(115) Factors associated with potentially inappropriate medicines use in older adults during the covid-19 pandemic in two Brazilian municipalities: a cross-sectional study

Background: The use of potentially inappropriate medicines (PIM) is a significant concern for safety medication in the elderly. Furthermore, the pandemic has caused significant changes in the population lifestyle and has led to a reorganization of healthcare provision, including pharmaceutical care. However, studies of drug utilization by older adults during the covid-19 pandemic are still scarce, particularly in the context of community use in Brazil.

Objectives: This study aims to investigate the prevalence and factors associated with PIM used by older adults during the covid-19 pandemic in Ouro Preto and Mariana, municipalities of Minas Gerais state, Brazil.

Methods: This is a cross-sectional study, component of an epidemiological survey conducted between October and December 2020, with a representative sample of the urban population of Ouro Preto and Mariana. The study population was the older adults (≥65 years old) using at least one medicine at the time of data collection. All medicines were classified by WHO ATC codes. PIMs were assessed using Beers criteria (2019). The primary outcome was the use of PIMs and the study population was characterised by socio-demographic aspects, lifestyle, health conditions and drug utilization. Descriptive analysis was performed using frequency distributions with 95%CI. Chi-square and multivariable logistic regression were performed, with p< 0.05. Gender was used to adjust the model.

Results: The study included 308 participants aged between 65 and 94 years (µ = 73.21±6,58 years). The majority self-reported medicines use (92.49%; 95%CI 84.87-94.63). A total of 924 medicines were reported, 3.19 medicines/person. The prevalence of PIM use was 29.03% (IC95% 20.64 - 39.15). The most common PIM, in ATC level 2, were those that drugs used in diabetes (A10; n=20; 17.39%), psycholeptics (N05; n=18; 15.65%) and drugs for acid disorders (A02; n=15; 13.04%). Among the participants who reported using PIM, 16.15% (95% CI 3.96-47.4) indicated that they initiated the use of the drug during the pandemic.
The multivariate analysis revealed an association between the use of PIM and diabetes (OR 3.61, 95%CI 1.35-9.65), polypharmacy (OR 3.05, 95%CI 1.39 - 6.71) and self-medication (OR 3.87, 95%CI 1.23-12.19). The population that did not adhere to social distancing (49.71 95%CI 14.65-85.06) had a higher use of PIMs compared to those who had total adherence (29.59 95%CI 15.67-48.72) or partial adherence(22.57 95%CI 14.76 - 32.92).

Conclusions: During the pandemic, the elderly in the two Brazilian cities evaluated were exposed to factors that decreased medication safety. The high use of PIMs is concerning, particularly when considering self-medication. Therefore, interventions aimed at promoting rational and safe use of medicines by the elderly are essential.
"The authors would like to thank the Federal University of Ouro Preto (UFOP), the Postgraduate Programme in Pharmaceutical Sciences (PPG CiPharma), CAPES, the Municipal Health Departments of Ouro Preto and Mariana and the Research and Teaching Group in Nutrition and Collective Health at UFOP".