ABSTRACT:

Introduction:

Self-medication involves the concept of the spontaneous search by the individual for some drug that he or she considers appropriate to solve a health problem. Self-medication practice is little explored by the elderly according to other studies based in population data.

Objective:

To examine the trends in self-medication practice among the Brazilian elderly between 2006 and 2010.

Methods:

This is a population-based study whose data were obtained from the Health, Well-being and Ageing Study (SABE Study). Thesample consisted of 1,257 elderly people in 2006 and 865 in 2010, who used drugs.

Results:

The findings showed self-medication reduction from 42.3% in 2006 to 18.2% in 2010. In both periods, predominant utilized therapeutic classes were those acting on the nervous system (27.9% in 2006, and 29.6% in 2010) and on the alimentary tract and metabolism (25.5% in 2006, and 35.9% in 2010). The most commonly used medicines in 2006 and 2010 were analgesics, anti-inflammatories, and vitamins. There was a tendency to decrease the use of potentially inappropriate medicines between 2006 (26.4%) and 2010 (18.1%). The elderly themselves were the main responsible for the decision about the drug use in 2006 (62.5%) and 2010 (66.5%).

Conclusion:

Theextent of self-medication practice among the elderly who participated in the study decreased between 2006 and 2010, but the use of medicines that offer risks to health was still reported. Thus, the findings reinforce the importance of monitoring, evaluating, and continuously educating the elderly about risks and benefits of drug consumption, particularly over-the-counter medicines.

Keywords:
Self-medication; Aged; Drug utilization.Inappropriate Prescribing; Pharmacoepidemiology; Cohort studies

INTRODUCTION

Worldwide, countries experience a significant growth of the elderly population. Thisdemographic aspect has been accompanied by the widespread use of drugs and the harmful effects associated with their misuse¹. The magnitude of drug consumption in this age group is a public health problem whose occurrence has, as context, the increasing prevalence of chronic diseases and the consequences of aging; the medicalization in the development process of the health professionals; the lack of continuity in elderly’s care; the short-term solutions to the health problems; the large arsenal of medicines available in the market, including nonprescription drugs; and the practice of self-medication²2. Secoli, SR. Polifarmácia: interações e reações adversas no uso de medicamentos por idosos. Rev Bras Enferm 2010; 63(1): 136-40..

The term self-medication is defined as the initiative of the individual or of the person responsible to obtain or use a product that will bring benefits to the treatment of disease or to the symptom without a prescription that should come from the doctor or dentist³3. Paulo GL, Zanini AC. Automedicação no Brasil. Rev Ass Med Brasil. 1988; 34(2): 69-75.. Thepractice of self-medication may occur by the sharing of drugs with family members, neighbors, or friends; by the use of drugs remaining from previous prescriptions; by the reuse of old prescriptions; by the extension of the treatment prescribed; and by the acquisition of the product without doctor’s prescription⁴4. Vilarino JF, Soares IC, Silveira CM, Rodel APP, Bortoli R, Lemos RR. Perfil da automedicação em município do sul do Brasil. Rev Saúde Públ 1998; 32(1): 43-9.^,55. Brasil. Portaria n.º 3.916/MS/GM, de 30 de outubro de 1998. Política Nacional de Medicamentos. Aprova Politica Nacional de Medicamentos. Diário Oficial da União; 1998 Nov..

