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Occam's Razor, Geriatric Syndromes, and the Dizzy Patient

David A. Drachman, MD
[+] Article and Author Information

University of Massachusetts Medical School; Worcester, MA 01655 (Drachman)


Grant Support: In part by grant AG05134, the Sterling Morton Charitable Trust, and the Harriet and Stanley Friedman Research Fund.

Requests for Single Reprints: David A. Drachman, MD, Department of Neurology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655.

Requests To Purchase Bulk Reprints (minimum, 100 copies): Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.


Ann Intern Med. 2000;132(5):403-405. doi:10.7326/0003-4819-132-5-200003070-00010
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In the 14th century, English philosopher William of Ockham (Occam) stated: Pluralitas non est ponenda sine necessitate, or “Plurality must not be posited without necessity” (1). In medicine, the application of “Occam's razor,” the concept of parsimony in diagnosis, has become firmly entrenched as a fundamental principle. For persons older than 65 years of age, however—especially those who experience dizziness—Occam's razor is often too sharp and cuts too narrowly to be the instrument of choice (2). Senescence, the age-related changes that result in increased vulnerability to impairment and disease and in decreased survival (3), results in at least one chronic illness in most of the Medicare population. The serial accumulation of additional ailments, and of medications for their treatment, is nearly universal with advancing age. The concept of “geriatric syndromes” (4) reflects the recognition of multifactorial disorders that plague the elderly in particular, as the functions of organs and the defenses against disease decline and impairments accumulate.

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