Uso de medicamentos por idosos na atenção primária à saúde : enfoque nos critérios de Beers-Fick.

Abstract

Introduction: Population aging is directly associated with increased multimorbidity and polypharmacy, making medication use a central element in elderly health care. However, the concomitant use of multiple drugs heightens the risk of drug interactions, adverse reactions, avoidable hospitalizations, and reduced therapeutic adherence. In this context, the Beers–Fick Criteria stand out as a support tool for identifying potentially inappropriate medications (PIMs), although they present limitations when applied to the Brazilian context, such as the exclusion of commonly used medications and the definition of older adults as those aged ≥65 years, in contrast with the Brazilian Elderly Statute (≥60 years). Additionally, antimicrobial use in older adults requires special attention in Primary Health Care (PHC) due to global concerns regarding bacterial resistance and the need for stewardship strategies tailored to this level of care. Objective: To evaluate medication use in older adults receiving care in PHC, using the Beers– Fick Criteria. MANUSCRIPT 1 – Objective: To assess the prevalence of polypharmacy and the use of PIMs in older adults receiving care in PHC, according to the Beers–Fick Criteria. Methods: A cross-sectional study was conducted in Santa Cruz do Sul (RS, Brazil), between December 2024 and March 2025, through electronic medical record review, with 406 older adults. Clinical, sociodemographic, and pharmacological variables were analyzed. Descriptive statistics and Poisson regression were used. Results: The sample was predominantly female (66.5%), with a mean age of 69.6 years. The median number of medications was 5 (IQR 3–8), resulting in a polypharmacy prevalence of 60.1%, while the use of PIMs reached 29.4% of older adults. Men had higher metformin use (PR = 1.51; 95% CI: 1.04–2.18; p = 0.029), while age was associated with acetylsalicylic acid use (PR = 1.03; 95% CI: 1.01–1.06; p = 0.013). No significant difference between sexes was observed in the total number of medications. Conclusions: Polypharmacy represents a major challenge in the clinical management of older adults. The Beers–Fick Criteria proved useful for identifying PIMs, but they have limitations in the Brazilian context and should be applied critically and complemented by individualized clinical judgment. MANUSCRIPT 2 – Objective: To analyze antimicrobial use among older adults in PHC and its appropriateness according to the Beers–Fick Criteria. Methods: A cross-sectional study was conducted in Santa Cruz do Sul (RS, Brazil), between December 2024 and March 2025, through electronic medical record review. A total of 406 older adults (≥60 years) were included, and sociodemographic, clinical, and pharmacological variables were evaluated. Descriptive statistics, Poisson regression, and Negative Binomial regression were applied. Results: Antimicrobial use was observed in 13.3% of participants. Prescriptions predominantly involved single-agent antibiotics, followed by antifungals and antivirals. However, 63.4% of antibiotic prescriptions were classified as inappropriate according to the Beers–Fick Criteria, and a substantial proportion was considered indeterminate due to incomplete medical records. Older age was associated with higher antimicrobial use, and non-white individuals had a higher prevalence of antiviral prescriptions. Conclusions: The high frequency of inappropriate antimicrobial prescriptions highlights gaps in clinical care and reinforces the need for antimicrobial stewardship strategies in Brazilian PHC. Overall Conclusion Medication use among older adults in PHC revealed a high prevalence of polypharmacy and a considerable rate of PIM use, along with significant inadequacies in antimicrobial prescribing. The Beers–Fick Criteria proved to be a relevant tool, but with limited applicability in the Brazilian context. Deprescribing strategies, continuous professional education, and strengthened patient-centered care are essential to promote safer and healthier aging.