Although the consumption of injudicious drug may present more risks to the elderly, the self-medication phenomenon in this age group is still little explored. Research conducted with elderly shows diverse data regarding the prevalence, ranging from 17.7 to 31.2% in developed countries and 8.9 to 80.5% in developing countries⁴4. Vilarino JF, Soares IC, Silveira CM, Rodel APP, Bortoli R, Lemos RR. Perfil da automedicação em município do sul do Brasil. Rev Saúde Públ 1998; 32(1): 43-9.^,66. Carrasco-Garrido P, Jiménez-García R, Barrera VH, Gil de Miguel A. Predictive factors of self-medicated drug use among the Spanish adult population. Pharmacoepidemiol Drug Saf 2008; 17(2): 193-9.^,77. Martins AP, Miranda AC, Mendes Z, Soares MA, Ferreira P, Nogueira A. Self-medication in a Portuguese urban population: a prevalence study. Pharmacoepidemiol Drug Saf 2002; 11(5): 409-14.^,88. Nunes de Melo M, Madureira B, Ferreira APN, Mendes Z, Miranda AC, Martins AP. Prevalence of self-medication in rural areas of Portugal. Pharm World Sci 2006; 28(1): 19-25.^,99. De Bolle L, Mehuys E, Adriaens E, Remon JP, Van Bortel L, Christiaens T. Home medication cabinets and self-medication: a source of potential health threats? Ann Pharmacother 2008; 42(4): 572-9.^,1010. Albarrán KF, Zapata LV. Analysis and quantification of self-medication patterns of customers in community pharmacies in southern Chile. Pharm World Sci. 2008; 30(6): 863-8.^,1111. Oliveira MA, Francisco PMSB, Costa KS, Barros MBA. Automedicação em idosos residentes em Campinas, São Paulo, Brasil: prevalência e fatores associados. Cad Saúde Públ 2012; 28(2): 335-45.^,1212. Cascaes EA, Falchetti ML, Galato D. Perfil da automedicação em idosos participantes de grupos da terceira idade de uma cidade do sul do Brasil. ACM Arq Catarin Med 2008; 37(1): 63-9.. These differences seem to be more related to the method (sample, study site, evaluation of self-medication, type of analysis) than to self-medication itself.

Given that no drug is 100% effective and totally safe, self-medication can be considered a potentially harmful practice and a problem associated with drugs, especially in the elderly. Thus, the improper use of drugs without careful evaluation of a qualified professional can cause adverse reactions, the appearance of nonspecific symptoms, and deterioration of health condition.

In Latin American countries, the investment in strategies for monitoring practices related to the use of drugs has been limited to hospitals¹³13. Tellez YAS, Teeuwisse AKM, Dreser A, Leufkens HG, Wirtz VJ. Impact of over-the-counter restrictions on antibiotic consumption in Brazil and Mexico. PLoS One 2013 16; 8(10): e75550.^,1414. Castro MS, Pilger D, Ferreira MBC, Kopittkea L. Tendências na utilização de antimicrobianos em um hospital universitário, 1990-1996. Rev Saúde Públ 2002; 36(5): 553-8., and there is still little emphasis on the situation of self-medication among the community-dwelling elderly.

In this context, the objective of this study was to examine the trends in the practice of self-medication among the elderly participating on the Health, Well-being and Ageing Study (SABE) between 2006 and 2010.

METHODS

SAMPLE AND STUDY DESIGN

This research is part of the SABE study.¹⁵15. Lebrão ML, Duarte YAO. SABE - Saúde, Bem Estar e Envelhecimento - O projeto SABE no município de São Paulo: uma abordagem inicial [Internet]. Brasília: Athalaia Bureau; 2003 [cited 2006 Feb 20]. Available from: http://www.opas.org.br/sistema/arquivos/l_saber.pdf.
http://www.opas.org.br/sistema/arquivos/... . The complete methodology is part of the first article of this supplement. In this study, the samples were used in 2006 and 2010. Inthe latter, elderly aged 60 - 64 years (Cohort C) were not considered in order to allow comparisons between the same populations who participated in the two periods, that is, 1,413elderly in2006 and 990 in 2010. Only the elderly who used drugs were considered for the analysisin the two time points of the study. Figure 1 illustrates the flowchart of the sample.

DATA EXTRACTION

Data were collected by means of home interviews conducted by interviewers previously trained¹⁵15. Lebrão ML, Duarte YAO. SABE - Saúde, Bem Estar e Envelhecimento - O projeto SABE no município de São Paulo: uma abordagem inicial [Internet]. Brasília: Athalaia Bureau; 2003 [cited 2006 Feb 20]. Available from: http://www.opas.org.br/sistema/arquivos/l_saber.pdf.
http://www.opas.org.br/sistema/arquivos/... . A questionnaire consisting of sections related to the living conditions and health status of the elderly was applied. The following questions were asked to obtain information about the use of drugs:

The dependent variable was the practice of self-medication attributed to the referred use of at least one drug without the prescription of doctor or dentist, indicated by the pharmacist or pharmacy clerk, nurse, the elderly themselves, or others.

