DESCRIPTION: This is a new application from Duke University Medical Center whose overall aim is to determine if a multi-disciplinary geriatric health service known as Geriatric Evaluation and Management (GEM) is effective in reducing drug-related problems in the elderly, including adverse drug events (ADEs) and adverse drug reactions (ADRs), inappropriate prescribing, polypharmacy, and undermedication. The specific aims are to determine if an inpatient GEM unit (GEMU) and outpatient GEM Clinic (GEMC) care, alone or in combination, can reduce the above drug-related problems in the elderly when compared with usual care. This proposed study capitalizes on the methods of an ongoing Veterans Administration cooperative study (Evaluation of GEM units and geriatric follow-up), a randomized controlled trial with a 2 X 2 factorial design which is studying the effects of the above combinations of GEM care on other study outcomes (health, quality of life, and mortality) at 10 VA medical centers. The proposed study thus incorporates the existing design, sample, interventions, and independent variables of the parent study. Patients are followed for one year following randomization to the study conditions. The proposed investigation will collect selected additional clinical data from medical records and computer files and will interview patients for suspected ADEs. Baseline and twelve-month follow-up measures will include previously used measures of inappropriate prescribing, polypharmacy, and undermedication. Data analysis will be conducted to determine the main and interactive effects of the GEM interventions on these outcomes.