The full content of Annals is available to subscribers

Subscribe/Learn More  >
Diagnosis and Treatment |

Drug Use in the Nursing Home

Jerry Avorn; and Jerry H. Gurwitz
[+] Article, Author, and Disclosure Information

From Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. The Brockton/West Roxbury Veterans Affairs Medical Center, West Roxbury, Massachusetts. Requests for Reprints: Jerry Avorn, MD, Program for the Analysis of Clinical Strategies, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115. Acknowledgments: The authors thank Mark Monane, MD, MS, for providing data used in Table 1 and Ms. Rita Bloom for assistance in the manuscript preparation. Grant Support: In part by a grant from the Medications and Aging Program of the John A. Hartford Foundation of New York. Dr. Gurwitz is the recipient of a Clinical Investigator Award (K08 AG00510) from the National Institute on Aging, Bethesda, Maryland.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(3):195-204. doi:10.7326/0003-4819-123-3-199508010-00007
Text Size: A A A

Some of the most intensive pharmacotherapy today occurs in nursing homes in very complex and vulnerable patients. The nursing home provides an opportunity for highly effective drug use, but it also presents risks for polypharmacy and adverse events. Nursing homes are complex social institutions, in which physicians, nurses, consultant pharmacists, other health care professionals, aides, and administrators must interact to make decisions about drug use for patients who generally are frail and have numerous comorbid conditions. Federal regulations have recently been implemented to direct the ways in which specific drugs are to be used in this setting. The nursing home environment can present an ideal opportunity for comprehensive drug regimen review, an exercise too often neglected in the care of elderly patients in all clinical settings. Psychoactive medications, analgesics, and laxatives are examples of drugs that should receive such review. The possible underuse of drug therapies that may be beneficial to nursing home residents, including antidepressant, antihypertensive, and antithrombotic agents; calcium supplements; and vaccines, must be further quantified and must receive increased attention. Morbidity and functional incapacity can be substantially reduced by applying currently established principles of geriatric pharmacology in the nursing home setting, but enormous gaps still exist in the knowledge base necessary to guide this aspect of geriatric medical practice. Data on the efficacy, toxicity, and cost-effectiveness of pharmacotherapeutic choices in nursing home patients are in short supply; considerably more clinical and epidemiologic research is needed to define the relations between the benefits and risks of drugs for this unique population.


Grahic Jump Location
Figure 1.
Mean ±SE serum urea nitrogen levels for patients receiving nonsteroidal anti-inflammatory drugs (NSAIDs) before baseline, at baseline, after 5 to 7 days of therapy, and 14 days after discontinuation of therapy.closed circles[42]

Of 114 patients studied, 15 (13%) had an increase in serum urea nitrogen levels of more than 50% during NSAID therapy ( ) .

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.