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May 3, 1995, Vol 273, No. 17 >
ARTICLE | May 3, 1995

The Science of the Art of Geriatric Medicine FREE

Evan C. Hadley, MD
[+] Author Affiliations

Reprint requests to Geriatrics Program, National Institute on Aging, Gateway Bldg, Suite 3E327, Bethesda, MD 20892 (Dr Hadley).


JAMA. 1995;273(17):1381-1383. doi:10.1001/jama.1995.03520410075030
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References

Two fundamental precepts of geriatrics are the importance of evaluating the whole person and matching therapy to that person's specific conditions and circumstances.1-4 The high prevalence of coexisting multiple diseases among older persons, the interactions of physiological systems affecting functional decline, and the heterogeneity of the older population create complex problems in deciding what information to obtain about a patient and applying it in clinical decisions. These complexities are often so great that good decision making in geriatrics may often be seen as more art than science.

Although art will probably always play a role in all fields of medicine, advances in geriatric research are providing a more scientific context for applying the geriatrician's integrative art to an expanding range of important clinical problems. The articles by Tinetti et al5 and Ouslander et al6 in this issue of JAMA reflect different aspects of these approaches.

Both studies

REFERENCES

1 +
Steel K, Williams TF.  Geriatrics: fruition of the clinician. Arch Intern Med . 1974;; 134:1125-1126.
2 +
Butler RN.  Cycles, clocks, and power plants. Am J Med . 1994;;97( (suppl) ):35S-39S.
3 +
Rowe JW.  Health care of the elderly. N Engl J Med . 1985;;312:827-835.
4 +
Hazzard WR.  The practice of geriatric medicine.  In: Hazzard WR, Andres R, Bierman EL, Blass JP, eds. Principles of Geriatric Medicine and Gerontology . New York, NY: McGraw-Hill Inc; 1990;:xxv-xxvii.
5 +
Tinetti ME, Inouye SK, Gill TM, Doucette JT.  Shared risk factors for falls, incontinence, and functional dependence: unifying the approach to geriatric syndromes. JAMA . 1995;;273:1348-1353.
6 +
Ouslander JG, Schnelle JF, Uman G, et al.  Predictors of successful prompted voiding among incontinent nursing home residents. JAMA . 1995;;273:1366-1370.
7 +
Rubenstein LZ, Campbell LJ, Kane RL, eds.  Geriatric assessment. Clin Geriatr Med . 1987;;3:1-236.
8 +
Applegate WB, Blass JP, Williams TF.  Instruments for the functional assessment of older patients. N Engl J Med . 1990;;322:1207-1214.
9 +
Solomon DH.  Geriatric assessment: methods for clinical decision making. JAMA . 1988;;259:2450-2452.
10 +
Tinetti ME.  Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc . 1986;;34:119-126.
11 +
Tinetti ME, Ginter SF.  Identifying mobility dysfunctions in elderly patients: standard neuromuscular examination or direct assessment? JAMA . 1988;;259:1190-1193.
12 +
Tinetti ME, Speechley M, Ginter SF.  Risk factors for falls among elderly persons living in the community. N Engl J Med . 1988;;319:1701-1707.
13 +
Tinetti ME, Williams TF, Mayewski R.  Fall risk index for elderly patients based on number of chronic disabilities. Am J Med . 1986;;80:429-434.
14 +
Koch M, Gottschalk M, Baker DI, Palumbo S, Tinetti ME.  An impairment and disability assessment and treatment protocol for community-living elderly persons. Phys Ther . 1994;;74:286-294.
15 +
Tinetti ME, Baker DI, McAvay G, et al.  A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med . 1994;;331:821-827.
16 +
Wagner EH, LaCroix AZ, Grothaus L, et al.  Preventing disability and falls in older adults: a population-based randomized trial. Am J Public Health . 1994;;84: 1800-1806.
17 +
Cummings SR, Nevitt MC, Browner WS, et al.  Risk factors for hip fracture in white women: the study of osteoporotic fractures. N Engl J Med . 1995;;332:767-773.
18 +
Reinsch S, MacRae P, Lachenbruch PA, Tobis JS.  Attempts to prevent falls and injury: a prospective community study. Gerontologist . 1992;;32:450-456.
