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Establishing Benchmarks for Quality Care for an Aging Population: Caring for Vulnerable Older Adults

Linda P. Fried, MD, MPH
[+] Article and Author Information

From The Johns Hopkins Medical Institutions Baltimore, MD 21205.


Grant Support: By Robert Wood Johnson Partnership for Solutions.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Linda P. Fried, MD, MPH, 2024 East Monument Street, Suite 2-700, Baltimore, MD 21205; e-mail, lfried@jhmi.edu.


Ann Intern Med. 2003;139(9):784-786. doi:10.7326/0003-4819-139-9-200311040-00014
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We are experiencing a demographic revolution, the aging of the United States and populations worldwide. Soon 20% of the U.S. population will be older than 65 years of age, and people will be living one third of their lives after retirement. Those 85 years of age and older are the most rapidly increasing segment of our population and contribute to the large subset of older adults that are highly vulnerable to adverse health outcomes, including disability, dependency, and death. Among the 95% of people 65 years and older living in the community, approximately one third can be considered highly vulnerable because of advanced age, compromised functional status, frailty, and diseases. This vulnerable group has been shown to benefit from clinical attention to a range of health issues, such as prevention of disease and disability and the complications of comorbid diseases, frailty, geriatric conditions, and functional decline. Specialized, geriatrically attuned approaches to care can also improve health outcomes in at-risk older adults. Some examples are team-based geriatric assessment and treatment, either on an outpatient or inpatient basis (15); attention to the hospital environment (5); and discharge planning and care coordination between practitioners or sites of care.

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