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April 14, 1989

Drugs in the Institutionalized Elderly-Reply

JAMA. 1989;261(14):2068. doi:10.1001/jama.1989.03420140068030

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In Reply.—  As Dr Kushnir points out, there are two sides to the anticholinergic coin. However, in elderly persons, serious adverse effects of anticholinergic psychotropics usually outweigh any secondary benefits.Dr Owen may be suffering from the "myopia" of which he accuses me when he writes that "the problem is the patients." How can both overmedicating and not overmedicating increase patients' risks of falls? Dr Loebel's data on the high prevalence of behavioral disturbances in the nursing home population are interesting. Nonetheless, I stand by my assertion that we can do better when it comes to prescribing psychotropic drugs for institutionalized elderly persons. One way we can do better, as Dr Owen suggests, is to frequent nursing homes.