NEJM â Collection Updates for Aging/Geriatrics

REVIEW ARTICLE: Alzheimer's Disease

Henry W. Querfurth, M.D., Ph.D., and Frank M. LaFerla, Ph.D. — Thu, 28Â JanÂ 2010 00:00:00 -05:00

More than 35 million people worldwide â 5.5 million in the United States â have Alzheimer's disease, a deterioration of memory and other cognitive domains that leads to death within...

SPECIAL ARTICLE: Increased Ambulatory Care Copayments and Hospitalizations among the Elderly

Amal N. Trivedi, M.D., M.P.H., Husein Moloo, M.P.H., and Vincent Mor, Ph.D. — Thu, 28Â JanÂ 2010 00:00:00 -05:00

Background: When copayments for ambulatory care are increased, elderly patients may forgo important outpatient care, leading to increased use of hospital care.

Methods: We compared longitudinal changes in the use of...

IMAGES IN CLINICAL MEDICINE: Anterior Sternal Dislocation

Samer Taslaq, M.R.C.S. (Engl.) and R. Christopher Nordstrom, M.B., B.S. — Thu, 03Â DecÂ 2009 00:00:00 -05:00

An 83-year-old man was admitted to the acute medical ward after having fallen down in his home. On admission he was confused and agitated. Physical examination revealed a swelling with...

CORRESPONDENCE: Older Age and a Reduced Likelihood of 2009 H1N1 Virus Infection

Thu, 12Â NovÂ 2009 00:00:00 -05:00

To the Editor: Early epidemiologic reports regarding the 2009 pandemic influenza A (H1N1) virus suggest that cases of infection and deaths are concentrated in adults between the ages of 20...

CORRESPONDENCE: Loss of Independence in Patients Starting Dialysis at 80 Years of Age or Older

Thu, 15Â OctÂ 2009 00:00:00 -05:00

To the Editor: We report a negative effect of initiation of dialysis on independent living by patients 80 years of age or older. Using a single-center, retrolective cohort study design...

EDITORIAL: Dialysis in Frail Elders â A Role for Palliative Care

Robert M. Arnold, M.D., and Mark L. Zeidel, M.D. — Thu, 15Â OctÂ 2009 00:00:00 -05:00

The methods and availability of dialysis and transplantation have improved, and patients who are beginning to undergo dialysis have become sicker and more debilitated than in the past.1 Increased numbers...

EDITORIAL: Dying from Dementia

Greg A. Sachs, M.D. — Thu, 15Â OctÂ 2009 00:00:00 -05:00

As a teenager, I had the unfortunate but ultimately career-shaping experience of watching my maternal grandmother decline from Alzheimer's disease. She resided in a nursing home, where her final months...

ORIGINAL ARTICLE: Functional Status of Elderly Adults before and after Initiation of Dialysis

Thu, 15Â OctÂ 2009 00:00:00 -05:00

Background: It is unclear whether functional status before dialysis is maintained after the initiation of this therapy in elderly patients with end-stage renal disease (ESRD).

Methods: Using a national registry of...

ORIGINAL ARTICLE: The Clinical Course of Advanced Dementia

Thu, 15Â OctÂ 2009 00:00:00 -05:00

Background: Dementia is a leading cause of death in the United States but is underrecognized as a terminal illness. The clinical course of nursing home residents with advanced dementia has...

REVIEW ARTICLE: DNA Damage, Aging, and Cancer

Jan H.J. Hoeijmakers, Ph.D. — Thu, 08Â OctÂ 2009 00:00:00 -05:00

DNA damage has emerged as a major culprit in cancer and many diseases related to aging. The stability of the genome is supported by an intricate machinery of repair, damage...

ORIGINAL ARTICLE: High-Dose Daunorubicin in Older Patients with Acute Myeloid Leukemia

Thu, 24Â SepÂ 2009 00:00:00 -05:00

Background: A complete remission is essential for prolonging survival in patients with acute myeloid leukemia (AML). Daunorubicin is a cornerstone of the induction regimen, but the optimal dose is unknown....

