This study on 93 patients was conducted at a skilled nursing facility. Twenty-two of the 93 patients had pressure sores; 34 of the 54 sores were present when the patients were admitted and 20 developed after admission. Only 5 of the 54 sores healed. Healing times ranged from 15 to 55 days after the beginning of treatment. Thirteen deaths occurred among the 71 patients without sores, and 17 deaths among the 22 patients with sores. Specific treatment regimens varied (cleaning solutions, antimicrobial drugs, heat, enzymatic debridement) but always included frequent changes in the position of the patient. Ten of the 22 patients with sores were anemic vs. 19 of the 71 patients without sores. Half of the patients with sores were maintained with tube feedings whereas more than half of the patients without sores received regular house diets. Pressure sores are a serious problem among geriatric patients in nursing homes. All those who care for the aged should be fully aware of the procedures involved in the prevention and management of these sores.

L ittle is known about drug effects in the elderly, except that all drugs can be hazardous to the elderly and that much uncertainty remains about the appropriate and safe use of drugs for older adults. The difficulty is to match the right drug to the right disease in the right patient. Yet, in the absence of explicit rules or appropriate tools, dealing successfully with that uncertainty remains one of the major tasks of clinicians caring for elderly patients. Even less is known about the effect of chronic drug use and its costeffectiveness, particularly in terms of such tertiary costs as loss of productivity, loss of quality of life, and additional nonhealth care costs such as long-term maintenance care and loss of productivity for family members who must provide care. Further, current patterns of care and treatment, as well as third-party reimbursement policies for institutionalization and technical procedures, focus primarily on acute care and cure. This philosophy of health care has literally been transposed to long-term care, and is a major barrier to quality care for older adults with chronic disorders and disabilities. Chronic diseases mandate disease management rather than cure. The major issue is the need to understand the appropriate balance between acute care (high technology, high cost, compulsive prescribing patterns) and long-term care.

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