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The purpose of this study was to describe the use and concomitant use of psychotropics and other drugs as chemical restraints in the aged in long-term hospital care. The study consisted of 154 patients (42 men, 112 women) hospitalized in five long-term care wards in Pori City Hospital, Finland. Three or more psychotropics were regularly given to 33% of the patients and regularly or irregularly to 53% of the patients. Two or more benzodiazepine derivatives or related drugs were regularly given to 24% of the patients and regularly or irregularly to 46% of the patients. The very poor cognitive and functional abilities of the patients, the common concomitant use of psychotropic drugs, the use of psychotropics to control the behavior of the patients, and the lack of documentation of the effects and side effects of the drugs give rise to the conclusion that psychotropics were used as chemical restraints in these long-term care wards. KEYWORDS chemical restraints, psychotropics, use of psychotropics, elder abuse, aged

Two groups of patients have been studied in order to investigate the relationship between age and the effect of oral anticoagulant therapy. The first group comprised 364 patients aged 23-89 years who showed a stable anticoagulant effect on medium- or long-term warfarin therapy; in this group the elderly subjects were found to require, on average, a lower drug dose to maintain the same degree of anticoagulation. The second group comprised 130 patients aged 15-83 years who had received an initial standard oral dose of 10 mg of warfarin. No significant difference was found in the degree of anticoagulation achieved by 16 hours. Although the maintenance dose in elderly patients is somewhat lower than in younger, the same protocols can be used for the introduction of therapy.

Drug use patterns in a large ambulatory elderly population were studied cross-sectionally over a 10-year period. There were 24 192 drug histories obtained on 4509 individuals during the period from 1 August 1978 to 31 July 1988. The average number of drugs used per person increased from 3.22 in 1978-9 to 3.94 in 1987-8. Prescribed drug use increased by 0.52 per person compared with an increase of 0.21 for nonprescribed medication. Analysis of two mutually exclusive groups of participants from 1978-9 and 1987-8 revealed a significant (p

Background. The choice of administering digitalis to older patients with congestive heart failure (CHF) cannot be made on the account of univocally defined criteria because of uncertainty about efficacy and concern about safety of digitalis in this population. The purpose of this study was to verify whether the clinical characteristics on admission to the acute care hospital determine the use of digitalis therapy in elderly patients. Methods. A total of 1239 patients (mean age 77.8 [+ or -] 7.1 years, range 65-100 years, males 49.8%) consecutively admitted to 69 General Medicine and Geriatrics wards over a 4-month period were grouped by combining two dichotomous factors (Carlson's score [is greater than] 4: definite or possible diagnosis of CHF; Carlson's score [is less than] 5: unlikely diagnosis of CHF; in-hospital adoption of digitalis therapy: yes or no) as follows: Group A: Carlson's score [is greater than] 4, digitalis (n = 413); Group B: Carlson's score [is greater than] 4, no digitalis (n = 260); Group C: Carlson's score [is less than] 5, digitalis (n = 104); Group D: Carlson's score [is less than] 5, no digitalis (n = 462). Variables significantly distinguishing groups were entered into a discriminant analysis aimed at assessing the group specificity of individual clinical profiles. Results. Use of digoxin at home, atrial fibrillation, older age, and comorbidity (mainly COPD and chronic renal failure) characterized most of the patients given digoxin with or without a definite diagnosis of CHF. Clinical profiles of groups A, B, and C largely overlapped. Conclusion. Age, historical use of digitalis, and comorbidity might lead to seemingly incongruous digitalis prescription. The choice of adopting digitalis therapy cannot be reliably predicted on the basis of clinical variables only. Presently unexplored physician-related factors, such as cultural background, likely outweigh clinical variables in prompting digitalis prescription.