Drugs in the Institutionalized Elderly

To the Editor.—  Although few nursing home medical directors would argue that all patients in their institutions are receiving optimal drug therapy, many of us have been attuned to the problem of overmedication and abuse of chemical restraints (psychotropic medications and other sedating drugs) for a long time. The study by Beers et al¹is illuminating, but Dr Riesenberg's² editorial takes a myopic view of the problem.There are some 20 000 nursing homes in the United States containing an everincreasing number of patients, a significant percentage of whom are agitated and noisy to the point of being antisocial and hard to live with. There are strict federal and state regulations regarding the chemical and physical restraint of nursing home residents. These are enforced by federal and state surveyors with varying but generally strict interpretation of the regulations, both from a pharmacy and nursing point of view.The