19 +
Rubenstein LZ, Robbins AS, Josephson KR, Schulman BL, Osterweil D.  The value of assessing falls in an elderly population: a randomized clinical trial. Ann Intern Med . 1990;;113:308-316.
20 +
Resnick NM, Yalla SV, Laurino E.  The pathophysiology of urinary incontinence among institutionalized elderly persons. N Engl J Med . 1989;;320:1-7.
21 +
Province MA, Hadley EC, Hornbrook MC, et al.  The effects of exercise on falls in elderly patients: a preplanned meta-analysis of the FICSIT trials. JAMA . 1995;; 273:1341-1347.
22 +
Hadley EC, Ory MG, Suzman R, Weindruch R, Fried L, eds.  Physical frailty: a treatable cause of dependence in old age. J Gerontol . 1993;;48 (special issue):1-88.
23 +
Guralnik JM, Simonsick EM, Ferrucci L, et al.  A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol . 1994;;49:M85-M94.
24 +
Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB.  Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med . 1995;;332:556-561.
25 +
Fiatarone MA, Marks EC, Meredith CN, Lipsitz LA, Evans WJ.  High intensity strength training in nonagenarians: effects on skeletal muscle. JAMA . 1990;;263: 3029-3034.
26 +
Hu MH, Woollacott MH.  Multisensory training of standing balance in older adults, I: postural stability and one-leg stance balance. J Gerontol . 1994;;49:M52-M61.
27 +
Hu MH, Woollacott MH.  Multisensory training of standing balance in older adults, II: kinematic and electromyographic postural responses. J Gerontol . 1994;;49: M62-M71.
28 +
Ades PA, Waldmann ML, Poehlman ET, et al.  Exercise conditioning in older coronary patients: submaximal lactate response and endurance capacity. Circulation . 1993;;88:572-577.
29 +
Ory MG, Schechtman KB, Miller JP, et al.  Frailty and injuries later in life: the FICSIT trials. J Am Geriatr Soc . 1993;;41:283-296.
30 +
Fiatarone MA, O'Neill EF, Doyle N, et al.  The Boston FICSIT study: the effects of resistance training and nutritional supplementation on physical frailty in the oldest old. J Am Geriatr Soc . 1993;;41:333-337.
31 +
Buchner DM, Cress ME, Wagner EH, de Lateur BJ, Price R, Abrass IB.  The Seattle FICSIT/Movelt study: the effect of exercise on gait and balance in older adults. J Am Geriatr Soc . 1993;;41:321-325.
32 +
Wolf SL, Kutner NG, Green RC, McNeely E.  The Atlanta FICSIT study: two exercise interventions to reduce frailty in elders. J Am Geriatr Soc . 1993;;41:329-332.
33 +
Wolfson L, Whipple R, Judge J, Amerman P, Derby C, King M.  Training balance and strength in the elderly to improve function. J Am Geriatr Soc . 1993;;41:341-343.
34 +
Fiatarone MA, O'Neill EF, Ryan ND, et al.  Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med . 1994;;330: 1769-1775.
35 +
Judge JO, Whipple RH, Wolfson LI.  Effects of resistive and balance exercises on isokinetic strength in older persons. J Am Geriatr Soc . 1994;;42:937-946.
36 +
Mulrow CD, Gerety MB, Kanten D, DeNino LA, Cornell JE.  Effects of physical therapy on functional status of nursing home residents. J Am Geriatr Soc . 1993;;41: 326-328.
37 +
Tinetti ME, Baker DI, Garrett PA, Gottschalk M, Koch ML, Horwitz RI.  Yale FICSIT: risk factor abatement strategy for fall prevention. J Am Geriatr Soc . 1993;; 41:315-320.
38 +
Hornbrook MC, Stevens VJ, Wingfield DJ.  Seniors' Program for Injury Control and Education. J Am Geriatr Soc . 1993;;41:309-314.
39 +
Mulrow CD, Gerety MB, Kanten D, et al.  A randomized trial of physical rehabilitation for very frail nursing home residents. JAMA . 1994;;271:519-524.
40 +
Wagner EH, LaCroix AZ, Buchner DM, Larson EB.  Effects of physical activity on health status in older adults, I: observational studies. Annu Rev Public Health . 1992;;13:451-468.
41 +
Buchner DM, Beresford SA, Larson EB, LaCroix AZ, Wagner EH.  Effects of physical activity on health status in older adults, II: intervention studies. Annu Rev Public Health . 1992;;13:469-488.

