Abstract
The occurrence of several geriatric conditions may influence the efficacy and limit the use of drugs prescribed to treat chronic conditions. Functional and cognitive impairment, geriatric syndromes (i.e. falls or malnutrition) and limited life expectancy are common features of old age, which may limit the efficacy of pharmacological treatments and question the appropriateness of treatment. However, the assessment of these geriatric conditions is rarely incorporated into clinical trials and treatment guidelines. The CRIME (CRIteria to assess appropriate Medication use among Elderly complex patients) project is aimed at producing recommendations to guide pharmacologic prescription in older complex patients with a limited life expectancy, functional and cognitive impairment, and geriatric syndromes, and providing physicians with a tool to improve the quality of prescribing, independent of setting and nationality. To achieve these aims, we performed the following: (i) Existing disease-specific guidelines on pharmacological prescription for the treatment of diabetes, hypertension, congestive heart failure, atrial fibrillation and coronary heart disease were reviewed to assess whether they include specific indications for complex patients; (ii) a literature search was performed to identify relevant articles assessing the pharmacological treatment of complex patients; (iii) A total of 19 new recommendations were developed based on the results of the literature search and expert consensus. In conclusion, the new recommendations evaluate the appropriateness of pharmacological prescription in older complex patients, translating the recommendations of clinical guidelines to patients with a limited life expectancy, functional and cognitive impairment, and geriatric syndromes. These recommendations cannot represent substitutes for careful clinical consideration and deliberation by physicians; the recommendations are not meant to replace existing clinical guidelines, but they may be used to help physicians in the prescribing process.
Similar content being viewed by others
References
Lee PG, Cigolle C, Blaum C. The co-occurrence of chronic diseases and geriatric syndromes: the health and retirement study. J Am Geriatr Soc. 2009;57:511–6.
Inouye SK, Studenski S, Tinetti M, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55:780–91.
Onder G, Lattanzio F, Battaglia M, Cerullo F, Sportiello R, Bernabei R, Landi F. The risk of adverse drug reactions in older patients: beyond drug metabolism. Curr Drug Metab. 2011;12:647–51.
Fusco D, Lattanzio F, Tosato M, Corsonello A, Cherubini A, Volpato S, Maraldi C, Ruggiero C, Onder G. Development of CRIteria to assess appropriate Medication use among Elderly complex patients (CRIME) project: rationale and methodology. Drugs Aging. 2009;26(Suppl 1):3–13.
Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365:2002–12.
Onder G, Petrovic M, Tangiisuran B, Meinardi MC, Markito-Notenboom WP, Somers A, Rajkumar C, Bernabei R, van der Cammen TJ. Development and validation of a score to assess risk of adverse drug reactions among in-hospital patients 65 years or older: the GerontoNet ADR risk score. Arch Intern Med. 2010;170:1142–8.
Tangiisuran B, Davies JG, Wright JE, Rajkumar C. Adverse drug reactions in a population of hospitalized very elderly patients. Drugs Aging. 2012;29:669–79.
Zhang M, Holman CD, Price SD, Sanfilippo FM, Preen DB, Bulsara MK. Comorbidity and repeat admission to hospital for adverse drug reactions in older adults: retrospective cohort study. BMJ. 2009;338:a2752.
Beckman AG, Parker MG, Thorslund M. Can elderly people take their medicine? Patient Educ Couns. 2005;59:186–91.
Vetrano DL, Tosato M, Colloca G, Topinkova E, Fialova D, Gindin J, van der Roest HG, Landi F, Liperoti R, Bernabei R, Onder G; SHELTER Study. Polypharmacy in nursing home residents with severe cognitive impairment: results from the SHELTER Study. Alzheimers Dement 2013 Sep;9(5):587-93
Colloca G, Tosato M, Vetrano DL, Topinkova E, Fialova D, Gindin J, van der Roest HG, Landi F, Liperoti R, Bernabei R, Onder G, SHELTER project. Inappropriate drugs in elderly patients with severe cognitive impairment: results from the shelter study. PLoS ONE. 2012;7:e46669.
Cruz-Jentoft AJ, Boland B, Rexach L. Drug therapy optimization at the end of life. Drugs Aging. 2012;29:511–21.
Wenger NS, Roth CP, Shekelle P, ACOVE Investigators. Introduction to the assessing care of vulnerable elders-3 quality indicator measurement set. J Am Geriatr Soc. 2007;55(Suppl 2):S247–52.
