Drugs in the Institutionalized Elderly-Reply

In Reply.—  We agree with Dr Loebel that the presence or absence of a given diagnosis recorded in a patient's nursing home record cannot be regarded as a "gold standard" of appropriate drug therapy. Indeed, as he points out, many of these medications were probably being used to treat specific behaviors (such as wandering or a reluctance to go to bed on time) rather than to treat a specific psychiatric syndrome. Concern about overuse of psychoactive drugs in this population comes not from the lack of correlation between medications and diagnoses, but rather from the sheer level of use of such agents in a nonpsychiatric population. (Because of the unreliability of nursing home diagnoses, this correlation was not part of our original article, but was added at the request of the editors.) The dearth of articles describing medication use in long-term care facilities during the last 10 years indicated to