Reducing Anticholinergic Burden in Hospitalised Older Adults: Analysis From the INFAR Study Romana Santos Gama, Luiz Carlos Passos, Welma Wildes Amorim, Renato Morais Souza, Marcio Galvão Oliveira Basic and Clinical Pharmacology and Toxicology, 2026 This study aimed to evaluate the effectiveness of pharmacist‐led medication reviews in reducing the anticholinergic burden of hospitalised patients with cardiovascular diseases (CVDs), to identify which anticholinergic medications were most frequently prescribed or discontinued during hospitalisation and to investigate factors associated with an elevated anticholinergic burden via secondary analysis of the INFAR study. An uncontrolled before‐and‐after design was used, and medication reviews were performed for all patients so that the anticholinergic burden of medications prescribed to older adults during their hospital stay could be examined. The mean age of the 319 patients was 68.9 years (±6.2), and upon hospital admission, 40.4% were classified as having a high anticholinergic burden, decreasing to 22.6% at discharge. Multivariate analysis at admission indicated that polypharmacy (PR = 2.00; 95% CI = 1.47–2.72) and potentially inappropriate medication (PR = 4.47; 95% CI = 2.10–9.53) were independently associated with a higher anticholinergic burden; however, only inappropriate medication was significantly associated with a high burden (PR = 2.39; 95% CI = 1.54–3.71) at discharge. The results indicate that a clinical pharmacist‐led medication review may reduce the anticholinergic burden in older adults with CVD, highlighting the importance of such a review in promoting safer prescribing practices during hospitalisation.
Geriatric Syndromes and Mortality Among Hospitalized Older Adults Thiago J. Avelino-Silva, Maria Fernanda B. Roma, Adriana F. Dutra, Alexandra Malheiro, Ana Cristina C. Speranza, Arlety M. C. Casale, Beatriz N. A. Lopes, Clineu M. Almada-Filho, Danilsa V. de Sousa, Eduardo Marques da Silva, Fabiola Sepulveda, Flavia Barreto Garcez, Gabriel T. Constantino, Gabriela S. Keller, Ianna L. S. Braga, Jonas Gordilho Souza, Juliana J. M. Teixeira, Karoline Rodrigues da Silva Martins, Laiane Moraes Dias, Lara M. Q. Araujo, Luana A. C. Macedo, Lucas G. de Andrade, Lucas K. P. Prado, Luis Carlos Venegas-Sanabria, Marco P. D. Freitas, Marcos D. C. Saraiva, Maria Aparecida C. Bicalho, Maria Carolyna F. B. Arbex, Maria E. Pires, Maria M. V. Guedes, Marina M. G. Borges, Milton L. Gorzoni, Mirella R. Bezerra, Natalia I. B. Garção, Natascha G. F. Palmeira, Nereida K. C. Lima, Oberdã G. Moreira-Filho, Paulo José F. Villas Boas, Perola Q. de Almeida, Renata M. Dip, Renato G. Bandeira de Mello, Samir A. Aruachan, Theodora Karnakis, Vitor L. Pintarelli, Welma W. C. C. Amorim, Yngrid Dieguez Ferreira, Kenneth E. Covinsky, Eduardo Ferriolli, Sei J. Lee, Alexander K. Smith, Claudia K. Suemoto, Marlon J. R. Aliberti, , Ivan M. de Oliveira, Diana Francisco, Eunice Andrade, Nazareth Neto, Nidia Van Dunem, Beatriz N. da Cunha, Ewerton Miyadahira, Gustavo M. Mil Homens, Lisa L. Mello, Mariana M. Teruya, Mario S. S. Cabral, Matheus P. Viola, Renato T. Galvão, Beatriz N. Nassif, Dannielle M. Guimarães, Ezemir D. Fernandes, Flavia A. de Amorim, Flavia Campora, Flavia T. T. Nakamura, Jose S. Cardoso, Julia M. Menezes, Luis E. M. Martins, Mayara V. Batista, Raiza T. Lira, Silvio C. Amorim, Vitor A. Fontenelles, Gabriela M. Costa, Julio C. Moriguti, Edgar