Every internist recognizes that the medical care of older persons is becoming increasingly central to clinical practice. Keeping up in this discipline requires somewhat unconventional approaches because the reports of exciting and useful clinical trials are scattered throughout the medical and surgical literature. This Update discusses a representative group of studies that focus on common problems seen in medical offices, care of hospitalized older persons, and clinical problems frequently encountered in nursing homes.
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. Annual risk for hip fracture according to the number of risk factors and age-specific calcaneal bone density. The risk factors are age 80 years or older; maternal history of hip fracture; any fracture (except hip fracture) since age 50 years; fair, poor, or very poor health; previous hyperthyroidism; anticonvulsant therapy; current therapy with long-acting benzodiazepine; current weight less than weight at age 25 years; height at the age of 25 years of at least 168 cm; caffeine intake greater than the equivalent of two cups of coffee per day; on feet 4 or fewer hours per day; no walking for exercise; inability to rise from chair without using arms; lowest quartile of depth perception (SD >2.44); lowest quartile of contrast sensitivity (≤ 0.70 unit); and pulse rate greater than 80 beats/min. Reproduced with permission from Cummings SR, et al. N Engl J Med. 1995;332:767-73.
Figure 1Grahic Jump Location
. Mean (±SE) changes in bone mineral density of the spine in postmenopausal women, as measured by dual-energy x-ray absorptiometry. open circle = persons receiving placebo; □ = persons receiving 5 mg of alendronate; ▵ = persons receiving 10 mg of alendronate; ● = persons receiving 20 mg of alendronate plus placebo; ■ = persons receiving 40 mg of alendronate plus placebo; ▴ = persons receiving 40 and 2.5 mg of alendronate. * < 0.05 compared with baseline; ** < 0.01 compared with baseline; † < 0.001 for patients receiving alendronate compared with those receiving placebo. Reproduced with permission from Chesnut CH, et al. Am J Med. 1995;99:144-52.
Figure 2PPPGrahic Jump Location
. Relative changes (from values before intervention to values after intervention) in plasma lipoprotein lipid levels with intervention in the weight loss and aerobic exercise groups and at follow-up in the control group. Values with asterisks are significantly different at < 0.05 (analysis of variance). Data are expressed as the mean ± SE. HDL-C = high-density lipoprotein cholesterol; LDL-C = low-density lipoprotein cholesterol; TG = triglycerides. Reproduced with permission from Katzel LI, et al. JAMA. 1995;274:1915-21.
Figure 3PGrahic Jump Location
. Kaplan-Meier survival analysis of carriers and noncarriers of apolipoprotein E (APOE) ε4 for conversion from mild cognitive impairment to dementia ( < 0.01). Reproduced with permission from Petersen RC, et al. JAMA. 1995;273:1274-8.
Figure 4PGrahic Jump Location
. Estimated lifetime Medicare payments for persons in the study sample, according to age at death. These enrollees died in 1989 or 1990 at 65 years of age or older. Reproduced with permission from Lubitz J, et al. N Engl J Med. 1995; 332:999-1003.
Figure 5Grahic Jump Location
. Medicare payments in the last 2 years of life for persons in the study sample, according to age at death. These enrollees died in 1989 or 1990 at 65 years of age or older. Reproduced with permission from Lubitz J, et al. N Engl J Meal. 1995; 332:999-1003.
Figure 6Grahic Jump Location
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