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December 4, 1996, Vol 276, No. 21 >
ARTICLE | December 4, 1996

Preventing Disability: Title and subTitle BreakBeyond the Black Box FREE

John C. Beck, MD; Andreas Stuck, MD
[+] Author Affiliations

Reprints: John C. Beck, MD, Multicampus Program in Geriatric Medicine and Gerontology, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90024-1687.


JAMA. 1996;276(21):1756-1757. doi:10.1001/jama.1996.03540210064036
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References

Health and social care services required by older persons in this country will be a growing burden and a major societal concern for much of the next century.1 The long-accepted theories of Gompertz—that mortality rates increase at predictable trajectories—have been challenged because age trajectories of mortality do not follow predictable curves.2 In fact, in humans, mortality rates decelerate with age. Projections from the US Bureau of the Census have not taken this and other factors into account, however, and the US population of older persons continues to be dramatically underestimated.3 Thus, the 1990 projection of the number of older people who will be living in the United States in the year 2000 is 34.9 million,4 while Manton5 predicts 40.3 million, of whom a substantial proportion will be older than 85 years of age.

See also p 1725.

Projections of the numbers of disabled elderly in

REFERENCES

1 +
Lubitz J, Beebe J, Baker C.  Longevity and Medicare expenditures . N Engl J Med . 1995;;332:999-1003.
2 +
Manton KG, Vaupel JW.  Survival after the age of 80 in the United States, Sweden, France, England, and Japan . N Engl J Med . 1995;;338:1232-1235.
3 +
Schneider EL, Gurelnik JM.  The aging of America: impact on health care costs . JAMA . 1990;;263:2835-2840.
4 +
US Bureau of the Census. Current Population Reports, P-25 Series: Population Estimates and Projections . Washington, DC: US Bureau of the Census; 1990;: No. 1018.
5 +
Manton KG.  The dynamics of population aging: demography and policy analysis . Milbank Q . 1991;;69:309-339.
6 +
Jackson ME, Siu AL, Drugovich ML, et al. Alternative Projections of the Disabled Elderly Population:. Report to the Administration on Aging. Washington, DC: US Dept of Health and Human Services; 1991.
7 +
Manton KG.  Epidemiological, demographic, and social correlates of disability among the elderly . Milbank Q . 1989;;67( (suppl 2, pt 1) ):13-58.
8 +
Lieberman MA, Kramer JH.  Factors affecting decisions in institutionalized demented elderly . Gerontologist . 1991;;31:871-874.
9 +
Brodaty H, McGilchrist C, Harris L, Peters KB.  Time until institutionalization and death in patients with dementia: role of caregiver training and risk factors . Arch Neurol . 1993;;60:543-550.
10 +
Cohen CA, Gold DF, Shulman KI, Wortley JT, McDonald G, Wargon M.  Factors determining the decision to institutionalize dementing individuals: a prospective study . Gerontologist . 1993;;33:714-720.
11 +
Rice DP, Fox PJ, Hauch WW, et al. The burden of caring for Alzheimer's disease patients. In: Proceedings of the 1991 Public Health Conference on Records and Statistics. Washington, DC: US Dept of Health and Human Services; 1991:119-124.
12 +