N. de Moraes, Tatiana C. E. Pinheiro, Alicia R. M. Accioly, Hugo O. D. M. Gomes, Mariana A. de Luna, Mayara S. Honorato, Milena B. A. Silva, Rebeca M. S. Coelho, Rosana S. Batista, Andre Fattori, Estela F. Vilela, Jessica Valonini, Rodolfo A. O. Nogueira, Emilio H. Moriguchi, Francine F. Klein, Aline T. S. Santos, Giovanni G. N. Santos, João G. A. de Lima, Juliana C. de Souza, Juliano S. de Araujo, Maria C. T. Vianna, Natalia C. Guedes, Rafael V. S. Barreto, Raphael A. Filgueiras, Rayane L. C. D. de Medeiros, Brunna S. Oliveira, Esther S. M. Melo, Hellen M. M. Cardoso, Iuri C. Gusmão, Jonatas S. P. Porto, Marcio G. G. de Oliveira, Maria E. S. G. Roberto, Nara L. F. Rebouças, Roberta B. Jauris, Tatiane D. C. Valença, Andrezza M. Fernandes, Carolina M. Feijo, Hellen M. P. Rocha, Lara A. Vieira, Lirenna P. Narciso, Luisa B. Bruno, Nadedja L. Q. Rocha, Priscila P. S. Nogueira, Rafael S. B. Pinheiro, Wallena C. Brito, Adriana Alves, Margarete C. P. Miralia, Victor J. D. Melo, Vanessa A. L. Pires, Filipe Basto, Manuela O. C. Magalhães, Dominique K. B. Silva, Paula L. Ferreia, Rísia M. O. Barreto, Camila F. Lima, Tatiana S. Moreira, Josecy M. S. Peixoto, Alayne M. T. D. Yamada, Fabio A. Bittencourt, Graziela B. B. Ivanov, Mara G. M. Silveira, Debora D. Casagrande, Thatiana Dal Toe, Eduardo C. Cruz, Bruna M. de Carvalho, Michel S. Dantas, Naira H. S. L. Hojaij, Julia F. Brenny, Pedro H. A. Silva, Erika C. N. Giuliano, Amarildo B. S. Oliveira, Antonio L. Sarmento, Einstein F. de Camargos, Larissa F. L. e Abreu, Luciana L. L. Martini, Vanessa S. Canossa, Yan B. Jardim, Karlo E. Moreira, Eliana Pineda, Elly Morros, Catarina R. F. do Nascimento, Marconi E. Maia, Carla M. Ribeiro, Marilia G. S. Torre, Nathalia Gomes, Christiane M. Santana, Fabia S. O. Junqueira, Murilo S. S. Passos, Ronald C. Gomez, Ana L. Kanaji, Andreyna J. Rodrigues, Camila M. F. D. Ferreira, Iolanda G. R. de Oliveira, Ivo B. S. Silva, Luciulo Melo, Milena M. dos Santos, Walter A. de Araujo, Vanessa F. R. Saraiva, Flavio F. Arbex, Maria J. C. Souza, Laiane M. Dias JAMA Network Open, 2026 Importance Geriatric syndromes are common in hospitalized older adults and complicate acute care; however, their overall prevalence and cumulative burden remain poorly understood, especially in resource-limited settings. Objectives To measure the prevalence of geriatric syndromes upon hospital admission and examine the independent association between the number of geriatric syndromes and 90-day mortality. Design, Setting, and Participants This cohort study used data from the Creating a Hospital Assessment Network in Geriatrics (CHANGE) study, a multicenter, prospective cohort of 43 hospitals, including 38 in Brazil, 1 in Angola, 1 in Chile, 2 in Colombia, and 1 in Portugal. Consecutive patients aged 65 years or older admitted under geriatric teams between June 1, 2022, and December 31, 2023, were enrolled within 48 hours; patients with terminally illness were excluded. Data were analyzed from February 1 to November 23, 2025. Exposure A standardized comprehensive geriatric assessment captured 14 geriatric syndromes: loneliness, dementia, depressive symptoms, sensory impairment, disability, immobility, incontinence, falls, frailty, malnutrition, pressure ulcers, polypharmacy, potentially inappropriate medications, and delirium. The exposure of interest was the within-patient count of syndromes. Main Outcomes and Measures The primary outcome