Polypharmacy in Patients with Neurological Injuries in a Public Hospital Rehabilitation Unit in the Federal District: a cross-sectional study
DOI:
https://doi.org/10.30968/jhphs.2025.162.1310Abstract
Purpose: To estimate the prevalence of polypharmacy in patients admitted to a rehabilitation unit in Brazil and investigate associations with sociodemographic and clinical characteristics. Methods: A descriptive and analytical cross-sectional study with retrospective data collection from 99 patients admitted to the rehabilitation unit in the Federal District, Brazil, between January and December 2022. Patients aged ≥18 years with neurological injuries who were discharged from the hospital were included, excluding those with incomplete data or communication difficulties. Variables such as age, sex, race/color, nutritional status, level of functional dependence, and the presence of hypertension, diabetes and dyslipidemia were analyzed. The number of medications was categorized as less than 5, 5 to 9, and 10 or more, and associations were assessed using Fisher’s exact test (p<0.05). Results: Among the evaluated patients (n = 99), polypharmacy was identified in 90.9% of cases, with a mean of 8.59 ± 3.06 medications per patient. Regarding the sociodemographic profile, 71.7% were male and the mean age was 46.1 ± 15.4 years. The most common injuries were traumatic spinal cord injuries (40.4%) and non-traumatic brain injuries (21.3%). A significant association was found between polypharmacy and sex, nutritional status, and diabetes. Conclusion: The high prevalence of polypharmacy in rehabilitation patients highlights the complexity of their clinical management and underscores the need for pharmaceutical care in this population.
Downloads
References
Audulv Å, Hutchinson S, Warner G, et al. Managing everyday life: Self-management strategies people use to live well with neurological conditions. Patient Educ Couns. 2021;104(2):413-421. doi:10.1016/j.pec.2020.07.025
Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230. doi:10.1186/s12877-017-0621-2.
Manias E, Kabir MZ, Maier AB. Inappropriate medications and physical function: a systematic review. Ther Adv Drug Saf. 2021;12:20420986211030371. doi:10.1177/20420986211030371.
Yu X, Qian Y, Zhang Y, Chen Y, Wang M. Association between polypharmacy and cognitive impairment in older adults: A systematic review and meta-analysis. Geriatr Nurs. 2024;59:330-337. doi:10.1016/j.gerinurse.2024.07.005
Cheng CM, Chang WH, Chiu YC, et al. Association of Polypharmacy With Mild Cognitive Impairment and Cognitive Ability: A Nationwide Survey in Taiwan. J Clin Psychiatry. 2018;79(6):17m12043. doi:10.4088/JCP.17m12043.
Maust DT, Strominger J, Kim HM, et al. Prevalence of Central Nervous System-Active Polypharmacy Among Older Adults With Dementia in the US. JAMA. 2021;325(10):952-961. doi:10.1001/jama.2021.1195
Mohamed MR, Juba K, Awad H, et al. Effect of polypharmacy and potentially inappropriate medications on physical functional decline among older adults with advanced cancer receiving systemic treatment. Support Care Cancer. 2024;32(10):674. doi:10.1007/s00520-024-08877-6
Zanetti M, Veronese N, Riso S, et al. Polypharmacy and malnutrition in older people: A narrative review. Nutrition. 2023;115:112134. doi:10.1016/j.nut.2023.112134
Kose E, Wakabayashi H. Rehabilitation pharmacotherapy: A scoping review. Geriatr Gerontol Int. 2020;20(7):655-663. doi:10.1111/ggi.13975
Cadogan CA, Ryan C, Hughes CM. Appropriate Polypharmacy and Medicine Safety: When Many is not Too Many. Drug Saf. 2016;39(2):109-116. doi:10.1007/s40264-015-0378-5
Wakabayashi H. Rehabilitation pharmacotherapy: A combination of rehabilitation and pharmacotherapy. J Gen Fam Med. 2018;19(2):43-44. doi:10.1002/jgf2.163
Clarke CL, Witham MD. The Effects of Medication on Activity and Rehabilitation of Older People – Opportunities and Risks. Rehabilitation Process and Outcome. Adv Rehabil Sci Pract. 2017;6:1-7. doi:10.1177/1179572717711433
Ramos LR, Tavares NU, Bertoldi AD, et al. Polypharmacy and Polymorbidity in Older Adults in Brazil: a public health challenge. Rev Saude Publica. 2016;50(suppl 2):9s. doi:10.1590/S1518-8787.2016050006145
Sangaleti CT, Lentsck MH, Silva DCD, et al. Polypharmacy, potentially inappropriate medications and associated factors among older adults with hypertension in primary care. Rev Bras Enferm. 2023;76(Suppl 2):e20220785. doi:10.1590/0034-7167-2022-0785
Castel R. A dinâmica dos processos de marginalização: da vulnerabilidade à “desfiliação.” Caderno CRH. 2006;10(26). doi:10.9771/ccrh.v10i26.18664.
