Managing Behavior Problems in Nursing Homes

This issue ofJAMAcontains two disquieting articles on the use of neuroleptics and mechanical restraints in nursing homes. These articles have a special timeliness because of a growing movement, embodied in recent Health Care Financing Administration (HCFA)¹regulations, to transform nursing homes into rehabilitative environments that promote individualized care and the highest practical levels of functioning and independence. A major objective of this movement is to limit the use of medication and mechanical restraints to purposes of medical treatment. For 15 years, evidence has been accumulating that nursing home residents receive more psychotropic drugs, especially neuroleptics, than is easily explained by good medical practice.²,³Garrard et al⁴confirm previous evidence that the prescribing of neuroleptic drugs is widespread (not news) and show that the reasons for such prescribing are poorly documented (a new finding). Specifically, only half of the neuroleptic therapy used in the study of