Drugs and the elderly, part 1: The problems facing managed care

Objective: In part 1 of "Drugs and the Elderly," we review and summarize th e vast amount of clinical information on medication use in the elderly for healthcare providers and administrators within managed care. In part 2, we explore the literature on improving prescribing, focusing on those approach es most likely to be useful within a managed care environment. Study Design: We reviewed the general literature on medication use in the e lderly, focusing on problems and systems approaches to the improvement of m edication use in managed care. We created a topic list of general interest to health professionals within managed care and fit the available informati on into those topics. Thus, the result is an authoritative review rather th an a systematic literature review. Patients and Methods: Nonquantitative evaluation of the medical literature. Results: We identified several hundred articles describing issues related t o medication use in the elderly but only a trivial number that in any way a ddressed the managed care community directly. There is very little literatu re on how managed care can best incorporate the lessons of geriatric pharma cology and pharmacy. Conclusions: There is a paucity of literature for the managed care communit y of health professionals regarding pharmacology, pharmacoepidemiology, dru g utilization review, and other issues related to the use of medication in the elderly population.