Knopman DS, Kitto J, Deinard S, Heirlus J.  Longitudinal study of death and institutionalization in patients with primary degenerative dementia . J Am Geriatr Soc . 1988;;36:106-112.
13 +
Welch HG, Walsh JS, Larson EB.  The cost of institutional care in Alzheimer's disease: nursing home and hospital use in a prospective cohort . J Am Geriatr Soc . 1992;;40:221-234.
14 +
Kemper C.  The evaluation of the Long-term Care Demonstration Project: an overview of the findings . Health Serv Res . 1988;;23:161-174.
15 +
Weissert WG, Hedrick SC.  Lessons learned from research on effects of community-based long-term care . J Am Geriatr Soc . 1994;;42:348-353.
16 +
Weissert WG, Cready CM, Pawelak JE.  The past and future of home- and community-based long-term care . Milbank Q . 1988;;66:309-388.
17 +
Weissert WG, Wan TTH, Livieratos B, et al.  Cost-effectiveness of homemaker services for the chronically ill . Inquiry . 1980;;17:230-243.
18 +
Mittleman MS, Ferris SH, Shulman E, Steinberg G, Levin B.  A family intervention to delay nursing home placement of patients with Alzheimer disease: a randomized controlled trial . JAMA . 1996;;276:1725-1731.
19 +
Califano JF. Putting Aging on Hold: Delaying the Diseases of Old Age: An Official Report to the White House Conference on Aging . Washington DC: American Federation on Aging Research and Alliance for Aging Research; 1994;:21.
20 +
Knopman D, Schneider L, Davis K, et al, and the Tacrine Study Group.  Longterm tacrine treatment: effects on nursing home placement and mortality . Neurology . 1996;;47:166-177.
21 +
Nagi SZ.  Disability concepts revisited: implications for prevention . In: Pope A, Tarlov A, eds. Disability in America: Toward a National Agenda for Prevention . Washington, DC: National Academy Press; 1991;.
22 +
Verbrugge LM, Jette AM.  The disablement process . Soc Sci Med . 1994;;38:1-14.
23 +
World Health Association. International Classification of Impairments, Disabilities, and Handicaps . Geneva, Switzerland: World Health Organization; 1980;.
24 +
Lawrence RH, Jette AM.  Disentangling the disablement process . J Gerontol . 1996;;51B( (4) ):S173-S182.
25 +
Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ.  Effects of a comprehensive geriatric assessment on survival, residence and function: a meta-analysis of controlled trials . Lancet . 1993;;342:1032-1036.
26 +
Kornowski R, Zeeli D, Averbuch M, et al.  Intensive home-care surveillance prevents hospitalization and improves morbidity rates among elderly patients with severe congestive heart failure . Am Heart J . 1995;;129:762-766.
27 +
Rich MW, Beekham V, Wittenberg C, Leven CL, Freedland KB, Carney RM.  A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure . N Engl J Med . 1993;;333:1190-1195.
28 +
Stuck AE, Aronow HU, Steiner A, et al.  A trial of annual in-home comprehensive geriatric assessment for elderly people living in the community . N Engl J Med . 1995;;333:1184-1189.
29 +
Tinetti ME, Inouye SK, Gill TM, Doucette JT.  Shared risk factors for falls, incontinence, and functional dependence . JAMA . 1995;;273:1348-1353.
30 +
Rogers MM, Peoples-Sheps MD, Sorenson JR.  Translating research into MCH service: comparison of a pilot project and a large-scale resource mothers program . Public Health Rep . 1995;;110:563-569.