ORIGINAL ARTICLE: Longitudinal Modeling of Age-Related Memory Decline and the Îµ4 Effect

Thu, 16Â JulÂ 2009 00:00:00 -05:00

Background: The APOE Îµ4 allele is associated with the risk of late-onset Alzheimer's disease. The age at which memory decline diverges among persons who are homozygous for the APOE Îµ4...

ORIGINAL ARTICLE: Epidemiologic Study of In-Hospital Cardiopulmonary Resuscitation in the Elderly

Thu, 02Â JulÂ 2009 00:00:00 -05:00

Background: It is unknown whether the rate of survival after in-hospital cardiopulmonary resuscitation (CPR) is improving and which characteristics of patients and hospitals predict survival.

Methods: We examined fee-for-service Medicare data...

EDITORIAL: Cool with Plaques and Tangles

Douglas C. Ewbank, Ph.D., and Steven E. Arnold, M.D. — Thu, 28Â MayÂ 2009 00:00:00 -05:00

Survivors to the age of 95 years are a select and hardy few. At current mortality rates, only about 8% of persons will live to the age of 95, and...

ORIGINAL ARTICLE: Age, Neuropathology, and Dementia

Thu, 28Â MayÂ 2009 00:00:00 -05:00

Background: Research in Alzheimer's disease is focused mainly on younger old persons, whereas studies involving very old persons report attenuated relationships between the pathological features of Alzheimer's disease and dementia.

Methods:...

ORIGINAL ARTICLE: Adjuvant Chemotherapy in Older Women with Early-Stage Breast Cancer

Thu, 14Â MayÂ 2009 00:00:00 -05:00

Background: Older women with breast cancer are underrepresented in clinical trials, and data on the effects of adjuvant chemotherapy in such patients are scant. We tested for the noninferiority of...

CORRESPONDENCE: Outcome of Renal Transplantation from Very Old Donors

Thu, 02Â AprÂ 2009 00:00:00 -05:00

To the Editor: The use of kidneys from elderly donors may permit more transplantations, but it has been associated with poorer outcomes than transplantations performed with kidneys from younger donors.1...

EDITORIAL: The Growth of Hospitalists and the Changing Face of Primary Care

Thu, 12Â MarÂ 2009 00:00:00 -05:00

Two decades ago, most doctors who chose a career as a primary care physician did not imagine a professional life restricted to the outpatient setting. The architects of training programs...

SPECIAL ARTICLE: Growth in the Care of Older Patients by Hospitalists in the United States

Thu, 12Â MarÂ 2009 00:00:00 -05:00

Background: National and population-based information on the increase in patient care by hospitalists in the United States is lacking.

Methods: Using a 5% sample of Medicare beneficiaries in 1995, 1997, 1999,...

ORIGINAL ARTICLE: Breast Cancer after Use of Estrogen plus Progestin in Postmenopausal Women

Thu, 05Â FebÂ 2009 00:00:00 -05:00

Background: Following the release of the 2002 report of the Women's Health Initiative (WHI) trial of estrogen plus progestin, the use of menopausal hormone therapy in the United States decreased...

IMAGES IN CLINICAL MEDICINE: Occult Hip Fracture

Emily N. Vinson, M.D. — Thu, 25Â DecÂ 2008 00:00:00 -05:00

An 87-year-old man tripped and fell; subsequently, persistent pain developed in the left hip. A radiograph of the left hip 2 weeks after the fall revealed diffuse osteopenia with no...

PERSPECTIVE: Screening for Prostate Cancer among Men 75 Years of Age or Older

Thu, 11Â DecÂ 2008 00:00:00 -05:00

Prostate-cancer screening with the prostate-specific antigen (PSA) test remains one of the most controversial issues in modern medicine. The U.S. Preventive Services Task Force (USPSTF), an independent group of experts...