was 90-day all-cause mortality, ascertained by masked telephone follow-up with verification in medical records or public registries. Prespecified mixed-effects Cox proportional hazards regression were performed. Results The study included 2556 participants (mean [SD] age, 79 [9] years, 1437 female [56.2%]). The median number of geriatric syndromes was 5 (IQR, 3-8). The highest prevalence rates for syndromes were 70.8% (95% CI, 69.1%-72.6%) for disability, 61.7% (95% CI, 59.8%-63.6%) for polypharmacy, 58.2% (95% CI, 56.3%-60.1%) for frailty, and 54.7% (95% CI, 52.8%-56.7%) for sensory impairment. Across categories, the mortality rate rose from 8.4% (95% CI, 6.2%-11.4%) for 0 to 2 syndromes to 12.7% (95% CI, 10.1%-15.7%) for 3 to 4 syndromes, 25.4% (95% CI, 22.2%-29.1%) for 5 to 6 syndromes, 30.4% (95% CI, 26.7%-34.5%) for 7 to 8 syndromes, 39.5% (95% CI, 34.4%-44.8%) for 9 to 10 syndromes, and 47.0% (95% CI, 36.4%-57.9%) for 11 or more syndromes. After adjusting for confounders, each additional geriatric syndrome was associated with an increased risk of mortality (hazard ratio, 1.22 [95% CI, 1.15-1.30), which became increasingly pronounced in older age groups. Conclusions and Relevance This cohort study found that hospitalized older adults had a median of 5 geriatric syndromes, which were independently and incrementally associated with 90-day mortality. Multidomain assessments should be integrated into standard hospital care to identify and address vulnerabilities that commonly affect older adults with acute illness.
Effectiveness of Pharmacist Interventions in Improving Medication Use in Hospitalised Older Patients Diagnosed With Cardiovascular Diseases: INFAR Before-and-After Study Romana Santos Gama, Luiz Carlos Passos, Welma Wildes Amorim, Renato Morais Souza, Marcio Galvão Oliveira Journal of Evaluation in Clinical Practice, 2025 Objectives This study aimed to assess the effectiveness of pharmacist interventions to reduce the omission of evidence‐based cardiovascular medication, as well as polypharmacy and promote the deprescribing of potentially inappropriate medications in hospitalised older patients diagnosed with cardiovascular diseases. Methods This before‐and‐after study was conducted among patients aged ≥ 60 years ( n = 319) at a cardiovascular hospital in Brazil. Pharmacists conducted medication reviews for these patients. The first prescription on hospital admission and that at discharge were collected and compared for prescribing omission, polypharmacy, and prescribing of potentially inappropriate medications. Results The mean patient age was 68.9 (±6.2) years. The mean incidences of prescribing potentially inappropriate medications and omissions decreased from 0.90 at admission to 0.10 at discharge ( p < 0.001) and from 0.65 to 0.30 ( p < 0.001), respectively. The number of potentially inappropriate medications prescribed decreased significantly, from 291 at admission to 28 at discharge, reflecting a 90% reduction. Additionally, the mean number of medications prescribed decreased from 9.8 to 6.5 ( p < 0.001). Conclusion This study emphasises the role of medication reviews by clinical pharmacists in reducing polypharmacy, prescribing omissions, and inappropriate prescribing in older adults with cardiovascular diseases, demonstrating that targeted pharmacist interventions improve medication safety. Trial Registration Registered on ClinicalTrials.gov (NCT04800900).
