Neuroleptics in the elderly: guidelines for monitoring

The Nursing Home Reform Amendments of the Omnibus Reconciliation Act of 1987 provided guidelines for the use of neuroleptic medications in nursing home patients. Although the guidelines have been successful in reducing the inappropriate use of such drugs in this population, neuroleptics remain indicated in the treatment of many elderly patients. For these patients the new regulations also specified maximum daily neuroleptic doses, and they mandated monitoring for neuroleptic-induced movement disorders, although they did not provide guidelines for such monitoring. We review the existing empirical data base in an effort to refine the recommendations for neuroleptic dosage limits and to derive standards for the monitoring of neuroleptic-induced movement disorders in the elderly.