Ray KK, Seshasai SR, Wijesuriya S, et al. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials. Lancet. 2009;373:1765–72.
Bremer JP, Jauch-Chara K, Hallschmid M, et al. Hypoglycemia unawareness in older compared with middle-aged patients with type 2 diabetes. Diabetes Care. 2009;32:1513–7.
Chelliah A, Burge MR. Hypoglycaemia in elderly patients with diabetes mellitus: causes and strategies for prevention. Drugs Aging. 2004;21:511–30.
Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008;358:2545–59
Vijan S, Hofer TP, Hayward RA. Estimated benefits of glycemic control in microvascular complications in type 2 diabetes. Ann Intern Med. 1997;127:788–95.
Huang ES, Zhang Q, Gandra N, et al. The effect of comorbid illness and functional status on the expected benefits of intensive glucose control in older patients with type 2 diabetes: a decision analysis. Ann Intern Med. 2008;149:11–9.
Schwartz AV, Vittinghoff E, Sellmeyer DE. Diabetes-related complications, glycemic control, and falls in older adults. Diabetes Care. 2008;31:391–6.
Monami M, Cresci B, Colombini A. Bone fractures and hypoglycemic treatment in type 2 diabetic patients: a case–control study. Diabetes Care. 2008;31:199–203.
Volpato S, Leveille SG, Blaum C. Risk factors for falls in older disabled women with diabetes: the women’s health and aging study. J Gerontol A Biol Sci Med Sci. 2005;60:1539–45.
Berlie HD, Garwood CL. Diabetes medications related to an increased risk of falls and fall-related morbidity in the elderly. Ann Pharmacother. 2010;44:712–7.
Nelson JM, Dufraux K, Cook PF. The relationship between glycemic control and falls in older adults. J Am Geriatr Soc. 2007;55:2041–4.
Bruce DG, Davis WA, Casey GP, Clarnette RM, Brown SG, Jacobs IG, Almeida OP, Davis TM. Severe hypoglycaemia and cognitive impairment in older patients with diabetes: the Fremantle Diabetes Study. Diabetologia. 2009;52:1808–15.
Feil DG, Rajan M, Soroka O, Tseng CL, Miller DR, Pogach LM. Risk of hypoglycemia in older veterans with dementia and cognitive impairment: implications for practice and policy. J Am Geriatr Soc. 2011;59:2263–72.
Whitmer RA, Karter AJ, Yaffe K, Quesenberry CP Jr, Selby JV. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA. 2009;301:1565–72.
Bauduceau B, Doucet J, Bordier L, Garcia C, Dupuy O, Mayaudon H. Hypoglycaemia and dementia in diabetic patients. Diabetes Metab. 2010;36(Suppl 3):S106–11.
Brauner DJ, Muir JC, Sachs GA. Treating nondementia illnesses in patients with dementia. JAMA. 2000;283:3230–5.
Grant RW, Devita NG, Singer DE, Meigs JB. Polypharmacy and medication adherence in patients with type 2 diabetes. Diabetes Care. 2003;26:1408–12.
Hewitt J, Smeeth L, Chaturvedi N, Bulpitt CJ, Fletcher AE. Self management and patient understanding of diabetes in the older person. Diabet Med. 2011;28:117–22.
Wu JS, Yang YC, Lu FH. Population-based study on the prevalence and risk factors of orthostatic hypotension in subjects with pre-diabetes and diabetes. Diabetes Care. 2009;32:69–74.
Luukinen H, Koski K, Laippala P, Kivelä SL. Prognosis of diastolic and systolic orthostatic hypotension in older persons. Arch Intern Med. 1999;159:273–80.
Hiitola P, Enlund H, Kettunen R. Postural changes in blood pressure and the prevalence of orthostatic hypotension among home-dwelling elderly aged 75 years or older. J Hum Hypertens. 2009;23:33–9.
Mangoni AA, Jackson HD. The implications of a growing evidence base for drug use in elderly patients. Part 1. Statins for primary and secondary cardiovascular prevention. Br J Clin Pharmacol. 2006;61:494–501.
Brugts JJ, Yetgin T, Hoeks SE. The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ 2009;338:b2376. doi:10.1136/bmj.b2376.
Heart Protection Study Collaborative, Mihaylova B, Briggs A, Armitage J, Parish S, Gray A, Collins R. Lifetime cost effectiveness of simvastatin in a range of risk groups and age groups derived from a randomised trial of 20,536 people. BMJ 2006;333:1145.
