Despite the consumption of multiple prescription drugs by elderly people and the significant potential for medication toxicity, no studies have addressed. the specific impact of improved medication management. This study will: 1) assess the effects of adjustment of medications on physical, cognitive, and affective functioning, on pharmaceutical costs and utilization of services among geriatric outpatients who are taking multiple medications; and 2) identify factors that characterize those individuals most likely to benefit from a medication adjustment program. Physicians (n=70-80) serving patients aged 65 and older in the General Medicine Clinic of the University of North Carolina hospitals will be stratified by the proportion of black patients within their practice and randomly assigned to intervention or control conditions. Eligible subjects will concurrently be identified from the clinic database who are active patients taking five or more prescription medications two of which are on a 'target' list of drugs frequently prescribed for elderly persons. The assignment of subjects (n=600) to intervention or control conditions will follow that of their primary physician. Subjects will be stratified by age and sex. Intervention subjects will participate in a medication adjustment program which consists of intensive evaluation and education, carried on conjointly with the individual's personal physician and a multidisciplinary, intervention team. Baseline measures will be done on both control and intervention subjects with follow-up at 2,4, and 6 weeks, and 3 and 6 months to assess change. Improved functioning of program participants has implications both for improved health-related quality of life of subjects but also for reducing the burden of cost to older patients and use of services by the population.