Riberto M. Orientação funcional para utilização da MIF. Hospital das Clínicas. Faculdade de Medicina da Universidade de São Paulo;2005.
Martins A do N, Santana EF, Neves EG de C, et al. Sociodemographic and Clinical Profile of Patients with Spinal Cord Injury at a public hospital in Brazil. ARACÊ. 2025;7(2):5885-5905. doi:10.56238/arev7n2-081.
Martins A do N, Santana ÉF, Lopes KS, et al. Farmacoterapia de reabilitação e o impacto da vulnerabilidade social no acesso a medicamentos. Revista Eletrônica Acervo Saúde. 2025;25:e19777. doi:10.25248/reas.e19777.2025.
Kim S, Lee H, Park J, et al. Global and regional prevalence of polypharmacy and related factors, 1997-2022: An umbrella review. Arch Gerontol Geriatr. 2024;124:105465. doi:10.1016/j.archger.2024.105465
Shin WY, Go TH, Kang DR, et al. Patterns of patients with polypharmacy in adult population from Korea. Sci Rep. 2022;12(1):18073. doi:10.1038/s41598-022-23032-z
Dietz N, Alkin V, Agarwal N, et al. Polypharmacy in spinal cord injury: Matched cohort analysis comparing drug classes, medical complications, and healthcare utilization metrics with 24-month follow-up. J Spinal Cord Med. 2024 [Ahead of print]. doi:10.1080/10790268.2024.2375892
Bergen D. Neurological disorders: Public health challenges. JAMA Neurol. Neurol. 2008;65(1):154. doi:10.1001/archneurol.2007.19.
Ladbrook E, Bouchoucha S, Hutchinson A. Frequency and Characteristics of Medical Complications in Rehabilitation Settings: A Scoping Review. J Rehabil Med. 2022;54:jrm00350. doi:10.2340/jrm.v54.2752
Kitzman P, Cecil D, Kolpek JH. The risks of polypharmacy following spinal cord injury. J Spinal Cord Med. 2017;40(2):147-153. doi: 10.1179/2045772314Y.0000000235
Fabbietti P, Ruggiero C, Sganga F, et al. Effects of hyperpolypharmacy and potentially inappropriate medications (PIMs) on functional decline in older patients discharged from acute care hospitals. Arch Gerontol Geriatr. 2018;77:158-162. doi:10.1016/j.archger.2018.05.007
Matsumoto A, Yoshimura Y, Nagano F, et al. Polypharmacy and potentially inappropriate medications in stroke rehabilitation: prevalence and association with outcomes. Int J Clin Pharm. 2022;44(3):749-761. doi:10.1007/s11096-022-01416-5
Leite IM de O, Barbosa GGG, Leite LRF, et al. Quais condições se associam à polifarmácia em uma população geriátrica? Revista Brasileira de Geriatria e Gerontologia. 2024;27. doi:10.1590/1981-22562024027.230242.pt.
