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Efecto de la deprescripción de medicación inapropiada en adultos mayores: una revisión de literatura y meta-análisis de ensayos clínicos controlados
Effect of deprescribing inappropriate medication in older adults: a literature review and meta-analysis of controlled clinical trials
Efeito da prescrição de medicamentos inapropriados em idosos: revisão de literatura e meta-análise de ensaios clínicos controlados
DOI:
https://doi.org/10.15446/rcciquifa.v53n3.119136Palabras clave:
Ancianos frágiles, polifarmacia, medicamentos potencialmente inapropiados, deprescripción (es)Frail Elderly, Polypharmacy, Potentially Inappropriate Medication List, Deprescriptions (en)
Idosos frágeis, polifarmácia, medicamentos potencialmente inapropriados, descrição (pt)
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Introducción: La pluripatología en las personas mayores es un factor de riesgo para polimedicación, cascada de medicación y medicación potencialmente inapropiada. La deprescripción se plantea como estrategia para reducir la carga farmacológica y medicación inapropiada. Objetivo: Establecer el efecto de la deprescripción en los resultados en salud de personas mayores según lo reportado por la literatura. Metodología: Se desarrolló una revisión sistemática y meta-análisis hasta junio del 2020, utilizando las bases de datos MEDLINE vía PubMed, LILACS, SciELO y Epistemonikos, siguiendo la metodología PRISMA. Se incluyeron estudios experimentales y cuasi-experimentales, en idioma inglés y español. Se evaluaron los niveles de evidencia y el riesgo de sesgo para cada estudio individual. La reducción de prescripciones potencialmente inapropiadas, la mortalidad, las caídas y el número de hospitalizaciones fueron evaluadas en el meta-análisis. Resultados: Se identificaron un total de 1524 registros por bases de datos. Se incluyeron 24 artículos en el análisis descriptivo y 14 en el cuantitativo. El número de prescripciones potencialmente inapropiadas se redujo significativamente (OR 0,51; IC 95% 0,41 – 0,62), igual que el número de caídas (OR 0,73; IC 95% 0,57 – 0,94) después de aplicar las intervenciones de deprescripción de medicación inapropiada. Conclusiones: Se evidenció un efecto positivo en la reducción de prescripciones potencialmente inapropiadas y el número de caídas. La deprescripción parece no tener efecto significativo sobre la mortalidad y la calidad de vida.
Introduction: Pluripathology in older people is a risk factor for polypharmacy, medication cascade and potentially inappropriate medication. Deprescribing is proposed as a strategy to reduce pharmacological burden and inappropriate medication. Objective: Establish the effect of deprescription on the health outcomes of older people as reported by the literature. Methodology: A systematic review and meta-analysis was developed until June 2020, using the MEDLINE databases via PubMed, LILACS, SciELO and Epistemonikos, following the PRISMA methodology. Experimental and quasi-experimental studies were included, in English and Spanish. Levels of evidence and risk of bias were assessed for each individual study. The reduction of potentially inappropriate prescriptions, mortality, falls and the number of hospitalizations were evaluated in the meta-analysis. Results: A total of 1524 records were identified per database. 24 articles were included in the descriptive analysis and 14 in the quantitative analysis. The number of potentially inappropriate prescriptions was significantly reduced (OR 0.51; 95% CI 0.41 – 0.62), as was the number of falls (OR 0.73; 95% CI 0.57 – 0.94) after applying interventions to deprescribe inappropriate medication. Conclusions: A positive effect was evident in the reduction of potentially inappropriate prescriptions and the number of falls. Deprescribing appears to have no significant effect on mortality and quality of life.
Introdução: A pluripatologia em idosos é um fator de risco para polifarmácia, cascata de medicamentos e medicamentos potencialmente inapropriados. A desprescrição é proposta como estratégia para reduzir a carga farmacológica e a medicação inadequada. Objetivo: Estabelecer o efeito da desprescrição nos desfechos de saúde dos idosos conforme relatado pela literatura. Metodologia: Foi desenvolvida uma revisão sistemática e meta-análise até junho de 2020, utilizando as bases de dados MEDLINE via PubMed, LILACS, SciELO e Epistemonikos, seguindo a metodologia PRISMA. Foram incluídos estudos experimentais e quase-experimentais, em inglês e espanhol. Os níveis de evidência e o risco de viés foram avaliados para cada estudo individual. A redução de prescrições potencialmente inapropriadas, mortalidade, quedas e número de internações foram avaliadas na metanálise. Resultados: Foram identificados 1.524 registros por base de dados. Foram incluídos 24 artigos na análise descritiva e 14 na análise quantitativa. O número de prescrições potencialmente inapropriadas foi significativamente reduzido (OR 0,51; IC 95% 0,41– 0,62), assim como o número de quedas (OR 0,73; IC 95% 0,57 – 0,94) após a aplicação de intervenções para prescrever medicamentos inapropriados. Conclusões: Foi evidente um efeito positivo na redução de prescrições potencialmente inadequadas e no número de quedas. A prescrição parece não ter efeito significativo na mortalidade e na qualidade de vida.
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