The drugs identified in the questionnaire were classified according to the Anatomical Therapeutic Chemical (ATC) classification system, adopted by the World Health Organization (WHO).

The independent variables were sociodemographic as gender, age, education (years of schooling completed), per capita income in minimum wages, and family arrangement; related to health status as self-rated health (categorized as very good/good, regular, and poor/very poor); presence of self-reported chronic disease (hypertension, diabetes, cardiovascular disease, cerebrovascular disease, osteoporosis and osteoarticular disease, and the total number of chronic diseases reported); and self-reported signs and symptoms; related to medicines as quantity and drug name; and related to the access to health services as type of health insurance and medical consultation in the last 12 months.

The Research Ethics Committee of Public Health of the Universidade de São Paulo (USP) approved the SABE study. All participants signed a consent form. There is no conflict of interest.

STATISTICAL ANALYSIS

The characteristics of the elderly were evaluated according to the practice of self-medication in 2006 and 2010. The differences between groups were estimated by the Wald test of mean equality and Rao-Scott test, which consider sample weights in population estimates with population weights.

The analyses were conducted by means of the Stata^® version 11 (ST module), taking into account the sample weights and inferences considering the design effect.

RESULTS

The trend of self-medication shows a significant reduction in the practice between 2006 and 2010. In 2006, the estimated prevalence was 42.3% (n = 525), and in 2010 18.2% (n=172) of the elderly used at least one drug without prescription.

The profile of the elderly who practiced self-medication is presented in Table 1. In 2006, there were significant differences in relation to elderly who did not self-medicated in the variables related to gender, age, schooling, health-care, polypharmacy, and lung disease. In2010, there was a significant difference regarding the group that only used drugs with prescription in the variables related to age, polypharmacy, doctor visits in the last year, and health symptoms (shortness of breath, fatigue, dizziness, nausea, and persistent vomiting), although chronic diseases were not significant to the practice of self-medication (Table 1). The average number of drugs used in self-medication revealed a tendency to increase -from 4.2 in 2006 to 6.1 in 2010.

Among elderly who reported self-medication in 2006, 17.3% (n = 61) continued to report the practice in 2010. Among the group who consumed only drugs with prescription, 83% (n = 381) of the participants remained consuming only prescribed drugs in 2010 and 17% (n = 84) started consuming at least one nonprescription drug.

In 2006 and 2010, 333 and 287 different medicines belonging to 12 ATC groups were identified, respectively. Chart 1 illustrates these drugs, according to the affected anatomical main group (ATC - level 1). The pattern of highlighted consumption of drugs in the action groups of alimentary tract and metabolism (Group A), and nervous system (Group N) was maintained in the years analyzed. A trend of increasing the use of such drugs, including also the agents acting in genitourinary and dermatologic systems, was observed. A trend of reducing the consumption of most ATC groups (58.4%) was observed.

Table 2 shows that drug consumption pattern (level 1) was similar in 2006 and 2010, highlighting dipyrone, multivitamins, diclofenac, and acetylsalicylic acid (ASA). In the analysis of drugs, potentially inappropriate medications (PIM) were identified, observing downward trend between 2006 (26.4%) and 2010 (18.1%). The PIM present in both periods were dexclorfeniramine, bisacodyl, scopolamine, carisoprodol, diazepam, naproxen, piroxicam and ferrous sulfate. In 2006, other PIM such as orphenadrine, ticlopidine, mineral oil, diphenhydramine, cimetidine, and estrogens have been used in self-medication. In 2010, the PIM group was smaller and included amitriptyline and chlorpropamide. Among the 20 prevalent drugs in both investigated periods, a trend of increasing the use of multivitamins, bisacodyl, paracetamol, and carisoprodol (Graph 2) was observed.

The elderly was primarily responsible for the choice of medication used in self-medication in 2006 (65.2%) and 2010 (66.5%). The category other, which included neighbors, friends, and relatives, was ranked in the second position: 24.2% (2006) and 20.2% (2010).

DISCUSSION

This study shows a declining trend of self-medication practice among the elderly of the SABE study, in 2006 and 2010. The therapeutic classes involved in this practice were predominantly the agents that acted in alimentary tract and metabolism and nervous system, emphasizing the multivitamins and analgesics such as dipyrone and diclofenac.

