Pattern of Medication Use Among Older Inpatients in Seven Hospitals in Italy: Results from the Criteria to Assess Appropriate Medication Use Among Elderly Complex Patients (CRIME) Project

Matteo      Tosato; Silvana      Settanni; Manuela      Antocicco; Miriam      Battaglia; Andrea      Corsonello; Carmelinda      Ruggiero; Stefano      Volpato; Paolo      Fabbietti; Fabrizia      Lattanzio; Roberto      Bernabei; Graziano      Onder

Abstract

Background: Prescribing pharmacological treatment for hospitalized older patients represents a challenge for physicians. In particular, hospitalized older adults present with acute and chronic diseases, which may require multiple treatments and increase their susceptibility to adverse drug reactions. Patterns of drugs use have rarely been investigated in these patients.

Objective: to describe patterns of drugs use among hospitalized older adults participating in the CRiteria to assess Appropriate Medication use among Elderly complex patients (CRIME) project.

Methods: we performed a cross-sectional multicentre study based on data from the CRIME project, a study performed in geriatric and internal medicine acute care wards of 7 Italian hospitals. The only two exclusion criteria were: age < 65 years old and unwillingness to participate in the study. Participants were assessed at hospital admission and followed until discharge.

Results: mean (Standard Deviation) age of 1123 participants was 81.5 (7.4) years, with 629 (56%) being women and 572 participants (51%) were admitted from Emergency Room. Mean length of stay was 11.2 (6.7) days. Mean number of drugs used greatly varied before (6.2, SD 3.2), during (10.6, SD 5.6) and after (7.1, SD 3.1) hospitalization. No difference in the number of drugs used during hospital stay was observed across age groups. During hospital stay, drugs for acid related disorders (77.9%) and antithrombotic agents (76.8%) were the most commonly used drugs, followed by drugs acting on the renin-angiotensin system (58.0%) and diuretics (57.1%). Very common was the use of psycholeptics (34.3%) and psychoanaleptics (22.4%).

Conclusion: Use of multiple drug treatments is common in hospitalized older adults and hospitalization is associated with a substantial increment in the number of drugs used, with no differences across age groups.

Keywords: Adverse drug reaction, CRIME project, elderly, frailty, hospital, medication.

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