Therapeutic competition in community-living elderly with multimorbidity (health, well-being and aging - SABE study)

Abstract

It is estimated that by 2025 Brazil will have the sixth largest population of elderly in the world. Aging implies increasing prevalence of chronic conditions which are a health problem of great magnitude, strongly affecting the poorest and most vulnerable population groups. The simultaneous occurrence of multiple chronic conditions, in the same individual, with their interrelations and implications for health, has received the name of multimorbidity. Multimorbidities requires a complex pharmacotherapy, leading to the use of several drugs at the same time (polypharmacy), increasing the risk of adverse effects and drug interactions and between medicine and disease. Frequently older adults present health problems induced by drugs due to drug interactions, therapeutic competitions and a higher frequency of unpredictable adverse reactions. Therapeutic competition is known as a type of drug-disease interaction in which the treatment recommended for a certain condition can negatively alter (compete) another coexisting condition. Reports have found that many medications are prescribed without assessing their effect on other coexisting conditions, which may adversely affect it, namely therapeutic competition. Although, concerns to the multimorbidity high prevalence are increasing, few studies and clinical practice guidelines address the pharmacological treatment of older adults with multimorbidity. Clinical practice guidelines rarely consider the presence of more than one chronic condition in their recommendations, meaning the cumulative impact of multiple treatment recommendations is usually not considered. Aging is a reality in Brazil which makes the investigation of therapeutic competition crucial to promote high quality health care and patient safety. The main purpose of this project is to investigate and evaluate the prevalence of therapeutic competition in community-living elderly people. For this study, we will analyze the cohort database Health, Well-being and Aging (SABE Study), and clinical practice guidelines for the treatment of most prevalent chronic conditions in older adults. We expected that the results of this project will assist in choosing the best pharmacological therapy for elderly with multimorbidities. (AU)