Self-medication observed in 42.3% of the elderly in 2006 was very close to that found in other studies, regardless of the country. In Spain and the United States, it was observed that self-medication occurred in 46 and 50% of elderly living in urban areas, respectively¹⁶16. Neafsey PJ, Jarrín O, Luciano S, Coffman MJ. Self-medication practices of Spanish-speaking older adults in Hartford, Connecticut. Hisp Health Care Int 2007; 5(4): 169-79.^,1717. Cobos F. Estudio de autoprescriptión en las residencias geriátricas de Granada. Rev Esp Geriatr Gerontol 1994; 29: 225-8.. InMexico, there was a prevalence of 53.5% in elderly¹⁸18. Balbuena FR, Aranda AB, Figueras A. Self-medication in older urban Mexicans. Drugs & Aging 2009; 26(1): 51-60..

Consumption of over-the-counter (OTC) drugs, especially in large cities, may be motivated by values ​​that predominate in modern society. Immediate solutions to health problems, ease of access to OTC products, unrestricted advertising in the media, and the absence of Brazilian regulation in 2006 that could limit the purchase of drugs may have partly contributed to this practice¹⁹19. Nascimento MC. Medicamentos apoio ou apoio à saúde? Rio de Janeiro: Vieira e Lent; 2003.^,2020. Figueiras A, Camaño F, Gestal-Otero JJ. Sociodemographics factors related to self-medication in Spain. Eur J Epidemiol 2002; 16(1): 19-26..

In this study, a possible explanation for the reduction in the pattern of self-medication in 2010 may have been the Collegiate Board Resolution (RDC) No 44/2009 of the National Health Surveillance Agency (Anvisa), which prohibited drug exposure in free access shelves in drugstores. Thus, analgesics such as paracetamol and dipyrone, which were among the ten most consumed drugs, were not easily accessible to the consumer, remaining inside thecounter. This fact may have contributed to some extent in the reduction of self-medication.

In the analyzed periods, the pattern of this practice varied according to age. In 2006, the elderly aged 60-74 years were the main practitioners of self-medication, in contrast to 2010, in which the age was 75 years or above.

The literature is quite divergent regarding the influence of age on self-medication²¹21. Fillenbaun GG, Horner RD, Hanlon JT, Landerman LR, Dawson DV, Cohen HJ. Factors predicting changer in prescription and nonprescription drug use in a communith-residing Black and White elderly population. J Clin Epidemiol 1996; 49: 587-93.^,2222. Fillenbaun GG, Hanlon JT, Corder EH, Ziqubu-Page T, Wall Jr. WE, Brock D. Prescription and nonprescription drug use among Black and White community-residing elderly. Am J Public Health 1993; 83: 1577-82.; however, this finding combined with the fact that the elderly themselves are the main responsible for the appointment of self-medication, is suggestive of the search for self-care in order to establish and maintain elderly’s own health. One aspect that favors self-medication is elderly living alone. Often, he or she is the one responsible for own care and sometimes consider him or herself capable of selecting the appropriate drug for the solution of health problems they evaluate as small.

To these individuals, the search for treatment, especially for those of frequent symptoms such as pain, fatigue, and poor digestion, may be influenced by the media and by prior experiences, leading to the use of old prescriptions. The advertisements are an incentive to self-medication, because information about the medications is incomplete, exploiting the unfamiliarity of consumers with drugs’ adverse reactions¹⁹19. Nascimento MC. Medicamentos apoio ou apoio à saúde? Rio de Janeiro: Vieira e Lent; 2003..

In this context, the risk of the problems related to self-medication can derive from two aspects. First, by not being formally monitored, the elderly are unaware of their clinical condition and the existence of any disease (potential or actual). Therefore, they choose the medicine they deem appropriate. Second, reduced visual acuity may occur, leading the elderly to present difficulties to understand and read the information contained in the medicine label, possibly taking the medicine in an incorrect manner. A study showed that 19% of the elderly people who practiced self-medication with OTC drugs had difficulty in understanding the label information and 12% were not able to read them¹⁶16. Neafsey PJ, Jarrín O, Luciano S, Coffman MJ. Self-medication practices of Spanish-speaking older adults in Hartford, Connecticut. Hisp Health Care Int 2007; 5(4): 169-79..