Using a mobile application to reduce potentially inappropriate prescribing for older Brazilian adults in primary care: a triple-blind randomised clinical trial Welma Wildes Amorim, Luiz Carlos Passos, Romana Santos Gama, Renato Morais Souza, Pablo Moura Santos, Jéssica Caline Macedo, Hévila Maciel Queiroga, Larissa Gusmão Nunes, Lavínia Mendonça Fraga, Brunna Santos Oliveira, Lucas Teixeira Graia, Marcio Galvão Oliveira BMC Geriatrics, 2024 Backgound Potentially inappropriate prescribing (PIP) has been evaluated in several countries, and several strategies have been devised for deprescribing drugs in older adults. The aim of this study was to evaluate the efficacy of a mobile application in reducing PIP for older adults in primary care facilities in Brazil. Methods This randomised, triple-blind, parallel-group trial was conducted in 22 public primary care facilities in Brazil. During the intervention phase, the general practitioners (GPs) were randomly allocated to the intervention (MPI Brasil app provides information about PIP, therapeutic alternatives and deprescribing) or control (MedSUS app provides general information about medications) group. All GPs were trained on the Clinical Decision-Making Process and how to access an Evidence-Based Health website. The GPs received an Android tablet with an installed mobile application depending on their allocated group, which they used when caring for older patients over at least 3 months. At the end of this period, a sample of older patients aged ≥ 60 years who had been awaiting medical consultation by the participating GPs were interviewed and their prescriptions analysed. The primary outcome was the frequency of PIP in and between the groups. Results Among 53 GPs who were administered the baseline survey, 14 were included in the clinical trial. At baseline, 146 prescriptions were analysed: the PIP overall was 37.7% (55/146), in the intervention group was 40.6% (28/69), and in the control group was 35.1% (27/77). After the intervention, 284 prescriptions were analysed: the PIP overall was 31.7% (90/284), in the intervention group was 32.2% (46/143), and in the control group was 31.2% (44/141) (RR: 1.16; 95% CI, 0.76–1.76). In the within-group analysis, the PIP reduced from before to after the intervention in both groups—more significantly in the intervention than in the control group (p < 0.001). In the stratified analysis of PIP frequency by GPs, there was a relative risk reduction in 86% (6/7) of GPs in the intervention group compared to 71% (5/7) in the control group. Conclusion We found that the MPI Brasil app effectively reduced PIP, suggesting that it may be useful to incorporate this tool into clinical practice. Trial registration The study was registered at ClinicalTrials.gov (NCT02918643). First registration on 22/09/2016.
Industry workers with hypertension and diabetes mellitus, the prevalence of self-reported adherence, and disease control Priscila Ribeiro Castro, Roberta Mendes Abreu, Clavdia Nicolaevna Kochergin, Danielle Souto de Medeiros, Daniela Arruda Soares, José Andrade Louzado, Kelle Oliveira Silva, Matheus Lopes Cortes, Sóstenes Mistro, Vanessa Moraes Bezerra, Welma Wildes Amorim, Márcio Galvão Oliveira Brazilian Journal of Pharmaceutical Sciences, 2022 To evaluate the prevalence of self-reported drug adherence and factors associated, as well as clinical health outcomes, for industry workers with hypertension (HTN) and diabetes mellitus (DM). This was a cross-sectional study of 137 Brazilian industry workers with HTN and/ or DM. Self-reported adherence was assessed, and the disease control was defined through blood pressure and capillary glycemia values. Data were descriptively analyzed and the factors associated with adherence were evaluated using the Poisson model with robust variance to calculate prevalence ratios. The prevalence of self-reported drug adherence was 79.6% and the prevalence of disease control was 53.8%. There was no statistically significant association between the two variables. In the controlled disease group, non-adherence was associated with being under 40 years of age, not having a partner, and having a risky alcohol consumption habit. In the uncontrolled disease group, adherence was highest for participants aged 40 years and older. The prevalence of self-reported drug adherence was high, but the prevalence of disease control was low and not associated with adherence, indicating that the self-reported adherence measure may be inaccurate. Our findings identify some factors that explain non-adherent behavior in the workforce.
