Abstract
To evaluate the prevalence of polypharmacy and the influence of income on the association between medication use and cognitive impairment among elderly people. Out of the 1,606 baseline members of the Bambuí cohort of elderly people, which started in 1997, 1,554 took part in the study. The Mini-Mental State Examination was applied to all the participants. The association between cognitive impairment and polypharmacy was tested by means of multivariate ordinal regression, performed for the whole population and for each of the income strata. The prevalence of polypharmacy (two or more medications consumed) was 70.4% and the number of medications used presented an independent negative association with cognitive impairment (OR=0.72; 95% CI: 0.55;0.95). When this was stratified according to personal income (<2 minimum monthly salaries versus >or= 2 minimum monthly salaries), a negative association was observed between medication use and cognitive impairment among elderly people with lower income (OR=0.64; 95% CI: 0.48;0.86), but not among those with higher income (OR=1.74; 95% CI: 0.81;3.74). With regard to the association between cognitive impairment and number of medications consumed, the results indicate social inequality in the use of medications. It is possible that these elderly people are not consuming the medicines needed for appropriate treatment of their health problems.
Highlights
Polypharmacy is more commonly defined as multiple consumption of medications, there is no consensus in the literature regarding the quantity of medications needed to characterize this practice.[7,8,14] The basis for this definition is solely quantitative and it does not take into account the clinical pertinence of the use of these medications or the adequacy of the proposed therapeutic regimen.[21]In addition to comorbidity, the factors implicated in the genesis of polypharmacy include the number of doctors consulted, absence of questions during consultations concerning the medications in use and self-medication.[21]
When this was stratified according to personal income ( 2 minimum monthly salaries), a negative association was observed between medication use and cognitive impairment among elderly people with lower income (OR=0.64; 95% CI: 0.48;0.86), but not among those with higher income (OR=1.74; 95% CI: 0.81;3.74)
It is possible that these elderly people are not consuming the medicines needed for appropriate treatment of their health problems
Summary
Polypharmacy is more commonly defined as multiple consumption of medications, there is no consensus in the literature regarding the quantity of medications needed to characterize this practice.[7,8,14] The basis for this definition is solely quantitative and it does not take into account the clinical pertinence of the use of these medications (for example, the presence of multiple diseases) or the adequacy of the proposed therapeutic regimen.[21]In addition to comorbidity, the factors implicated in the genesis of polypharmacy include the number of doctors consulted, absence of questions during consultations concerning the medications in use and self-medication.[21]. In Brazil, a study carried out among elderly people living in the metropolitan region of Belo Horizonte[16] showed that there were significant independent associations between the consumption of three or more medications and female sex, older age group (80 years or over), having at least one chronic disease and having three or more medical consultations over the last 12 months. Among this same population, high consumption of medications (five or more) was associated with higher schooling levels (eight years or more) and the other variables mentioned above
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