Drugs in the Institutionalized Elderly

To the Editor. —  I would like to underscore a point made in the editorial¹ on the article by Beers et al² and to draw a conclusion that has not been remarked on.Beers et al have made an important contribution to the growing literature on prescribing practices in long-term care facilities. They discovered that among 850 residents of such facilities, 53% took psychoactive medications, 28% using sedatives/hypnotics; 26%, antipsychotics; and 14%, antidepressant agents. The implication that emerges from these tabulations, together with the authors' demonstration of poor correlations between psychiatric diagnoses and prescribed medications and their observations that the actual agents prescribed were not the optimal ones for this population, is that there is a reprehensible degree of polypharmaceutical mismanagement occurring. The editorial¹ appears to endorse this conclusion with the comment that "the study... inspires little confidence in prescribing practices in the long-term care setting."The