Similar to previous studies⁴4. Vilarino JF, Soares IC, Silveira CM, Rodel APP, Bortoli R, Lemos RR. Perfil da automedicação em município do sul do Brasil. Rev Saúde Públ 1998; 32(1): 43-9.^,1212. Cascaes EA, Falchetti ML, Galato D. Perfil da automedicação em idosos participantes de grupos da terceira idade de uma cidade do sul do Brasil. ACM Arq Catarin Med 2008; 37(1): 63-9.^,2323. Coelho Filho JM, Marcopito LF, Castelo A. Perfil de utilização de medicamentos por idosos em área urbana do Nordeste do Brasil. Rev Saúde Públ 2004; 38(4): 557-64., the item others appeared among those responsible for indication of self-medication, which may include family, friends, and neighbors. Factorsthat seem to favor the influence of third parties in the individual’s decision are social interaction, exchange of experiences, and degree of dependence of the elderly. Regardless of the person involved in the indication of self-medication, the use of drugs without proper clinical assessment represents a risk.

In 2006, the practice of self-medication occurred in elderly people with low education (zero and one to three years of schooling), a finding consistent with other Brazilian¹²12. Cascaes EA, Falchetti ML, Galato D. Perfil da automedicação em idosos participantes de grupos da terceira idade de uma cidade do sul do Brasil. ACM Arq Catarin Med 2008; 37(1): 63-9.^,2323. Coelho Filho JM, Marcopito LF, Castelo A. Perfil de utilização de medicamentos por idosos em área urbana do Nordeste do Brasil. Rev Saúde Públ 2004; 38(4): 557-64.^,2424. Bortolon PC, Medeiros EFF, Naves JOS, Karnikowski M, Planton J, Edlund BJ. Strategies for reducing polypharmacy in older adults. J Gerontol Nurs 2010; 36(1): 8-12. and Mexican research¹⁸18. Balbuena FR, Aranda AB, Figueras A. Self-medication in older urban Mexicans. Drugs & Aging 2009; 26(1): 51-60.. Elderly people with low education may present subjacent elements such as lower income and less access to health services, with exclusive dependence on the public health service. The precarious public health services and the low purchasing power of the elderly contrast with the ease of access to obtaining drugs without the payment for consulting a doctor and without a prescription. In SABE study, similar to that by Bambuí²⁵25. Bortolon PC, Medeiros EFF, Naves JOS, Karnikowski MGO, Nóbrega OT. Análise do perfil de automedicação em mulheres idosas brasileiras. Ciênc Saúde Coletiva 2008; 13(4): 219-26., the search for self-medication seemed to replace medical attention in individual with low education.

In 2006 and 2010, polypharmacy showed a significant difference compared to the group that only used prescription drugs. Among the elderly, polypharmacy and self-medication are phenomena that tend to coexist. The care of the elderly by multiple prescribers, inadequate treatment generated by the lack of systematic follow-up, and ease of access to pharmacies are elements that may contribute to greater use of medicines. In the resolution of frequent health problems such as joint pain, poor digestion, and constipation, it is often more convenient to use medicine available at home than seek medical care, especially when the elderly is dependent on third parties or has low income. Often the elderly present two to six prescriptions and self-medicate with two or more medicines²⁶26. Loyola-Filho AL, Uchoa E, Guerra HL, Firmo JOA, Lima-Costa MF. Prevalência e fatores associados à automedicação: resultados do projeto Bambuí. Rev Saúde Públ 2002; 36(1): 55-62..