Navarrete-Villanueva D, Gesteiro E, Gómez-Cabello A, et al. Fat-Fit Patterns, Drug Consumption, and Polypharmacy in Older Adults: The EXERNET Multi-Center Study. Nutrients. 2021;13(8):2872. doi:10.3390/nu13082872
Silveira EA, Dalastra L, Pagotto V. Polypharmacy, chronic diseases and nutritional markers in community-dwelling older. Rev Bras Epidemiol. 2014;17(4):818-829. doi:10.1590/1809-4503201400040002
Feigin VL, Vos T, Nichols E, et al. The global burden of neurological disorders: translating evidence into policy. Lancet Neurol. 2020;19(3):255-265. doi:10.1016/S1474-4422(19)30411-9
Hanaoka S, Iwabuchi K, Hirai T, Seki T, Hayashi H. Effect of Increasing or Decreasing Use of Polypharmacy on Recovery of Activities of Daily Living in Patients With Stroke in the Recovery-Phase Rehabilitation Ward: A Retrospective Cohort Study Using Propensity Score Matching. Stroke Res Treat. 2024;2024:2381790. doi:10.1155/srat/2381790
Mesaque MA, Recalde DVG, Anes DJC, et al. Mortalidade masculina por causas externas em três agregados ecológicos (Brasil, Mato Grosso do Sul e Campo Grande), 2010 a 2019: implicações de classe, raça e gênero no perfil epidemiológico e suas tendências. Saúde e Pesquisa. 2024;17(1):e11403. doi:10.17765/2176-9206.2024v17n1.e11403.
Silva SK de A, Lima BL de, Barbosa DAM, et al. Óbitos por causas externas no Brasil: um estudo ecológico temporal de 2014 a 2018. Brazilian Journal of Development. 2021;7(7):67049-67059. doi:10.34117/bjdv7n7-128.
Tomasiello DB, Bazzo J, Parga J, et al. TD 2832 – Desigualdades raciais e de renda no acesso à saúde nas cidades brasileiras. 2023:1-38. doi:10.38116/td2832.
Maas F, Moser GAS, Goettens DA, et al. Characterization of traumatic spinal cord injuries: an integrative review of the literature. Scientific Electronic Archives. 2020;13(5):90. DOI:10.36560/1352020936.
Paiva VC, Nunes CV, Antonialli CV, et al. Epidemiology of post-traumatic spinal cord injury in a tertiary hospital. Acta Ortop Bras. 2023;31(5):e264492. doi:10.1590/1413-785220233105e264492
Paulo GML de, Colares CMP, Margarida MCA, et al. Trauma: característica sociodemográficas das vítimas e aspectos clínicos-assistenciais de sua ocorrência em hospital de urgência. Revista Eletrônica Acervo Saúde. 2021;13(10):e8683. doi:10.25248/reas.e8683.2021.
World Health Organization. Falls. April 26, 2021. Available in: https://www.who.int/news-room/fact-sheets/detail/falls. Accessed on: 29th Dec 2024.
Oliveira TS, Pereira AMM. Expressions of inequalities in access to health services in Latin America: a scoping review. Expressões das desigualdades no acesso aos serviços de saúde na América Latina: uma revisão de escopo. Cien Saude Colet. 2024;29(7):e04932024. doi:10.1590/1413-81232024297.04932024
Prokopidis K, Giannos P, Reginster JY, et al. Sarcopenia is associated with a greater risk of polypharmacy and number of medications: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2023;14(2):671-683. doi:10.1002/jcsm.13190
Pana A, Sourtzi P, Kalokairinou A, Velonaki VS. Sarcopenia and polypharmacy among older adults: A scoping review of the literature. Arch Gerontol Geriatr. 2022;98:104520. doi:10.1016/j.archger.2021.104520
Matsumoto A, Yoshimura Y, Shimazu S, et al. Association of polypharmacy at hospital discharge with nutritional intake, muscle strength, and activities of daily living among older patients undergoing convalescent rehabilitation after stroke. Jpn J Compr Rehabil Sci. 2022;13:41-48. doi:10.11336/jjcrs.13.41
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Authors
This work is licensed under a Creative Commons Attribution 4.0 International License.
The authors hereby transfer, assign, or otherwise convey to JHPHS : (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print republish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to JHPHS with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Serlf-archiving policy
This journal permits and encourages authors to post and archive the final pdf of the articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.
