In an interview, Dr. Jay A. Gold of MetaStar explains what medications are the culprits and how LTC staff can ensure compliance with prescribing principles. Toxic effects of medications and drug-related problems can have profound medical and safety consequences for older adults and economically affect the healthcare system. Thirty percent of hospital admissions in elderly patients may be linked to drug-related problems or drug toxic effects. Adverse drug events have been linked to preventable problems in elderly patients such as depression, constipation, falls, immobility, confusion, and hip fractures. The Medicare Modernization Act of 2003 directs Medicare Quality Improvement Organizations like MetaStar to offer QI assistance pertaining to prescription drug therapy to providers, practitioners, Medicare managed care organizations, and prescription drug plans. Working with the Centers for Medicare & Medicaid Services, MetaStar developed a project designed to decrease the use of medications known to pose unnecessary risk in the elderly.