Association between perceived stress and health-risk behaviours in workers Matheus Lopes Cortes, J. A. Louzado, M. G. Oliveira, V. M. Bezerra, S. Mistro, D. S. Medeiros, D. A. Soares, K. O. Silva, C. N. Kochergin, V. C. H. S. Carvalho, W. W. Amorim, S. S. Mengue Psychology Health and Medicine, 2022 Individuals who experience stress can engage in health-risk behaviours that may decrease work performance. The aim of this study was to determine perceived stress levels in Brazilian workers and verify whether perceived stress was associated with health-risk behaviours. Stress levels of 1,270 workers (1,019 men, 251 women) were assessed using the Perceived Stress Scale. The health-risk behaviours investigated were low intake of vegetables and fruits, daily smoking, high-risk alcohol consumption, physical inactivity, and the presence of obesity. The Student’s t-test or one-way analysis of variance was used to assess differences in stress levels. Ordinal regression was used to determine the association between the degrees of stress and health-risk behaviours. Women had higher perceived stress levels than men. In addition, perceived stress levels were higher in those who had low socioeconomic status, were unmarried, had a negative perception of their health, were smokers, or had obesity. Smoking and the presence of two or more health-risk behaviours were associated with 1.84 (95% CI: 1.24–2.73) times and 1.49 (95% CI: 1.18–1.89) times higher odds of experiencing higher degrees of stress, respectively. In women, such an association was observed with the presence of obesity (odds ratio: 2.0; 95% CI: 1.01–3.98).
Factors associated with older patients' misunderstandings of medication dosage regimen instructions after consultation in primary care in Brazil Welma W. Amorim, Luiz C. Passos, Romana S. Gama, Renato M. Souza, Marcio G. Oliveira Journal of Evaluation in Clinical Practice, 2021 Rationale, aims, and objectivesMisunderstanding medication dosage regimen instructions can lead to unintentional misuse of a prescribed medicine, non‐adherence to providers' instructions, and other treatment‐related issues. We aimed to evaluate the frequency of and factors associated with older patients' misunderstanding of medication dosage regimen instructions after consultation with a general practitioner.MethodThis cross‐sectional study was conducted in 22 primary‐care facilities in Brazil. Data were collected from September 2016 to December 2017 using a multidimensional questionnaire. Patients who were 60 years old or older who visited primary care units were included in the study (n = 416).ResultsOf the older patients interviewed, 38.2% had a misunderstanding of medication dosage regimen instructions; being female was a protective factor against the misunderstanding of medication dosage regimen instructions (prevalence ratio [PR] = 0.63; 95% confidence interval [CI] = 0.45‐0.89). In relation to other factors with an important association, misunderstanding medication dosage regimen instructions was 71% higher among illiterate participants (PR = 1.71; 95% CI = 1.25‐2.35), 39% higher among people who considered their memory to be poor (PR = 1.39; 95% CI = 1.01‐1.91), 49% higher in those who did not have a job at the time of the interview (PR = 1.49; 95% CI = 1.01‐2.19), and 50% higher in patients who had been prescribed five or more medications (PR = 1.50; 95% CI = 1.02‐2.20).ConclusionsThe results showed that older people's misunderstandings of medication dosage regimen instructions after consultation with a general practitioner was greater than expected due to a range of factors, especially polypharmacy, poor literacy, poor memory, and having a job at the time of the interview. Health services and professionals should implement strategies to increase the quality of the guidance given to elderly individuals and to ensure their adherence to the regimen instructions of their medications.
