Abstract
estudiar las prescripciones inapropiadas en ancianos institucionalizados y los factores asociados a éstas. estudio epidemiológico prospectivo realizado durante 14 meses en 5 residencias de ancianos de la ciudad de Granada (España) y su área metropolitana; se recogieron los datos relativos a la edad, el sexo, el tipo y número de prescripciones, los diagnósticos, la valoración psicofísica y la presencia de reacciones adversas a los medicamentos de los ancianos. Para las prescripciones inapropiadas se aplicaron los criterios explícitos de Beers, a los que se añadió el zolpidem. Como método estadístico se usó un test logístico de regresión multivariable y se utilizó el paquete estadístico STATA versión 7.0. se registraron 2.323 prescripciones, de las que un 19,5% eran inapropiadas; entre ellas destacaron las benzodiacepinas, zolpidem, vasodilatadores cerebrales, nootrópicos, mezclas de antipsicóticos y ansiolíticos, flebotónicos y antibióticos sistémicos. Hubo un mayor riesgo de incidencia de prescripciones inapropiadas relativas a los sistemas cardiocirculatorio y nervioso y del aparato digestivo, así como en las mujeres. No hallamos que la edad, el número de prescripciones o de diagnósticos, el deterioro psicofísico de los ancianos y la presencia de reacciones adversas a medicamentos se comportaran como factores de riesgo. en los ancianos de las residencias observamos una elevada proporción de prescripciones inapropiadas de fármacos cardiovasculares, del aparato digestivo y del sistema nervioso central; también en mujeres y en el caso de que el médico prescriptor no fuera el habitual. Destacamos el interés de estos estudios en geriatría. to study inappropriate prescribing practices in elderly individuals in nursing homes and associated factors. we performed a prospective, epidemiological study in the elderly residents of five nursing homes in the city of Granada (Spain) and its metropolitan area, over a 14-month period (June 1999 to September 2000). The variables recorded were age, sex, number and type of prescription, diagnoses, psychophysical status and adverse events. Inappropriate prescriptions were identified with explicit criteria developed by Beers. Zolpidem was also considered inappropriate for chronic treatment. All statistical methods were performed with the STATA 7.0. program. of the 2,323 prescriptions studied, 19.5% were judged inappropriate. The most frequent inappropriate prescriptions were for benzodiazepines, zolpidem, cerebral vasodilators, nootropics, combinations of antipsychotics plus anxiolytics, phlebotonic drugs and antibiotics. There was a higher risk of inappropriateness with cardiovascular, digestive and nervous system medications. Female sex was also associated with inappropriate prescriptions. No association was found between inappropriate prescriptions and age, number of prescriptions or diagnoses, psychophysical deterioration or adverse drug reactions. we found that a high proportion of prescriptions for drugs acting on the cardiovascular, digestive or central nervous systems was inappropriate. Female sex and prescriptions written by physicians other than the patient's usual physician were additional factors. We hope that our findings will help identify and avoid inappropriate prescribing practices in elderly nursing home residents.
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