Figures

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Steel K, Williams TF.  Geriatrics: fruition of the clinician. Arch Intern Med . 1974;; 134:1125-1126.
2 +
Butler RN.  Cycles, clocks, and power plants. Am J Med . 1994;;97( (suppl) ):35S-39S.
3 +
Rowe JW.  Health care of the elderly. N Engl J Med . 1985;;312:827-835.
4 +
Hazzard WR.  The practice of geriatric medicine.  In: Hazzard WR, Andres R, Bierman EL, Blass JP, eds. Principles of Geriatric Medicine and Gerontology . New York, NY: McGraw-Hill Inc; 1990;:xxv-xxvii.
5 +
Tinetti ME, Inouye SK, Gill TM, Doucette JT.  Shared risk factors for falls, incontinence, and functional dependence: unifying the approach to geriatric syndromes. JAMA . 1995;;273:1348-1353.
6 +
Ouslander JG, Schnelle JF, Uman G, et al.  Predictors of successful prompted voiding among incontinent nursing home residents. JAMA . 1995;;273:1366-1370.
7 +
Rubenstein LZ, Campbell LJ, Kane RL, eds.  Geriatric assessment. Clin Geriatr Med . 1987;;3:1-236.
8 +
Applegate WB, Blass JP, Williams TF.  Instruments for the functional assessment of older patients. N Engl J Med . 1990;;322:1207-1214.
9 +
Solomon DH.  Geriatric assessment: methods for clinical decision making. JAMA . 1988;;259:2450-2452.
10 +
Tinetti ME.  Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc . 1986;;34:119-126.
11 +
Tinetti ME, Ginter SF.  Identifying mobility dysfunctions in elderly patients: standard neuromuscular examination or direct assessment? JAMA . 1988;;259:1190-1193.
12 +
Tinetti ME, Speechley M, Ginter SF.  Risk factors for falls among elderly persons living in the community. N Engl J Med . 1988;;319:1701-1707.
13 +
Tinetti ME, Williams TF, Mayewski R.  Fall risk index for elderly patients based on number of chronic disabilities. Am J Med . 1986;;80:429-434.
14 +
Koch M, Gottschalk M, Baker DI, Palumbo S, Tinetti ME.  An impairment and disability assessment and treatment protocol for community-living elderly persons. Phys Ther . 1994;;74:286-294.
15 +
Tinetti ME, Baker DI, McAvay G, et al.  A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med . 1994;;331:821-827.
16 +
Wagner EH, LaCroix AZ, Grothaus L, et al.  Preventing disability and falls in older adults: a population-based randomized trial. Am J Public Health . 1994;;84: 1800-1806.
17 +
Cummings SR, Nevitt MC, Browner WS, et al.  Risk factors for hip fracture in white women: the study of osteoporotic fractures. N Engl J Med . 1995;;332:767-773.
18 +
Reinsch S, MacRae P, Lachenbruch PA, Tobis JS.  Attempts to prevent falls and injury: a prospective community study. Gerontologist . 1992;;32:450-456.
19 +
Rubenstein LZ, Robbins AS, Josephson KR, Schulman BL, Osterweil D.  The value of assessing falls in an elderly population: a randomized clinical trial. Ann Intern Med . 1990;;113:308-316.
20 +
Resnick NM, Yalla SV, Laurino E.  The pathophysiology of urinary incontinence among institutionalized elderly persons. N Engl J Med . 1989;;320:1-7.
21 +
Province MA, Hadley EC, Hornbrook MC, et al.  The effects of exercise on falls in elderly patients: a preplanned meta-analysis of the FICSIT trials. JAMA . 1995;; 273:1341-1347.
22 +
Hadley EC, Ory MG, Suzman R, Weindruch R, Fried L, eds.  Physical frailty: a treatable cause of dependence in old age. J Gerontol . 1993;;48 (special issue):1-88.