PERSPECTIVE: Home Delivery â Bringing Primary Care to the Housebound Elderly

Thu, 04Â DecÂ 2008 00:00:00 -05:00

Nurse practitioner Gail Metcalf toted her medical bag up the steep stairway of a triple-decker house in Dorchester, a low-income neighborhood of Boston, and greeted her patient, Mrs. E, a...

EDITORIAL: Treating Low Sexual Desire â New Findings for Testosterone in Women

Julia R. Heiman, Ph.D. — Thu, 06Â NovÂ 2008 00:00:00 -05:00

Decreased or low sexual desire is commonly reported by women from late adolescence through the seventh decade across a number of cultures. Estimates of prevalence range from 25 to 53%.123...

ORIGINAL ARTICLE: Testosterone for Low Libido in Postmenopausal Women Not Taking Estrogen

Thu, 06Â NovÂ 2008 00:00:00 -05:00

Background: The efficacy and safety of testosterone treatment for hypoactive sexual desire disorder in postmenopausal women not receiving estrogen therapy are unknown.

Methods: We conducted a double-blind, placebo-controlled, 52-week trial in...

ORIGINAL ARTICLE: Toll-like Receptor 3 and Geographic Atrophy in Age-Related Macular Degeneration

Thu, 02Â OctÂ 2008 00:00:00 -05:00

Background: Age-related macular degeneration is the most common cause of irreversible visual impairment in the developed world. Advanced age-related macular degeneration consists of geographic atrophy and choroidal neovascularization. The specific...

ORIGINAL ARTICLE: Incidental Meniscal Findings on Knee MRI in Middle-Aged and Elderly Persons

Thu, 11Â SepÂ 2008 00:00:00 -05:00

Background: Magnetic resonance imaging (MRI) of the knee is often performed in patients who have knee symptoms of unclear cause. When meniscal tears are found, it is commonly assumed that...

EDITORIAL: Tibolone and the Promise of Ideal Hormone-Replacement Therapy

Ghada El-Hajj Fuleihan, M.D., M.P.H. — Thu, 14Â AugÂ 2008 00:00:00 -05:00

Since the mean life expectancy at menopause is 32.7 years, women spend more than one third of their lives in the estrogen-deficient postmenopausal state.1 Of the majority of menopausal women...

ORIGINAL ARTICLE: The Effects of Tibolone in Older Postmenopausal Women

Thu, 14Â AugÂ 2008 00:00:00 -05:00

Background: Tibolone has estrogenic, progestogenic, and androgenic effects. Although tibolone prevents bone loss, its effects on fractures, breast cancer, and cardiovascular disease are uncertain.

Methods: In this randomized study, we assigned...

BOOK REVIEW:

Thu, 24Â JulÂ 2008 00:00:00 -05:00

In the past half-century, life expectancy has increased considerably. As a result, we need to develop a more comprehensive understanding of aging than we have now. Whether in health or...

ORIGINAL ARTICLE: Effect of Dissemination of Evidence in Reducing Injuries from Falls

Thu, 17Â JulÂ 2008 00:00:00 -05:00

Background: Falling is a common and morbid condition among elderly persons. Effective strategies to prevent falls have been identified but are underutilized.

Methods: Using a nonrandomized design, we compared rates of...

REVIEW ARTICLE: Age-Related Macular Degeneration

Rama D. Jager, M.D., William F. Mieler, M.D., and Joan W. Miller, M.D. — Thu, 12Â JunÂ 2008 00:00:00 -05:00

Age-related macular degeneration is the leading cause of irreversible blindness in people 50 years of age or older in the developed world.12 More than 8 million Americans have age-related macular...

