Prescribing Patterns and Pharmacotherapeutic Risk Among Community-Dwelling Older Adults in Brazil: A Cross-Sectional Study.

Abstract

Background Prescribing for older adults can be particularly challenging, as treatment regimens are often complex in geriatric patients, increasing the likelihood of polypharmacy, escalating the risk of exposure to potentially inappropriate medications (PIMs), and to a pharmacotherapeutic risk. Therefore, this study aims to identify prescribing patterns and the pharmacotherapeutic risk in community-dwelling older adults in Brazil. Methodology This cross-sectional study included 504 physically independent older individuals who self-reported sociodemographic characteristics, comorbidities, and data on current pharmacologic therapies. To analyze the pharmacotherapy, all medications used by the patients were recorded, including complementary alternative medications and over-the-counter medications (OTC). The Beers 2023 criteria were used to identify PIMs. Pharmacotherapeutic risk was stratified into two categories based on the presence of PIMs or OTC on the medication regimen. Results This study included 504 older adults (mean age = 69.5 ± 6.4 years), 339 women (67.3%), and 165 men (32.7%). Polypharmacy was observed in 136 (26.98%) individuals, while 180 (36.0%) individuals were using PIMs. Moreover, 97 (19.2%) individuals used OTC medication. Notably, 205 (40.7%) older individuals were classified as being at pharmacotherapeutic risk. In logistic regression, individuals with polypharmacy had nearly five times increased risk of being at pharmacotherapeutic risk (odds ratio = 4.9, p = 0.001), after controlling for sociodemographic and clinical variables. Conclusions A marked pharmacotherapeutic risk was observed, driven chiefly by polypharmacy among community-dwelling older adults. Thus, medical education regarding rational use of medication and deprescribing practices can help mitigate adverse outcomes in older adults. Moreover, future research should focus on user-centered design of technological solutions to support clinicians and patients in safely managing and discontinuing high-risk medications.