Objective: To evaluate the efficacy and safety of olanzapine in a hospitalized geriatric population that had previously failed to respond to, or tolerate, numerous trials with other antipsychotic medications. Method: A retrospective chart analysis was conducted on 58 elderly patients with psychotic symptoms who were given a trial on olanzapine. Data was collected regarding patients 'psychiatric diagnoses, duration of illness, duration of hospitalization, prior response to psychotropic therapies, concomitant psychotropic agents, side effects, and clinically determined changes over time. Results: Results indicated that 60.3% of this refractory group of patients improved on olanzapine. Side effects were reported for 38% of the patients, with delirium, extrapyramidal symptoms (EPS), and drowsiness or lethargy being the most common. Conclusions: The reported level of improvement in this group of refractory elderly. psychotic patients indicates that olanzapine can make an important contribution to the mental health of elderly patients with similar characteristics.