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July 27, 1994

Suboptimal Medication Use in the ElderlyThe Tip of the Iceberg

Author Affiliations

From the Program for the Analysis of Clinical Strategies, Gerontology Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass, and the Brockton/West Roxbury Veterans Affairs Medical Center, West Roxbury, Mass.

JAMA. 1994;272(4):316-317. doi:10.1001/jama.1994.03520040078046

The problem of inappropriate prescribing of medications to older patients is widely acknowledged and has been publicized by professional societies, governmental organizations, advocacy groups for the elderly, and the media. However, the true magnitude of the problem remains unclear. Although the use of antipsychotic medications in the nursing home setting has come under considerable scrutiny,1 it is generally recognized that suboptimal prescribing to the elderly extends well beyond excessive prescribing of this single drug category. Yet, to date, information regarding the quality of drug prescribing to geriatric patients in other clinical settings has been extremely limited, and claims about suboptimal prescribing have been based more on anecdote and conjecture than on actual data. Which pharmacotherapeutic domains comprise the most serious problem areas and how frequently inappropriate prescribing actually occurs are just some of the questions that need to be more fully answered to develop strategies to improve the quality

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