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.

Background: pharmacological treatment of hospitalized older patients represents a challenge for prescribing physicians. In particular, hospitalized older adults are usually 'frail' and present with acute diseases, which may require multiple treatments and increase their susceptibility to adverse drug reactions. Patterns of medication use among in-hospital patients have rarely been investigated. Objective: to describe patterns of medication used among hospitalized older adults in Italy participating to 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 to 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, women were 629 (56%) 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 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 agents 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. Understanding patterns of drug use may be useful to design and implement effective drug utilization programs aimed to influence prescribing attitudes