Development of CRIteria to Assess Appropriate Medication Use among Elderly Complex Patients (CRIME) Project
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Development of CRIteria to Assess Appropriate Medication Use among Elderly Complex Patients (CRIME) Project Rationale and Methodology Domenico Fusco,1 Fabrizia Lattanzio,2 Matteo Tosato,1 Andrea Corsonello,2 Antonio Cherubini,3 Stefano Volpato,4 Cinzia Maraldi,4 Carmelinda Ruggiero3 and Graziano Onder1 1 Centro Medicina dell’Invecchiamento, Universita` Cattolica del Sacro Cuore, Rome, Italy 2 Italian National Research Centre on Aging (INRCA), Ancona and Cosenza, Italy 3 Institute of Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy 4 Department of Clinical and Experimental Medicine, Section of Internal Medicine, Gerontology and Geriatrics, University of Ferrara, Ferrara, Italy
Abstract
Pharmacological treatment of complex older adults with comorbidities, multiple impairments in function, cognition, social status and geriatric syndromes represents a challenge for prescribing physicians and often results in a high rate of iatrogenic illnesses. Clinical guidelines are commonly used to indicate appropriate prescription, but they are often based on the results of clinical trials that are conducted on young subjects with a low level of complexity. Therefore, the recommendations of clinical guidelines may be difficult to apply to older complex adults. In this paper we present the rationale and methodology of the Development of CRIteria to assess appropriate Medication use among Elderly complex patients (CRIME) project, a study aimed at producing recommendations to evaluate the appropriateness of pharmacological prescription in older complex patients, translating the recommendations of clinical guidelines to this type of patient. A literature search will be performed to integrate and revise the recommendations of disease-specific guidelines on the pharmacological treatment of patients with common chronic conditions. New recommendations will be provided and approved in a consensus meeting of international experts. Both data from randomized controlled trials and observational studies will be used to meet this aim. Recommendations provided by the CRIME project are not meant to replace existing clinical guidelines, but they may be used to help physicians in the prescribing process. Once completed these recommendations should be validated in interventional studies.
The aging process is characterized by a high level of complexity, which makes the care of older adults particularly challenging. Typically, older
adults show the co-occurrence of multiple chronic diseases (comorbidity) and conditions, such as urinary incontinence, delirium or falls,
Fusco et al.
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which cannot be ascribed to a specific organ system pathology and have multiple causes (the socalled geriatric syndromes).[1,2] Both comorbidity and geriatric syndromes contribute to increase the rate of disability, mortality and poor outcomes seen in older age (such as institutionalization and death).[3,4] This high degree of comp
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