Currently, polypharmacy and inappropriate self-medication are recognized as problems related to drugs that can lead to negative outcomes, such as adverse reactions, dangerous drug interactions, medication errors, and increased morbidity and mortality of the elderly²2. Secoli, SR. Polifarmácia: interações e reações adversas no uso de medicamentos por idosos. Rev Bras Enferm 2010; 63(1): 136-40.^,2727. Prybys KM, Melville K, Hanna J, Gee A, Chyka P. Polypharmacy in the elderly: clinical challenges in emergency practice: part 1. Overview, etiology, and drug interactions. Emerg Med Rep 2002; 23(1): 145-53.^,2828. Secoli SR, Figueras A, Lebrão ML, Lima FD, Santos JL. Risk of potential drug-drug interactions among Brazilian elderly. Drugs & Aging 2010: 27(9): 759-70.. A study revealed that in nursing homes for every US dollar spent on medicines, 1.33 USD was necessary to treat adverse events to medicines²⁹29. Bootman JL, Harrison DL, Cox E. The health care cost of drug-related morbidity and mortality in nursing facilities. Arch Intern Med 1997; 157: 2089-96.. Self-medication, particularly, may mask symptoms or diseases and delay diagnosis of serious disease²2. Secoli, SR. Polifarmácia: interações e reações adversas no uso de medicamentos por idosos. Rev Bras Enferm 2010; 63(1): 136-40.^,1616. Neafsey PJ, Jarrín O, Luciano S, Coffman MJ. Self-medication practices of Spanish-speaking older adults in Hartford, Connecticut. Hisp Health Care Int 2007; 5(4): 169-79.^,2121. Fillenbaun GG, Horner RD, Hanlon JT, Landerman LR, Dawson DV, Cohen HJ. Factors predicting changer in prescription and nonprescription drug use in a communith-residing Black and White elderly population. J Clin Epidemiol 1996; 49: 587-93..

In the periods analyzed, the predominant therapeutic classes in self-medication consisted of drugs acting on the nervous system (Group N) and on the alimentary tract and metabolism (Group A), which is similar to the findings of other studies⁶6. Carrasco-Garrido P, Jiménez-García R, Barrera VH, Gil de Miguel A. Predictive factors of self-medicated drug use among the Spanish adult population. Pharmacoepidemiol Drug Saf 2008; 17(2): 193-9.^,2626. Loyola-Filho AL, Uchoa E, Guerra HL, Firmo JOA, Lima-Costa MF. Prevalência e fatores associados à automedicação: resultados do projeto Bambuí. Rev Saúde Públ 2002; 36(1): 55-62.. Many of these drugs are included in therapeutic classes that constitute PIM.

The high prevalence of drugs in the Group N is mainly because analgesics such as dipyrone, aspirin, and paracetamol are included in this group, according to the ATC classification system. Due to the comprehensive pharmacological actions (reduction of fever, pain relief, and reduction of inflammation), these agents are useful in the treatment of acute and chronic conditions found in the elderly³⁰30. Goh LY, Vitry AI, Semple SJ, Esterman A, Luszcz MA. Self-medication with over-the-counter drugs and complementary medications in South Australia's elderly population. BMC Complement Altern Med 2009; 9: 42. doi: 10.1186/1472-6882-9-42.
https://doi.org/10.1186/1472-6882-9-42... . Similar to the SABE study, these drugs were the most consumed by the elderly in urban areas of different countries⁸8. Nunes de Melo M, Madureira B, Ferreira APN, Mendes Z, Miranda AC, Martins AP. Prevalence of self-medication in rural areas of Portugal. Pharm World Sci 2006; 28(1): 19-25.^,1010. Albarrán KF, Zapata LV. Analysis and quantification of self-medication patterns of customers in community pharmacies in southern Chile. Pharm World Sci. 2008; 30(6): 863-8.^,1818. Balbuena FR, Aranda AB, Figueras A. Self-medication in older urban Mexicans. Drugs & Aging 2009; 26(1): 51-60.^,2020. Figueiras A, Camaño F, Gestal-Otero JJ. Sociodemographics factors related to self-medication in Spain. Eur J Epidemiol 2002; 16(1): 19-26.^,2323. Coelho Filho JM, Marcopito LF, Castelo A. Perfil de utilização de medicamentos por idosos em área urbana do Nordeste do Brasil. Rev Saúde Públ 2004; 38(4): 557-64.^,3030. Goh LY, Vitry AI, Semple SJ, Esterman A, Luszcz MA. Self-medication with over-the-counter drugs and complementary medications in South Australia's elderly population. BMC Complement Altern Med 2009; 9: 42. doi: 10.1186/1472-6882-9-42.
https://doi.org/10.1186/1472-6882-9-42... .