23 +
Guralnik JM, Simonsick EM, Ferrucci L, et al.  A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol . 1994;;49:M85-M94.
24 +
Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB.  Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med . 1995;;332:556-561.
25 +
Fiatarone MA, Marks EC, Meredith CN, Lipsitz LA, Evans WJ.  High intensity strength training in nonagenarians: effects on skeletal muscle. JAMA . 1990;;263: 3029-3034.
26 +
Hu MH, Woollacott MH.  Multisensory training of standing balance in older adults, I: postural stability and one-leg stance balance. J Gerontol . 1994;;49:M52-M61.
27 +
Hu MH, Woollacott MH.  Multisensory training of standing balance in older adults, II: kinematic and electromyographic postural responses. J Gerontol . 1994;;49: M62-M71.
28 +
Ades PA, Waldmann ML, Poehlman ET, et al.  Exercise conditioning in older coronary patients: submaximal lactate response and endurance capacity. Circulation . 1993;;88:572-577.
29 +
Ory MG, Schechtman KB, Miller JP, et al.  Frailty and injuries later in life: the FICSIT trials. J Am Geriatr Soc . 1993;;41:283-296.
30 +
Fiatarone MA, O'Neill EF, Doyle N, et al.  The Boston FICSIT study: the effects of resistance training and nutritional supplementation on physical frailty in the oldest old. J Am Geriatr Soc . 1993;;41:333-337.
31 +
Buchner DM, Cress ME, Wagner EH, de Lateur BJ, Price R, Abrass IB.  The Seattle FICSIT/Movelt study: the effect of exercise on gait and balance in older adults. J Am Geriatr Soc . 1993;;41:321-325.
32 +
Wolf SL, Kutner NG, Green RC, McNeely E.  The Atlanta FICSIT study: two exercise interventions to reduce frailty in elders. J Am Geriatr Soc . 1993;;41:329-332.
33 +
Wolfson L, Whipple R, Judge J, Amerman P, Derby C, King M.  Training balance and strength in the elderly to improve function. J Am Geriatr Soc . 1993;;41:341-343.
34 +
Fiatarone MA, O'Neill EF, Ryan ND, et al.  Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med . 1994;;330: 1769-1775.
35 +
Judge JO, Whipple RH, Wolfson LI.  Effects of resistive and balance exercises on isokinetic strength in older persons. J Am Geriatr Soc . 1994;;42:937-946.
36 +
Mulrow CD, Gerety MB, Kanten D, DeNino LA, Cornell JE.  Effects of physical therapy on functional status of nursing home residents. J Am Geriatr Soc . 1993;;41: 326-328.
37 +
Tinetti ME, Baker DI, Garrett PA, Gottschalk M, Koch ML, Horwitz RI.  Yale FICSIT: risk factor abatement strategy for fall prevention. J Am Geriatr Soc . 1993;; 41:315-320.
38 +
Hornbrook MC, Stevens VJ, Wingfield DJ.  Seniors' Program for Injury Control and Education. J Am Geriatr Soc . 1993;;41:309-314.
39 +
Mulrow CD, Gerety MB, Kanten D, et al.  A randomized trial of physical rehabilitation for very frail nursing home residents. JAMA . 1994;;271:519-524.
40 +
Wagner EH, LaCroix AZ, Buchner DM, Larson EB.  Effects of physical activity on health status in older adults, I: observational studies. Annu Rev Public Health . 1992;;13:451-468.
41 +
Buchner DM, Beresford SA, Larson EB, LaCroix AZ, Wagner EH.  Effects of physical activity on health status in older adults, II: intervention studies. Annu Rev Public Health . 1992;;13:469-488.

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