Drug therapy, potential interactions and iatrogenesis as factors related to frailty in the elderly

Abstract Objective: to investigate the use of drugs, potential drug interactions and iatrogenesis, as factors associated with frailty. Method: an observational, cross-sectional, population-based study of elderly persons registered with the Family Health Strategies of the urban area of a municipal region in the south of Brazil was carried out. The sample was probabilistic and involved 554 elderly persons; and the proportional stratified sampling technique by FHS and gender was used. Data collection was performed in the home, with the gathering of information regarding sociodemographic characteristics and pharmacotherapeutic profile and the evaluation of frailty based on Fried et al. (2001). Results: medications were taken by 86.3% of the elderly and there was a prevalence of frailty of 63.0%. A total of 39.4% of the elderly were exposed to polypharmacy, 49.1% used potentially inappropriate medications and 52.2% were exposed to potential drug interactions, the most frequent being enalapril and metformin. An association between increased risk of frailty and the variables: polypharmacy; use of potentially inappropriate medications; potential drug interactions; more than two potential drug interactions with the presence or absence of potentially inappropriate medication was identified. Conclusion: an association was found between frailty and polypharmacy, the use of potentially inappropriate medication and the presence of drug interactions. The findings underscore the importance of the monitoring of drug therapy in this population group with a view to the early detection, prevention and resolution of iatrogenesis arising from the use of medicines.

摘要 研究目的：探讨药物使用、潜在药物相互作用及医源性损害作为与衰弱症相关的影响因素的作用。研究方法：本研究为观察性横断面人群研究，纳入巴西南部某城市市区家庭健康策略（Family Health Strategies）登记的老年人作为研究对象。研究采用概率抽样方法，最终纳入554名老年人，使用基于家庭健康策略（FHS）和性别的比例分层抽样技术。数据采集于受试者家中，收集社会人口学特征、药物治疗概况相关信息，并依据Fried等人2001年的标准评估衰弱状态。结果：86.3%的老年人存在用药行为，衰弱症患病率为63.0%。共计39.4%的老年人存在多重用药情况，49.1%使用了潜在不适当药物，52.2%存在潜在药物相互作用，其中最常见的药物组合为依那普利与二甲双胍。本研究发现，衰弱风险升高与以下变量显著相关：多重用药、潜在不适当药物使用、潜在药物相互作用，以及在伴随或不伴随潜在不适当药物使用的情况下存在2种及以上潜在药物相互作用的情况。结论：本研究证实衰弱症与多重用药、潜在不适当药物使用及药物相互作用存在关联。研究结果凸显了对该老年人群开展药物治疗监测的重要性，以期早期发现、预防并解决因用药引发的医源性损害。