In agreement with the research conducted in several countries, vitamins were the most utilized drugs acting on the alimentary tract and metabolism²⁰20. Figueiras A, Camaño F, Gestal-Otero JJ. Sociodemographics factors related to self-medication in Spain. Eur J Epidemiol 2002; 16(1): 19-26.^,2222. Fillenbaun GG, Hanlon JT, Corder EH, Ziqubu-Page T, Wall Jr. WE, Brock D. Prescription and nonprescription drug use among Black and White community-residing elderly. Am J Public Health 1993; 83: 1577-82.^,2626. Loyola-Filho AL, Uchoa E, Guerra HL, Firmo JOA, Lima-Costa MF. Prevalência e fatores associados à automedicação: resultados do projeto Bambuí. Rev Saúde Públ 2002; 36(1): 55-62.^,3030. Goh LY, Vitry AI, Semple SJ, Esterman A, Luszcz MA. Self-medication with over-the-counter drugs and complementary medications in South Australia's elderly population. BMC Complement Altern Med 2009; 9: 42. doi: 10.1186/1472-6882-9-42.
https://doi.org/10.1186/1472-6882-9-42... . Worldwide, the consumption of vitamins has grown, especially in the 1970s, due to the popular belief that these products would be able to provide long and healthy life. Thus, nowadays the consumption of vitamins is higher among the elderly compared to other age groups. This behavior seems to be reinforced by the media and relatives. However, similar to any other medication, the effects are not innocuous and their indiscriminate use may cause intoxication. In addition, many elderly use vitamin complexes that are formulated with a fixed dose of the active ingredient. This may represent a problem as the individual’s needs of specific components may vary according to the health condition of each individual. Thus, the use of these complexes may lead to unnecessary consumption of certain vitamins and insufficient intake of those that are essential.

The trend of self-medication with regard to the most consumed therapeutic classes was similar in 2006 and 2010. However, in a more detailed analysis, it was found that there wasa tendency to decline the use of PIM, according to Fick etal.³¹31. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the beers criteria for potentially inappropriate medication use in older adults. Arch Inter Med 2003; 163(22): 2716-25.. In 2006, one in four drugs (26.4%) was inappropriate. In 2010, the percentage was 18.1. Despite this reduction, PIM as dexclorfeniramine, bisacodyl, scopolamine, carisoprodol, diazepam, naproxen, piroxicam, and ferrous sulfate were present in both periods. One possible explanation for this pattern is that there were leftovers of these PIM that were previously prescribed, especially of those that are controlled.

In this topic, particularly, it is important to point out that more technical aspects related to medicines may influence the inappropriate consumption. The sale of these products in larger quantities than those of the prescription leads to medication leftover at the end of the treatment. This may induce the reuse of drugs in situations where the symptoms seem to be the same, as is the case of allergy, constipation, and abdominal cramps.

CONCLUSION

In the scope of the geriatric pharmacoepidemiology, this study brings important contributions. This is the first study that demonstrates, by means of a population-based investigation, the reduction of self-medication practice in 4 years, despite the maintenance of therapeutic classes of consumption that act on the nervous system and alimentary tract. Westudied two cohorts of the elderly, and the tool applied to evaluate the dependent variable was the same. The question on self-medication was individualized to each drug referred to by the elderly, which allowed identifying among the set of drugs reported which in fact was used in the group of interest. In the analysis of the drugs, the PIM were also identified, according to the criteria of Fick etal.³¹31. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the beers criteria for potentially inappropriate medication use in older adults. Arch Inter Med 2003; 163(22): 2716-25.. This fact demonstrates that the periodic review by the health professionals of the benefits and risks of all drugs used by the elderly is fundamental.

The study has limitations that should be considered in relation to the implications of the findings. Medicinal plants were not analyzed in self-medication, although the problems related to them are recognized. Data collection did not identify the reason for the elderly’s self-medication, the dose or duration of the drug’s use. Thus, drugs such as aspirin could not be examined in relation to the indication of the use (dose dependent). With regard to the responsible for the indication of the drug, the category other did not allow identifying who was the person responsible, limiting the comparison of the SABE study with other studies.

Finally, despite the declining trend in the practice of self-medication among the elderly included in the SABE study between 2006 and 2010, the findings reinforce the importance of monitoring, evaluating, and continuously educating the elderly about the risks and benefits of consuming drugs, especially nonprescription drugs.

References

Publication Dates

History