Cholesterol Treatment Trialists' (CTT) Collaborators Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008;371:117–25.
Holmes HM, Sachs GA, Shega JW, Hougham GW, Cox Hayley D, Dale W. Integrating palliative medicine into the care of persons with advanced dementia: identifying appropriate medication use. J Am Geriatr Soc. 2008;56:1306–11.
UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34) [published erratum appears in Lancet 1998;352:1558]. Lancet. 1998;352:854–65.
Haas L. Management of diabetes mellitus medications in the nursing home. Drugs Aging. 2005;22:209–18.
Neumiller JJ, Setter SM. Pharmacologic management of the older patient with type 2 diabetes mellitus. Am J Geriatr Pharmacother. 2009;7:324–42.
Kirpichnikov D, McFarlane SI, Sowers JR. Metformin: an update. Ann Intern Med. 2002;137:25–33.
Kapoor JR, Chaudry S, Agostini JV, Foody JA. Systolic hypertension in older persons: how aggressive should treatment be? Prog Cardiovasc Dis. 2006;48:397–406.
Razay G, Williams J, King E, Smith AD, Wilcock G. Blood pressure, dementia and Alzheimer’s disease: the OPTIMA longitudinal study. Dement Geriatr Cogn Disord. 2009;28:70–4.
Nilsson SE, Read S, Berg S, Johansson B, Melander A, Lindblad U. Low systolic blood pressure is associated with impaired cognitive function in the oldest old: longitudinal observations in a population-based sample 80 years and older. Aging Clin Exp Res. 2007;19:41–7.
Molander L, Lövheim H, Norman T, Nordström P, Gustafson Y. Lower systolic blood pressure is associated with greater mortality in people aged 85 and older. J Am Geriatr Soc. 2008;56:1853–9.
Qiu C, Winblad B, Fratiglioni L. The age-dependent relation of blood pressure to cognitive function and dementia. Lancet Neurol. 2005;4:487–99.
Steinman MA, Goldstein MK. When tight blood pressure control is not for everyone: a new model for performance measurement in hypertension. Jt Comm J Qual Patient Saf. 2010;36:164–72.
Vinyoles E, De la Figuera M, Gonzalez-Segura D. Cognitive function and blood pressure control in hypertensive patients over 60 years of age: COGNIPRES study. Curr Med Res Opin. 2008;24:3331–9.
Cooper LA. A 41-year-old African American man with poorly controlled hypertension: review of patient and physician factors related to hypertension treatment adherence. JAMA. 2009;301:1260–72.
Kassai B, Gueyffier F, Boissel JP, Boutitie F, Cucherat M. Absolute benefit, number needed to treat and gain in life expectancy: which efficacy indices for measuring the treatment benefit? J Clin Epidemiol. 2003;56:977–82.
Mazza A, Ramazzina E, Cuppini S, Armigliato M, Schiavon L, Rossetti C, Marzolo M, Santoro G, Ravenni R, Zuin M, Zorzan S, Rubello D, Casiglia E. Antihypertensive treatment in the elderly and very elderly: always “the lower, the better?”. Int J Hypertens. 2012;2012:590683.
Montgomery AA, Fahey T, Ben-Shlomo Y, Harding J. The influence of absolute cardiovascular risk, patient utilities, and costs on the decision to treat hypertension: a Markov decision analysis. J Hypertens. 2003;21:1753–9.
Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan KM, Marra CA. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169:1952–60.
Kamaruzzaman S, Watt H, Carson C, Ebrahim S. The association between orthostatic hypotension and medication use in the British Women’s Heart and Health Study. Age Ageing. 2010;39:51–6.
Tinetti ME. Clinical practice: preventing falls in elderly persons. N Engl J Med. 2003;348:42–9.
Butt DA, Mamdani M, Austin PC, Tu K, Gomes T, Glazier RH. The risk of hip fracture after initiating antihypertensive drugs in the elderly. Arch Intern Med. 2012;172:1739–44.
Weir RA, McMurray JJ, Puu M, Solomon SD, Olofsson B, Granger CB, Yusuf S, Michelson EL, Swedberg K, Pfeffer MA, CHARM Investigators. Efficacy and tolerability of adding an angiotensin receptor blocker in patients with heart failure already receiving an angiotensin-converting inhibitor plus aldosterone antagonist, with or without a beta blocker. Findings from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM)-Added trial. Eur J Heart Fail. 2008;10:157–63.
