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Update in Geriatrics
- William J. Hall, MD
- From the University of Rochester, Rochester, New York. Requests for Reprints: William J. Hall, MD, Department of Medicine, University of Rochester, School of Medicine and Dentistry, 601 Elmwood Avenue, Box MED, Rochester, NY 14642. Current Author Addresses: Dr. Hall: Department of Medicine, University of Rochester, School of Medicine and Dentistry, 601 Elmwood Avenue, Box MED, Rochester, NY 14642.
Every internist recognizes that the medical care of older persons is becoming increasingly central to clinical practice. Keeping up in this discipline requires somewhat unconventional approaches because the reports of exciting and useful clinical trials are scattered throughout the medical and surgical literature. This Update discusses a representative group of studies that focus on common problems seen in medical offices, care of hospitalized older persons, and clinical problems frequently encountered in nursing homes.
Common Problems in Medical Offices
Advances in office practices for the care of elderly patients have focused on preventing osteoporosis, fractures, and coronary artery disease and on the risks for developing Alzheimer disease.
Risks for Hip Fracture Were Identified
Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med. 1996; 332:767-73.
One in every six white women will sustain a hip fracture in her lifetime [1]. Hip fractures are also strongly associated with subsequent death. A major clinical question is whether preventive measures can reduce the risk for hip fracture.
This cohort study included 9516 white women who were 65 years of age or older and had not previously had a hip fracture. Participants were followed four times a year for a mean of 4.1 years to determine the frequency of hip fractures. Baseline data included bone densities and the most recently recognized risk factors for hip fracture.
During the study, 192 women sustained a hip fracture for the first time. Important risk factors were current use of anticonvulsant drugs (relative risk, 2.8 [95% CI, 1.2 to 6.3]), inability to rise from a chair (relative risk, 2.1 [CI, 1.3 to 3.2]), history of maternal hip fracture (relative risk, 2.0 [CI, 1.4 to 2.9]), previous hyperthyroidism (relative risk, 1.8 [CI, 1.2 to 2.6]), resting pulse rate …
