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April 14, 1989

Drugs in the Institutionalized Elderly

JAMA. 1989;261(14):2067. doi:10.1001/jama.1989.03420140068025

To the Editor.—  The article by Beers et al1 is probably correct, but I would like to point out an often neglected reason for the use of oversedating medications. Individual state Medicaid formularies usually contain the least-expensive medications in their drug classification, not those medications most efficacious for the frail elderly. Unfortunately for our frail elderly, most of the least-expensive medications cause the most sedation and have the longest half-lives.We can hope that articles like the one by Beers et al will lead to better state Medicaid formularies, so the elderly can get the best and most efficacious treatments, not just the least expensive, and physicians in geriatric and long-term care in the future will have input into state Medicaid formularies.