Jneid H, Moukarbel GV, Dawson B, Hajjar RJ, Francis GS. Combining neuroendocrine inhibitors in heart failure: reflections on safety and efficacy. Am J Med 2007;120:1090.e1–8.
Cheng JW, Nayar M. A review of heart failure management in the elderly population. Am J Geriatr Pharmacother. 2009;7:233–49.
Cherubini A, Oristrell J, Pla X, Ruggiero C, Ferretti R, Diestre G, Clarfield AM, Crome P, Hertogh C, Lesauskaite V, Prada GI, Szczerbinska K, Topinkova E, Sinclair-Cohen J, Edbrooke D, Mills GH. The persistent exclusion of older patients from ongoing clinical trials regarding heart failure. Arch Intern Med. 2011;171:550–6.
Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs. J Am Geriatr Soc. 1999;47:40–50.
Mehagnoul-Schipper DJ, Colier WN, Hoefnagels WH, Verheugt FW, Jansen RW. Effects of furosemide versus captopril on postprandial and orthostatic blood pressure and on cerebral oxygenation in patients > or = 70 years of age with heart failure. Am J Cardiol. 2002;90:596–600.
Ahmed A, Husain A, Love TE, Gambassi G, Dell’Italia LJ, Francis GS, Gheorghiade M, Allman RM, Meleth S, Bourge RC. Heart failure, chronic diuretic use, and increase in mortality and hospitalization: an observational study using propensity score methods. Eur Heart J. 2006;27:1431–9.
Abdel-Qadir HM, Tu JV, Yun L, Austin PC, Newton GE, Lee DS. Diuretic dose and long-term outcomes in elderly patients with heart failure after hospitalization. Am Heart J. 2010;160:264–71.
Eshaghian S, Horwich TB, Fonarow GC. Relation of loop diuretic dose to mortality in advanced heart failure. Am J Cardiol. 2006;97:1759–64.
Lim LS, Fink HA, Blackwell T, Taylor BC, Ensrud KE. Loop diuretic use and rates of hip bone loss and risk of falls and fractures in older women. J Am Geriatr Soc. 2009;57:855–62.
Lee DS, Ghosh N, Floras JS, Newton GE, Austin PC, Wang X, Liu PP, Stukel TA, Tu JV. Association of blood pressure at hospital discharge with mortality in patients diagnosed with heart failure. Circ Heart Fail. 2009;2:616–23.
Muzzarelli S, Leibundgut G, Maeder MT, Rickli H, Handschin R, Gutmann M, Jeker U, Buser P, Pfisterer M, Brunner-La Rocca HP, TIME-CHF Investigators. Predictors of early readmission or death in elderly patients with heart failure. Am Heart J. 2010;160:308–14.
Banach M, Bhatia V, Feller MA, Mujib M, Desai RV, Ahmed MI, Guichard JL, Aban I, Love TE, Aronow WS, White M, Deedwania P, Fonarow G, Ahmed A. Relation of baseline systolic blood pressure and long-term outcomes in ambulatory patients with chronic mild to moderate heart failure. Am J Cardiol. 2011;107:1208–14.
Desai RV, Banach M, Ahmed MI, Mujib M, Aban I, Love TE, White M, Fonarow G, Deedwania P, Aronow WS, Ahmed A. Impact of baseline systolic blood pressure on long-term outcomes in patients with advanced chronic systolic heart failure (insights from the BEST trial). Am J Cardiol. 2010;106:221–7.
Vidán MT, Bueno H, Wang Y, Schreiner G, Ross JS, Chen J, Krumholz HM. The relationship between systolic blood pressure on admission and mortality in older patients with heart failure. Eur J Heart Fail. 2010;12:148–55.
Gheorghiade M, Abraham WT, Albert NM, Greenberg BH, O’Connor CM, She L, Stough WG, Yancy CW, Young JB, Fonarow GC, OPTIMIZE-HF Investigators and Coordinators. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA. 2006;296:2217–26.
Qiu C, Winblad B, Marengoni A, Klarin I, Fastbom J, Fratiglioni L. Heart failure and risk of dementia and Alzheimer disease: a population-based cohort study. Arch Intern Med. 2006;166:1003–8.
