David K. Conn, MB, BCh, BAO, FRCPC
Head, Dept. of Psychiatry,
Baycrest Centre for Geriatric Care,
Department of Psychiatry,
University of Toronto,
A variety of studies have raised concerns about the quality of medication prescribing to elderly residents of long-term care facilities. Despite the fact that criteria for "inappropriate prescribing" can be debated, there is general agreement that considerable improvement is required to ensure optimal prescribing. Beers et al.1 brought together a panel of national experts in the United States in an attempt to reach consensus on defining inappropriate medication use in the nursing home. Having developed specific criteria, they subsequently reported that more than 40% of residents in a group of California nursing homes had at least one inappropriate prescription. The term "silent epidemic" has been used to describe the problems caused by adverse drug reactions. A 1998 report from the United States consisting of a meta-analysis of 39 studies estimated that more than two million hospitalized patients had serious adverse drug reactions over a one-year period.