Original Research ARTICLE
PAIN AND INFLAMMATION MANAGEMENT IN OLDER ADULTS: A BRAZILIAN CONSENSUS OF POTENTIALLY INAPPROPRIATE MEDICATION AND THEIR ALTERNATIVE THERAPIES
- 1Universidade do Vale do Rio dos Sinos, Brazil
- 2Kolling Institute of Medical Research, Royal North Shore Hospital, Australia
Purpose: The aim of the present study was to develop and validate a Potentially Inappropriate Medications (PIM) list and alternative therapies for treatment of pain and inflammation in older people adapted to the Brazilian context.
Methods: A preliminary PIM list suitable for the Brazilian market was developed on the basis of three published international PIM lists (Beers 2015, Screening Tool of Older People's Potentially Inappropriate Prescriptions - 2005, European Union (7) PIM list). We used the modified Delphi technique (two-round) to validate concerns of use and alternative therapies related to PIM for treatment of pain and inflammation in older adults ≥65 years in Brazil. The panel involved nine Brazilian experts in geriatric pharmacotherapy. All items with mean Likert scale score ≥4.0 (agree) and the lower limit of 95% confidence interval ≥4.0 were considered validated in this study.
Results: At the end of the consensus process, 94 (65.3%) items of 144 were validated. In total, consensus was reached for 33/35 (94.3%) concerns about drugs that should be avoided in older patients regardless of diagnosis, for 22/23 (95.7%) concerns about drugs that should be avoided in older patients with specific conditions or diseases, for 11/23 (47.8%) with special considerations of use, and for 28/63 (44.4%) of therapeutic alternatives.
Conclusion: Although these criteria are not designed to replace clinical judgement, PIM and alternative therapies lists can be useful to inform prescribers, pharmacists, and health care planners and may serve as a starting point for safe and effective use of medications in older people.
Keywords: Inappropriate prescribing (MeSH term), Potentially Inappropriate Medication List, Deprescriptions, Aged, Brazil
Received: 31 Jul 2019;
Accepted: 05 Nov 2019.
Copyright: © 2019 Motter, Hilmer and Vieira Paniz. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: PhD. Fabiane R. Motter, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil, firstname.lastname@example.org