Zuccalà G, Onder G, Pedone C, Carosella L, Pahor M, Bernabei R, Cocchi A, GIFA-ONLUS Study Group [Gruppo Italiano di Farmacoepidemiologia nell'Anziano]. Hypotension and cognitive impairment: selective association in patients with heart failure. Neurology. 2001;11(57):1986–92.
Spiess JL. Can I stop the warfarin? A review of the risks and benefits of discontinuing anticoagulation. J Palliat Med. 2009;12:83–7.
Kierner KA, Gartner V, Schwarz M, Watzke HH. Use of thromboprophylaxis in palliative care patients: a survey among experts in palliative care, oncology, intensive care, and anticoagulation. Am J Hosp Palliat Care. 2008;25:127–31.
Lurie Y, Loebstein R, Kurnik D, Almog S, Halkin H. Warfarin and vitamin K intake in the era of pharmacogenetics. Br J Clin Pharmacol. 2010;70:164–70.
Sebastian JL, Tresch DD. Use of oral anticoagulants in older patients. Drugs Aging. 2000;16:409–35.
Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest. 2008;133:160–98.
Kwok CS, Loke YK, Hale R, Potter JF, Myint PK. Atrial fibrillation and incidence of dementia: a systematic review and meta-analysis. Neurology. 2011;76:914–22.
Rose AJ, Hylek EM, Ozonoff A, Ash AS, Reisman JI, Berlowitz DR. Patient characteristics associated with oral anticoagulation control: results of the Veterans AffaiRs Study to Improve Anticoagulation (VARIA). J Thromb Haemost. 2010;8:2182–91.
van Deelen BA, van den Bemt PM, Egberts TC, van 't Hoff A, Maas HA. Cognitive impairment as determinant for sub-optimal control of oral anticoagulation treatment in elderly patients with atrial fibrillation. Drugs Aging. 2005;22:353–60.
Flaker GC, Pogue J, Yusuf S, Pfeffer MA, Goldhaber SZ, Granger CB, Anand IS, Hart R, Connolly SJ; Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events (ACTIVE) Investigators. Cognitive function and anticoagulation control in patients with atrial fibrillation. Circ Cardiovasc Qual Outcomes 2010;3:277–83.
Gage BF, Birman-Deych E, Kerzner R, Radford MJ, Nilasena DS, Rich MW. Incidence of intracranial hemorrhage in patients with atrial fibrillation who are prone to fall. Am J Med. 2005;118:612–7.
Gage BF, Yan Y, Milligan PE, Waterman AD, Culverhouse R, Rich MW, Radford MJ. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF). Am Heart J. 2006;151(3):713–9.
Man-Son-Hing M, Nichol G, Lau A, Laupacis A. Choosing antithrombotic therapy for elderly patients with atrial fibrillation who are at risk for falls. Arch Intern Med. 1999;159(7):677–85.
Sellers MB, Newby LK. Atrial fibrillation, anticoagulation, fall risk, and outcomes in elderly patients. Am Heart J. 2011;161(2):241–6.
Kaplan RC, Heckbert SR, Koepsell TD, Furberg CD, Polak JF, Schoen RE, Psaty BM. Risk factors for hospitalized gastrointestinal bleeding among older persons. Cardiovascular Health Study Investigators. J Am Geriatr Soc. 2001;49:126–33.
Stroke prevention in atrial fibrillation study: final results. Circulation 1991;84:527–39
Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. EAFT (European Atrial Fibrillation Trial) Study Group. Lancet 1993;342:1255–62
Diug B, Evans S, Lowthian J, Maxwell E, Dooley M, Street A, Wolfe R, Cameron P, McNeil J. The unrecognized psychosocial factors contributing to bleeding risk in warfarin therapy. Stroke. 2011;42:2866–71.
Arlt S, Lindner R, Rösler A, von Renteln-Kruse W. Adherence to medication in patients with dementia: predictors and strategies for improvement. Drugs Aging. 2008;25:1033–47.
Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, Kirby A, Sourjina T, Peto R, Collins R, Simes R, Cholesterol Treatment Trialists’ (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005;366:1267–78.
Verwoert GC, Mattace-Raso FU, Hofman A, Heeringa J, Stricker BH, Breteler MM, Witteman JC. Orthostatic hypotension and risk of cardiovascular disease in elderly people: the Rotterdam study. J Am Geriatr Soc. 2008;56:1816–20.
