Drugs in the Institutionalized Elderly: Time to Get It Right?

The use and misuse of medications in elderly persons who reside in long-term—care institutions have important consequences. Psychotropic drugs are among those that greatly affect the quality of life for the roughly 1.5 million institutionalized elderly persons in the United States. It is well known that some benzodiazepines, eg, diazepam, boast a much longer half-life in elderly patients.¹Such antipsychotics as thioridazine, may cause significant orthostatic hypotension,²as is the case with certain tricyclic antidepressants. Additionally, the latter class of drugs includes some that produce anticholinergic side effects,³which can result in urinary retention for patients with tenuous bladder function, such as men with prostatic hypertrophy. The study by Beers et al,⁴in this issue ofTHE JOURNAL, inspires little confidence in prescribing practices in the long-term—care setting, specifically intermediate-care facilities (ICFs). Twelve such institutions in eastern Massachusetts, shown to be representative of those in the