Guided prescription of psychotropic medications for geriatric inpatients

Arch Intern Med. 2005 Apr 11;165(7):802-7. doi: 10.1001/archinte.165.7.802.


Background: Inappropriate use or excessive dosing of psychotropic medications in the elderly is common and can lead to a variety of adverse drug events including falls, oversedation, and cognitive impairment.

Methods: We developed a database of psychotropic medication dosing and selection guidelines for elderly inpatients. We displayed these recommendations to physicians through a computerized order entry system at a tertiary care academic hospital. The system was activated for 2 of 4 six-week study periods in an off-on-off-on pattern. Main outcome measures were agreement with the recommended daily dose for the initial drug order, incidence of dosing at least 10-fold greater than the recommended daily dose, prescription of nonrecommended drugs, inpatient falls, altered mental status as measured by a brief nursing assessment, and hospital length of stay.

Results: A total of 7456 initial orders for psychotropic medications were prescribed for 3718 hospitalized elderly patients with a mean +/- SD age of 74.7 +/- 6.7 years. The intervention increased the prescription of the recommended daily dose (29% vs 19%; P<.001), reduced the incidence of 10-fold dosing (2.8% vs 5.0%; P<.001), and reduced the prescription of nonrecommended drugs (10.8% vs 7.6% of total orders; P<.001). Patients in the intervention cohort had a lower in-hospital fall rate (0.28 vs 0.64 falls per 100 patient-days; P = .001). No effect on hospital length of stay or days of altered mental status was found.

Conclusion: A geriatric decision support system for psychotropic medications increased the prescription of recommended doses, reduced the prescription of nonrecommended drugs, and was associated with fewer inpatient falls.

Publication types

  • Evaluation Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Accidental Falls / prevention & control
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cognition Disorders / prevention & control
  • Decision Support Systems, Clinical*
  • Drug Prescriptions*
  • Female
  • Humans
  • Length of Stay
  • Male
  • Medication Systems, Hospital*
  • Psychotropic Drugs / administration & dosage*


  • Psychotropic Drugs