevância clínica das potenciais interações medicamentosas em idosos institucionalizados |
title_fullStr |
Relevância clínica das potenciais interações medicamentosas em idosos institucionalizados |
title_full_unstemmed |
Relevância clínica das potenciais interações medicamentosas em idosos institucionalizados |
title_sort |
Relevância clínica das potenciais interações medicamentosas em idosos institucionalizados |
author |
Flores, Rennã Dall Puppo |
author_facet |
Flores, Rennã Dall Puppo |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Portella, Marilene Rodrigues |
dc.contributor.advisor1ID.fl_str_mv |
261.379.250-72 |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/5139810903269611 |
dc.contributor.advisor-co1.fl_str_mv |
Hahn, Siomara Regina |
dc.contributor.advisor-co1ID.fl_str_mv |
493.829.770-15 |
dc.contributor.advisor-co1Lattes.fl_str_mv |
http://lattes.cnpq.br/8757164546962882 |
dc.contributor.authorID.fl_str_mv |
028.353.370-67 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/0293275769955320 |
dc.contributor.author.fl_str_mv |
Flores, Rennã Dall Puppo |
contributor_str_mv |
Portella, Marilene Rodrigues Hahn, Siomara Regina |
dc.subject.por.fl_str_mv |
Envelhecimento Idosos - Assistência em instituições Medicamentos - Interações |
topic |
Envelhecimento Idosos - Assistência em instituições Medicamentos - Interações SAUDE COLETIVA::SAUDE PUBLICA |
dc.subject.cnpq.fl_str_mv |
SAUDE COLETIVA::SAUDE PUBLICA |
description |
The number of institutionalized people has grown in recent times due to several factors, whether personal, economic, social or the sum of both, however, advanced age, cognitive and functional decline and the condition of multimorbidity are factors that influence institutionalization, among these is the use of polypharmacy. The elderly are vulnerable to adverse drug-related events, including drug interactions. The general objective of this study was to classify the potential drug interactions in institutionalized elderly people using antihypertensive drugs according to the severity and type of interaction, in addition to the specific objectives, which are: I. To verify the prevalence of potential drug interactions according to severity and type of interaction. II. Describe the type and mechanism of potential clinically relevant drug interactions between the most prescribed drugs. Cross-sectional study carried out with individuals aged 60 years or over, of both sexes, residing in Long Stay Institutions for the Elderly (ILPI) in municipalities in southern Brazil. The total population residing in these institutions was 479 elderly people. Data collection was carried out through a structured questionnaire, covering sociodemographic variables, variables related to health in general and medications used. For this study, the database was consulted and individuals using antihypertensive drugs were selected. The severity of potential drug interactions, the level of documentation/scientific evidence and the mechanism of action involved were defined according to the Drug-Reax® System software, developed by Thomson MicromedexTM and accessed on the Capes journal portal. The study included 257 institutionalized elderly people who used antihypertensive drugs, most of whom were long-lived, female, widowed, educated and with multimorbidity. The most prevalent health problems were urinary and fecal incontinence and dementia. The study points out the distribution of potential drug interactions according to severity, being, Major 87.1%; Moderate 82.8%; Lower 21.1%. Contraindicated 3,4 Of the prescriptions analyzed for 257 institutionalized elderly people who use antihypertensive drugs, 232 (90.3%) of the elderly had at least one DI. It can also be observed that in relation to polypharmacy, it was identified that among the prescriptions evaluated, 83.7% of them had polypharmacy and 66.9% had excessive polypharmacy. Therefore, it is necessary for the health team to know the potential for seriousness of interactions, in the medications in use, so as not to compromise patient safety, and many of them can be monitored and avoided. |
publishDate |
2022 |
dc.date.accessioned.fl_str_mv |
2022-06-07T18:01:08Z |
dc.date.issued.fl_str_mv |
2022-03-25 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
FLORES, Rennã Dall Puppo. Relevância clínica das potenciais interações medicamentosas em idosos institucionalizados. 2022 63 f. Dissertação (Mestrado em Envelhecimento Humano) - Universidade de Passo Fundo, Passo Fundo, RS, 2022 |
dc.identifier.uri.fl_str_mv |
http://tede.upf.br:8080/jspui/handle/tede/2240 |
identifier_str_mv |
FLORES, Rennã Dall Puppo. Relevância clínica das potenciais interações medicamentosas em idosos institucionalizados. 2022 63 f. Dissertação (Mestrado em Envelhecimento Humano) - Universidade de Passo Fundo, Passo Fundo, RS, 2022 |
url |
http://tede.upf.br:8080/jspui/handle/tede/2240 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.program.fl_str_mv |
-9132566411690049154 |
dc.relation.confidence.fl_str_mv |
500 500 600 |
dc.relation.department.fl_str_mv |
-6530859672398272641 |
dc.relation.cnpq.fl_str_mv |
3112649244584600979 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade de Passo Fundo |
dc.publisher.program.fl_str_mv |
Programa de Pós-Graduação em Envelhecimento Humano |
dc.publisher.initials.fl_str_mv |
UPF |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
Faculdade de Educação Física e Fisioterapia – FEFF |
publisher.none.fl_str_mv |
Universidade de Passo Fundo |
dc.source.none.fl_str_mv |
reponame:Biblioteca de teses e dissertações da Universidade de Passo Fundo (BDTD UPF) instname:Universidade de Passo Fundo (UPF) instacron:UPF |
instname_str |
Universidade de Passo Fundo (UPF) |
instacron_str |
UPF |
institution |
UPF |
reponame_str |
Biblioteca de teses e dissertações da Universidade de Passo Fundo (BDTD UPF) |
collection |
Biblioteca de teses e dissertações da Universidade de Passo Fundo (BDTD UPF) |
bitstream.url.fl_str_mv |
http://tede.upf.br:8080/jspui/bitstream/tede/2240/1/license.txt http://tede.upf.br:8080/jspui/bitstream/tede/2240/2/2022RennaDallPuppoFlores.pdf |
bitstream.checksum.fl_str_mv |
1ea0bfd7af108792edd8df732bb777fc 19f961dfeb2d96841203aef00509e051 |
bitstream.checksumAlgorithm.fl_str_mv |
MD5 MD5 |
repository.name.fl_str_mv |
Biblioteca de teses e dissertações da Universidade de Passo Fundo (BDTD UPF) - Universidade de Passo Fundo (UPF) |
repository.mail.fl_str_mv |
biblio@upf.br || bio@upf.br || cas@upf.br || car@upf.br || lve@upf.br || sar@upf.br || sol@upf.br || upfmundi@upf.br || jucelei@upf.br |
_version_ |
1817440924761849856 |