Medication regimen complexity in institutionalized elderly people in an aging society

Background Complex medication regimens may adversely affect compliance and treatment outcomes. Complexity can be assessed with the medication regimen complexity index (MRCI), which has proved to be a valid, reliable tool, with potential uses in both practice and research. Objective To use the MRCI to assess medication regimen complexity in institutionalized elderly people. Setting Five nursing homes in mainland Portugal. Methods A descriptive, cross-sectional study of institutionalized elderly people (n = 415) was performed from March to June 2009, including all inpatients aged 65 and over taking at least one medication per day. Main outcome measure Medication regimen complexity index. Results The mean age of the sample was 83.9 years (±6.6 years), and 60.2 % were women. The elderly patients were taking a large number of drugs, with 76.6 % taking more than five medications per day. The average medication regimen complexity was 18.2 (±SD = 9.6), and was higher in the females (p < 0.001). The most decisive factors contributing to the complexity were the number of drugs and dosage frequency. In regimens with the same number of medications, schedule was the most relevant factor in the final score (r = 0.922), followed by pharmaceutical forms (r = 0.768) and additional instructions (r = 0.742). Conclusion Medication regimen complexity proved to be high. There is certainly potential for the pharmacist’s intervention to reduce it as part as the medication review routine in all the patients.

Tectonoestratigrafia do Terreno Ibérico no sector Tomar- Sardoal-Ferreira do Zêzere e relações com o Terreno Finisterra

A cartografia geológica da região Tomar-Sardoal-Ferreira do Zêzere permitiu individualizar sucessões tectono-estratigráficas em domíníos da Zona Centro-Ibérica (ZCI) e da Zona Ossa Morena (ZOM) que anteriormente eram considerados apenas como ZOM, separadas entre si pelo carreamento de Ortiga-Torrão. A sucessão centro-ibérica monometamórfica, datada do Neoproterozóico ao Silúrico (?), encontra-se numa estrutura triangular e é constituída por unidades típicas do Paleozóico/Neoproterozóico da ZCI. Na ZOM foram estabelecidas duas sucessões polimetamórficas nas regiões do Sardoal e de Serra (Tomar), ambas datadas no geral do Neoproterozóico. A primeira constitui um autóctone relativo e a outra, alóctone; ambas são compostas por unidades deformadas da crosta cadomiana. A continuidade das sucessões tectono-estratigráficas antecedentes do Terreno Ibérico e do carreamento que as limita é interrompida a E pela Zona de Cisalhamento Porto-Tomar-Ferreira do Alentejo (N-S e cinemática direita), a ocidente da qual se encontra o Terreno Finisterra.