Luukinen H, Koski K, Laippala P, Airaksinen KE. Orthostatic hypotension and the risk of myocardial infarction in the home-dwelling elderly. J Intern Med. 2004;255:486–93.
Søgaard P, Thygesen K. Potential proischemic effect of early enalapril in hypotension-prone patients with acute myocardial infarction. The CONSENSUS II Holter Substudy Group. Cardiology. 1997;88:285–91.
Avanzini F, Ferrario G, Santoro L, Peci P, Giani P, Santoro E, Franzosi MG, Tognoni G, Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico-3 Investigators. Risks and benefits of early treatment of acute myocardial infarction with an angiotensin-converting enzyme inhibitor in patients with a history of arterial hypertension: analysis of the GISSI-3 database. Am Heart J. 2002;144:1018–25.
Acknowledgments
The CRIME project was funded by a grant from the Italian Ministry of Labour, Health and Social Policy (Bando Giovani Ricercatori 2007, convenzione no. 4). The authors have no conflicts of interest that are directly relevant to this review.
Author information
Authors and Affiliations
Corresponding author
Appendices
Appendix 1: List of Guidelines Examined
1.1 Heart Failure
Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW; American College of Cardiology Foundation; American Heart Association. 2009 Focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. J Am Coll Cardiol 2009 Apr 14;53(15):e1–e90.
McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Køber L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A; ESC Committee for Practice Guidelines. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012 Jul;33(14):1787–847.
1.2 Hypertension
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003 May 21;289(19):2560–72.
Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Boudier HA, Zanchetti A, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Erdine S, Kiowski W, Agabiti-Rosei E, Ambrosioni E, Lindholm LH, Viigimaa M, Adamopoulos S, Agabiti-Rosei E, Ambrosioni E, Bertomeu V, Clement D, Erdine S, Farsang C, Gaita D, Lip G, Mallion JM, Manolis AJ, Nilsson PM, O’Brien E, Ponikowski P, Redon J, Ruschitzka F, Tamargo J, van Zwieten P, Waeber B, Williams B; Management of Arterial Hypertension of the European Society of Hypertension; European Society of Cardiology. 2007 guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007 Jun;25(6):1105–87.
1.3 Atrial Fibrillation
Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Kay GN, Le Huezey JY, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann LS. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am Coll Cardiol 2011 Mar 15;57(11):e101–98.
European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010 Oct;31(19):2369–429.
1.4 Coronary Artery Disease
Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB 3rd, Kligfield PD, Krumholz HM, Kwong RY, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR Jr, Smith SC Jr, Spertus JA, Williams SV; American College of Cardiology Foundation. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2012 Dec 18;126(25):3097–137.
Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F, Daly C, De Backer G, Hjemdahl P, Lopez-Sendon J, Marco J, Morais J, Pepper J, Sechtem U, Simoons M, Thygesen K, Priori SG, Blanc JJ, Budaj A, Camm J, Dean V, Deckers J, Dickstein K,Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo J, Zamorano JL; Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology; ESC Committee for Practice Guidelines (CPG). Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J 2006 Jun;27(11):1341–81.
1.5 Diabetes
American Diabetes Association. Standards of medical care in diabetes–2012. Diabetes Care 2012 Jan;35 Suppl 1:S11–63.
Brown AF, Mangione CM, Saliba D, Sarkisian CA; California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes. Guidelines for improving the care of the older person with diabetes mellitus. J Am Geriatr Soc 2003 May;51(5 Suppl Guidelines):S265–80.
Appendix 2: Names and Affiliations of Experts
Name | Affiliation | Country |
---|---|---|
Antonio Cherubini | University of Perugia | Italy |
Stefano Volpato | University of Ferrara | Italy |
Andrea Corsonello | Italian National Research Center on Aging (INRCA) | Italy |
Eva Topinkova | Prague University | Czech Republic |
Mirko Petrovic | Ghent University | Belgium |
Tischa Van der Cammen | Erasmus Medical Center | The Netherlands |
Dorom Garfinkel | Shoham Geriatric Medical Center | Israel |
Rights and permissions
About this article
Cite this article
Onder, G., Landi, F., Fusco, D. et al. Recommendations to Prescribe in Complex Older Adults: Results of the CRIteria to Assess Appropriate Medication Use Among Elderly Complex Patients (CRIME) Project. Drugs Aging 31, 33–45 (2014). https://doi.org/10.1007/s40266-013-0134-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40266-013-0134-4