THE QUALITY of medication prescribing and use in older persons has been a recurring issue of substantial concern for policymakers, regulators, health care researchers, and the public. Although there have been numerous efforts to measure the extent of the problem and to identify areas in greatest need of change, constructing meaningful quality indicators relevant to drug therapy in elderly patients has continued to be a challenge.1 In 1991, Beers et al2 published explicit criteria for determining inappropriate medication use in the institutionalized elderly patient population, which were updated and expanded in 1997.3 The Beers criteria have been widely used by regulators as a drug utilization review tool.4 They have also been used in numerous studies5,6 that examine patterns of potentially inappropriate prescribing in various US populations and clinical settings. In 1994, Willcox and colleagues7 attracted national attention to the issue with the publication of a study that used the Beers criteria to assess inappropriate drug prescribing for community-dwelling elderly patients, using data from the 1987 National Medical Expenditure Survey. The authors reported that US physicians had prescribed potentially inappropriate medications to nearly a quarter of all elderly patients living in the community. Newspapers nationwide reported the study's findings under headlines such as "Medication Peril for the Elderly" and "Docs Giving Many Seniors Wrong Drugs."
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