Gender differences in the quality of life of formal workers José Andrade Louzado, Matheus Lopes Cortes, Marcio Galvão Oliveira, Vanessa Moraes Bezerra, Sóstenes Mistro, Danielle Souto de Medeiros, Daniela Arruda Soares, Kelle Oliveira Silva, Clávdia Nicolaevna Kochergin, Vivian Carla Honorato dos Santos de Carvalho, Welma Wildes Amorim, Sotero Serrate Mengue International Journal of Environmental Research and Public Health, 2021 Background: This study aimed to assess the quality of life associated with gender inequalities in formal workers and to determine the effect of sociodemographic, clinical, and behavioral factors on the quality of life (QOL). Methods: This cross-sectional study involved 1270 workers. Quality of life was measured using the EUROHIS-QOL 8-Item and assessed in terms of psychological, environmental, social, and physical domains, while demographic, socioeconomic, behavioral, and clinical variables served as explanatory variables. Analyses were performed using an ordinal logistic regression model whose significance level was 5%. Results: Of the participants, 80.2% were men, and 19.8% were women; the mean age was 34 (standard deviation: ±10) and 32 (±9) years, respectively. In all prediction scenarios, men were more likely to have a higher quality of life, especially in the physical (odds ratio: 2.16; 95% confidence interval: 1.60–2.93) and psychological (odds ratio: 2.09; 95% confidence interval: 1.51–2.91) domains. Conclusions: Men and women had significantly different levels of quality of life, and sociodemographic, clinical, and behavioral variables partially clarified these differences, which were possibly established by a socio-historical process of construction of the work role determined by gender issues.
Quality of life and associated factors in young workers José Andrade Louzado, Matheus Lopes Cortes, Márcio Galvão Oliveira, Vanessa Moraes Bezerra, Sóstenes Mistro, Danielle Souto de Medeiros, Daniela Arruda Soares, Kelle Oliveira Silva, Clávdia Nicolaevna Kochergin, Vivian Carla Honorato dos Santos de Carvalho, Welma Wildes Amorim, Sotero Serrate Mengue International Journal of Environmental Research and Public Health, 2021
Cost-Effectiveness of Point-of-Care A1C Tests in a Primary Care Setting Lorena de Sousa Rosa, Sóstenes Mistro, Marcio Galvão Oliveira, Clavdia Nickolaevna Kochergin, Mateus Lopes Cortes, Danielle Souto de Medeiros, Daniela Arruda Soares, José Andrade Louzado, Kelle Oliveira Silva, Vanessa Moraes Bezerra, Welma Wildes Amorim, Mark Barone, Luiz Carlos Passos Frontiers in Pharmacology, 2021
Comparison of cardiovascular risk calculators in patients with diabetes Luana Karem Ribeiro, Welma Wildes Amorim, Igor Thiago Alvin Cardoso, Wester Silva Vieira, Clavdia Nicolaevna Kochergin, Danielle Souto de Medeiros, Daniela Arruda Soares, José Andrade Louzado, Kelle Oliveira Silva, Matheus Lopes Cortes, Sóstenes Mistro, Vanessa Moraes Bezerra, Marcio Galvão Oliveira Revista Da Associacao Medica Brasileira, 2021
Periodic occupational examination: An opportunity for diagnosis and monitoring of chronic noncommunicable diseases in men Tamyres Araújo Andrade Donato, Roberta Mendes Abreu Silva, Amanda Cristina de Souza Andrade, Clávdia Nicolaevna Kochergin, Danielle Souto de Medeiros, Daniela Arruda Soares, José Andrade Louzado, Kelle Oliveira Silva, Matheus Lopes Cortes, Sóstenes Mistro, Welma Wildes Cunha Coelho Amorim, Márcio Galvão Guimarães de Oliveira, Vanessa Moraes Bezerra Cadernos De Saude Publica, 2020
Polypharmacy in older patients at primary care units in Brazil Milena Santos Gomes, Welma Wildes Amorim, Renato Souza Morais, Romana Santos Gama, Lucas Teixeira Graia, Hévila Maciel Queiroga, Márcio Galvão Oliveira International Journal of Clinical Pharmacy, 2019
