Geriatric Medicine

The magnitude of health care services required by older adults in the United States will continue to be a growing health care burden and a major societal concern well into the next century.¹ Declining mortality rates in persons older than 65 years contribute substantially to the increased number of older adults living into advanced old age. Recent reports by Manton and Vaupel² have refuted the centuries-old theories of the actuary Benjamin Gompertz that mortality rates increase at predictable trajectories with age. We now know that the age trajectories of mortality do not follow predictable curves. Variability in mortality curves exists even into advanced old age. Mortality rates in the upper age ranges in several species, including humans, actually decelerate with age.² The influence of genetics and environment affects the changing trajectories of the mortality curves in persons of advanced age. During the course of human existence, the