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Advisor(s)
Abstract(s)
Introdução: Com o envelhecimento populacional e o aumento da prevalência de doenças
crónicas nesta faixa etária, tem crescido o número de idosos que se apresentam num
regime terapêutico de polifarmácia. Tendo em conta as consequências que podem advir
destes regimes, é essencial compreender como tornar as práticas de prescrição e
desprescrição em idosos mais seguras e eficazes.
Objetivo: Apresentar e discutir os desafios da prescrição e desprescrição de fármacos no
idoso.
Metodologia: Revisão da literatura como base em artigos científicos retirados da base de
dados PubMed e publicações da Direção-Geral da Saúde, Organização Mundial da Saúde,
Nações Unidas, Instituto Nacional de Estatística e Eurostat. Foi utilizada também a
plataforma Pordata para obtenção de dados estatísticos adicionais.
Resultados: Neste trabalho são discutidas as principais causas e consequências do
envelhecimento demográfico, bem como o seu impacto no sistema de saúde. De igual
forma, são descritas as alterações fisiológicas características do processo de
envelhecimento, realçando a sua individualidade, e as consequências que delas advêm
no que diz respeito à terapia farmacológica. Foram analisados diversos critérios que
permitem identificar situações de prescrição potencialmente inapropriada, bem como
guias que contribuem para a execução eficaz de um processo de otimização terapêutica,
incluindo a desprescrição de fármacos inapropriados para os idosos. Diversas vantagens
e limitações foram encontradas para cada um dos critérios. De igual forma, este trabalho
permitiu avaliar de forma mais abrangente a complexidade deste processo pela
identificação de diferentes fatores com influência no seu sucesso ou insucesso que
dependem da perspetiva do utente e do profissional de saúde.
Conclusão: As consequências dos regimes terapêuticos de polifarmácia, a insuficiente
evidência científica acerca da segurança e eficácia dos fármacos em idosos e as alterações
anátomo-fisiológicas características do envelhecimento representam os principais
desafios à prescrição e desprescrição em idosos. A utilização dos critérios de identificação
de situações de prescrição potencialmente inapropriada e dos guias estruturados de
desprescrição analisados mostrou diminuir as complicações associadas ao tratamento.
Destes critérios, verificou-se que os Critérios de Beers e os EU(7)PIM-List já se
encontram operacionalizados para Portugal.
Background: With the ageing of the population and the increase in the prevalence of chronic diseases in this age group, the number of elderly people who find themselves in a polypharmacy therapeutic regimen has grown. Bearing in mind the consequences that may arise from these regimens, it is essential to understand how to make the prescribing and deprescribing practices in the elderly safer and more effective. Objective: To present and discuss the challenges of prescribing and deprescribing drugs in the elderly. Methods: Literature review based on scientific articles taken from the PubMed database and publications from the Direção-Geral de Saúde, World Health Organization, United Nations, Instituto Nacional de Estatística and Eurostat. The Pordata platform was used to obtain additional statistical data. Results: In this work, the main causes and consequences of demographic ageing were discussed, as well as its impact on the health system. Likewise, the physiological changes characteristic of the ageing process have been described, highlighting their individuality, and the consequences that arise from them regarding pharmacological therapy. Several criteria were analyzed to identify situations of potentially inappropriate prescribing, as well as guides that contribute to the effective execution of a therapeutic optimization process, including deprescribing inappropriate drugs for the elderly. Several advantages and limitations were found for each of the criteria. Likewise, this work allowed a more comprehensive assessment of the complexity of this process by identifying different factors influencing its success or failure that depend on the perspective of the patient and the health professional. Conclusion: The consequences of polypharmacy therapeutic regimens, the insufficient scientific evidence about the safety and efficacy of drugs in the elderly and the anatomical and physiological changes that occur with ageing represent the main challenges to prescribing and deprescribing in the elderly. The use of Potentially Inappropriate Prescribing identification criteria and structured guides of deprescribing has shown to decrease the complications associated with treatment. Of these criteria, it was found that the Beers Criteria and the EU(7)PIM-List are already operationalized for Portugal.
Background: With the ageing of the population and the increase in the prevalence of chronic diseases in this age group, the number of elderly people who find themselves in a polypharmacy therapeutic regimen has grown. Bearing in mind the consequences that may arise from these regimens, it is essential to understand how to make the prescribing and deprescribing practices in the elderly safer and more effective. Objective: To present and discuss the challenges of prescribing and deprescribing drugs in the elderly. Methods: Literature review based on scientific articles taken from the PubMed database and publications from the Direção-Geral de Saúde, World Health Organization, United Nations, Instituto Nacional de Estatística and Eurostat. The Pordata platform was used to obtain additional statistical data. Results: In this work, the main causes and consequences of demographic ageing were discussed, as well as its impact on the health system. Likewise, the physiological changes characteristic of the ageing process have been described, highlighting their individuality, and the consequences that arise from them regarding pharmacological therapy. Several criteria were analyzed to identify situations of potentially inappropriate prescribing, as well as guides that contribute to the effective execution of a therapeutic optimization process, including deprescribing inappropriate drugs for the elderly. Several advantages and limitations were found for each of the criteria. Likewise, this work allowed a more comprehensive assessment of the complexity of this process by identifying different factors influencing its success or failure that depend on the perspective of the patient and the health professional. Conclusion: The consequences of polypharmacy therapeutic regimens, the insufficient scientific evidence about the safety and efficacy of drugs in the elderly and the anatomical and physiological changes that occur with ageing represent the main challenges to prescribing and deprescribing in the elderly. The use of Potentially Inappropriate Prescribing identification criteria and structured guides of deprescribing has shown to decrease the complications associated with treatment. Of these criteria, it was found that the Beers Criteria and the EU(7)PIM-List are already operationalized for Portugal.
Description
Keywords
Desprescrição Envelhecimento Idosos Polifarmácia Prescrição