title: Potentially inappropriate medications used by the elderly: prevalence and risk factors in Brazilian care homes.
abstract: BACKGROUND
  The use of potentially inappropriate medications (PIM) among the elderly is a serious public health problem because it is intrinsically linked to increased morbidity and mortality, causing high costs to public health systems. This study's objective was to verify the prevalence of and the factors associated with the use of PIMs by elderly Brazilians in institutional settings.
  
  
  METHODS
  We performed a transversal study, by consulting the case files of elderly people living in Long Term Care for the Elderly (LTC) in towns in the State of São Paulo, Brazil, as well as structured interviews with the nurses responsible for them.We identified PIMs using the list of recently updated Beers criteria developed by a group of specialists from the American Geriatrics Society (AGS), who reviewed the criteria based on studies with high scientific evidence levels. We defined the factors studied to evaluate the association with PIM use prior to the statistical analyses, which were the chi-square test and multiple logistic regression.
  
  
  RESULTS
  Among the elderly who used drugs daily, 82.6% were taking at least one PIM, with antipsychotics (26.5%) and analgesics (15.1%) being the most commonly used. Out of all the medications used, 32.4% were PIMs, with 29.7% of these being PIMs that the elderly should avoid independent of their condition, 1.1% being inappropriate medication for older adults with certain illnesses or syndromes, and 1.6% being medications that older adults should use with caution. In the multivariate analysis, the factors associated with PIM use were: polypharmacy (p = 0.0187), cerebrovascular disease (p = 0.0036), psychiatric disorders (p < 0.0001) and dependency (p = 0.0404).
  
  
  CONCLUSIONS
  The results of this study showed a high prevalence of PIM use in institutionalized elderly Brazilian patients. and the associated factors were polypharmacy, psychiatric disorders, cerebrovascular diseases and dependency.
authors.affiliation: Department of Child and Social Dentistry, Dental School of Araçatuba, Univ Estadual Paulista-UNESP (São Paulo State University), 1193 José Bonifácio Street, Araçatuba, SP 16015-050, Brazil. thaisodonto@yahoo.com.br
authors.forename: Thaís Jaqueline
authors.initials: TJ
authors.lastname: Vieira de Lima
authors.forename: Cléa Adas Saliba
authors.initials: CA
authors.lastname: Garbin
authors.forename: Artênio José Isper
authors.initials: AJ
authors.lastname: Garbin
authors.forename: Dóris Hissako
authors.initials: DH
authors.lastname: Sumida
authors.forename: Orlando
authors.initials: O
authors.lastname: Saliba
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D005260:Female; D006707:Homes for the Aged / Q000639:trends*; D006801:Humans; D057970:Inappropriate Prescribing / Q000009:adverse effects* / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000639:trends*; D015995:Prevalence; D012307:Risk Factors