Figures

Tables

Interactive Graphics

Video

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 +
Lubitz J, Beebe J, Baker C.  Longevity and Medicare expenditures . N Engl J Med . 1995;;332:999-1003.
2 +
Manton KG, Vaupel JW.  Survival after the age of 80 in the United States, Sweden, France, England, and Japan . N Engl J Med . 1995;;338:1232-1235.
3 +
Schneider EL, Gurelnik JM.  The aging of America: impact on health care costs . JAMA . 1990;;263:2835-2840.
4 +
US Bureau of the Census. Current Population Reports, P-25 Series: Population Estimates and Projections . Washington, DC: US Bureau of the Census; 1990;: No. 1018.
5 +
Manton KG.  The dynamics of population aging: demography and policy analysis . Milbank Q . 1991;;69:309-339.
6 +
Jackson ME, Siu AL, Drugovich ML, et al. Alternative Projections of the Disabled Elderly Population:. Report to the Administration on Aging. Washington, DC: US Dept of Health and Human Services; 1991.
7 +
Manton KG.  Epidemiological, demographic, and social correlates of disability among the elderly . Milbank Q . 1989;;67( (suppl 2, pt 1) ):13-58.
8 +
Lieberman MA, Kramer JH.  Factors affecting decisions in institutionalized demented elderly . Gerontologist . 1991;;31:871-874.
9 +
Brodaty H, McGilchrist C, Harris L, Peters KB.  Time until institutionalization and death in patients with dementia: role of caregiver training and risk factors . Arch Neurol . 1993;;60:543-550.
10 +
Cohen CA, Gold DF, Shulman KI, Wortley JT, McDonald G, Wargon M.  Factors determining the decision to institutionalize dementing individuals: a prospective study . Gerontologist . 1993;;33:714-720.
11 +
Rice DP, Fox PJ, Hauch WW, et al. The burden of caring for Alzheimer's disease patients. In: Proceedings of the 1991 Public Health Conference on Records and Statistics. Washington, DC: US Dept of Health and Human Services; 1991:119-124.
12 +
Knopman DS, Kitto J, Deinard S, Heirlus J.  Longitudinal study of death and institutionalization in patients with primary degenerative dementia . J Am Geriatr Soc . 1988;;36:106-112.
13 +
Welch HG, Walsh JS, Larson EB.  The cost of institutional care in Alzheimer's disease: nursing home and hospital use in a prospective cohort . J Am Geriatr Soc . 1992;;40:221-234.
14 +
Kemper C.  The evaluation of the Long-term Care Demonstration Project: an overview of the findings . Health Serv Res . 1988;;23:161-174.
15 +
Weissert WG, Hedrick SC.  Lessons learned from research on effects of community-based long-term care . J Am Geriatr Soc . 1994;;42:348-353.
16 +
Weissert WG, Cready CM, Pawelak JE.  The past and future of home- and community-based long-term care . Milbank Q . 1988;;66:309-388.
17 +
Weissert WG, Wan TTH, Livieratos B, et al.  Cost-effectiveness of homemaker services for the chronically ill . Inquiry . 1980;;17:230-243.
18 +
Mittleman MS, Ferris SH, Shulman E, Steinberg G, Levin B.  A family intervention to delay nursing home placement of patients with Alzheimer disease: a randomized controlled trial . JAMA . 1996;;276:1725-1731.
19 +
Califano JF. Putting Aging on Hold: Delaying the Diseases of Old Age: An Official Report to the White House Conference on Aging . Washington DC: American Federation on Aging Research and Alliance for Aging Research; 1994;:21.
20 +
Knopman D, Schneider L, Davis K, et al, and the Tacrine Study Group.  Longterm tacrine treatment: effects on nursing home placement and mortality . Neurology . 1996;;47:166-177.
21 +
Nagi SZ.  Disability concepts revisited: implications for prevention . In: Pope A, Tarlov A, eds. Disability in America: Toward a National Agenda for Prevention . Washington, DC: National Academy Press; 1991;.
22 +
Verbrugge LM, Jette AM.  The disablement process . Soc Sci Med . 1994;;38:1-14.
23 +
World Health Association. International Classification of Impairments, Disabilities, and Handicaps . Geneva, Switzerland: World Health Organization; 1980;.
24 +
Lawrence RH, Jette AM.  Disentangling the disablement process . J Gerontol . 1996;;51B( (4) ):S173-S182.
25 +
Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ.  Effects of a comprehensive geriatric assessment on survival, residence and function: a meta-analysis of controlled trials . Lancet . 1993;;342:1032-1036.
26 +
Kornowski R, Zeeli D, Averbuch M, et al.  Intensive home-care surveillance prevents hospitalization and improves morbidity rates among elderly patients with severe congestive heart failure . Am Heart J . 1995;;129:762-766.
27 +
Rich MW, Beekham V, Wittenberg C, Leven CL, Freedland KB, Carney RM.  A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure . N Engl J Med . 1993;;333:1190-1195.
28 +
Stuck AE, Aronow HU, Steiner A, et al.  A trial of annual in-home comprehensive geriatric assessment for elderly people living in the community . N Engl J Med . 1995;;333:1184-1189.
29 +
Tinetti ME, Inouye SK, Gill TM, Doucette JT.  Shared risk factors for falls, incontinence, and functional dependence . JAMA . 1995;;273:1348-1353.
30 +
Rogers MM, Peoples-Sheps MD, Sorenson JR.  Translating research into MCH service: comparison of a pilot project and a large-scale resource mothers program . Public Health Rep . 1995;;110:563-569.

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