(Medicaid) actually exceeded the cost of running the program by a factor of 2 to 1.43 This approach has now been extended to nursing homes, in which an educational outreach effort (also known as "public interest detailing") resulted in a significant reduction in the excessive use of psychoactive medication in the six long-term care facilities studied.5 The intervention, which consisted of separate educational sessions with physicians, nurses, and aides, also resulted in an improvement in the cognitive status of residents in the experimental homes as measured by a detailed battery of neuropsychiatric and functional status tests.

RECOMMENDATIONS

Services

  1. Physicians should review, with their elderly patients, all medications being taken, prescription and non-prescription, for appropriateness, potential adverse interactions, and continued need at least every six months.

  2. Periodic medication review should be reimbursed as a non-procedural activity.

Research

  1. Risk versus benefit: For many drug groups, it may not be appropriate to translate the risk and benefit properties of medications as determined in younger populations into care of the elderly. For example, although the efficacy of a drug may not diminish with age, the frequency and severity of the adverse effects it causes may well increase. Therefore, these drug characteristics should be reassessed in elderly patients de novo and not extrapolated from younger populations.

  2. Impact on functional capacity: It is not enough to measure drug effects in older patients merely in relation to one immediate therapeutic goal (e.g., cessation of ventricular arrhythmias, decrease in intra-ocular pressure). Rather, the effects of drugs should be measured in relation to functional status and other less obvious endpoints, including central nervous system function, gait stability, and functional capacity of other organ systems.

Education

  1. Virtually all health professional education (including that of most physicians, nurses, and pharmacists) is inadequate in its treatment



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