EDITORIAL: Bona Fide Genetic Associations with Bone Mineral Density

Joel N. Hirschhorn, M.D., Ph.D., and Luigi Gennari, M.D., Ph.D. — Thu, 29Â MayÂ 2008 00:00:00 -05:00

Osteoporosis is a common skeletal disorder characterized by compromised bone strength and increased bone fragility, affecting up to 40% of postmenopausal women and 15% of men.1 Its clinical significance lies...

IMAGES IN CLINICAL MEDICINE: The Aorta in Osteoporosis

Cesar A. Conde, M.D. and Roberto J. Cubeddu, M.D. — Thu, 29Â MayÂ 2008 00:00:00 -05:00

An 86-year-old woman with severe symptomatic aortic stenosis was referred for routine preoperative cardiac catheterization. During the procedure, pronounced tortuosity of the catheter was noted. Subsequent administration of intravenous contrast...

ORIGINAL ARTICLE: Multiple Genetic Loci for Bone Mineral Density and Fractures

Thu, 29Â MayÂ 2008 00:00:00 -05:00

Background: Bone mineral density influences the risk of osteoporosis later in life and is useful in the evaluation of the risk of fracture. We aimed to identify sequence variants associated...

CLINICAL PRACTICE: Rotator-Cuff Failure

Frederick A. Matsen III, M.D. — Thu, 15Â MayÂ 2008 00:00:00 -05:00

A 63-year-old woman presents with a 2-year history of progressive weakness and discomfort in her right shoulder, especially when she puts dishes on the top shelf in her kitchen. She...

ORIGINAL ARTICLE: Use of Multiple Biomarkers to Improve the Prediction of Death from Cardiovascular Causes

Thu, 15Â MayÂ 2008 00:00:00 -05:00

Background: The incremental usefulness of adding multiple biomarkers from different disease pathways for predicting the risk of death from cardiovascular causes has not, to our knowledge, been evaluated among the...

PERSPECTIVE: Planning for the Future â Long-Term Care and the 2008 Election

Thu, 08Â MayÂ 2008 00:00:00 -05:00

Long-term care has all the makings of a great campaign issue. It affects a large portion of the population, it is expensive (it currently accounts for about 10% of all...

EDITORIAL: Treating Hypertension in the Very Old

John B. Kostis, M.D. — Thu, 01Â MayÂ 2008 00:00:00 -05:00

Hypertension is prevalent and accounts for a large proportion of cardiovascular morbidity and mortality worldwide.1 There is a continuous, approximately linear, increase in systolic blood pressure with increasing age in...

ORIGINAL ARTICLE: Treatment of Hypertension in Patients 80 Years of Age or Older

Thu, 01Â MayÂ 2008 00:00:00 -05:00

Background: Whether the treatment of patients with hypertension who are 80 years of age or older is beneficial is unclear. It has been suggested that antihypertensive therapy may reduce the...

CLINICAL PRACTICE: Osteoporosis in Men

Peter R. Ebeling, M.D. — Thu, 03Â AprÂ 2008 00:00:00 -05:00

A 65-year-old asymptomatic man is concerned about his risk of osteoporosis. His mother died after a hip fracture at 74 years of age. The patient has no history of fractures...

CLINICAL PRACTICE: Hormonal Contraception in Women of Older Reproductive Age

Andrew M. Kaunitz, M.D. — Thu, 20Â MarÂ 2008 00:00:00 -05:00

A healthy, lean 46-year-old woman who is a nonsmoker requests advice about contraception. She notes that her menstrual periods are less regular than previously, and she also reports intermittent bothersome...

CLINICAL PRACTICE: Lumbar Spinal Stenosis

Jeffrey N. Katz, M.D., M.Sc., and Mitchel B. Harris, M.D. — Thu, 21Â FebÂ 2008 00:00:00 -05:00

A 72-year-old woman with hypertension presents with a 4-month history of lower back discomfort that radiates to both buttocks and lateral thighs. Previously, she had walked 2 miles (3.2 km)...

CLINICAL PRACTICE: Neurogenic Orthostatic Hypotension

Roy Freeman, M.B., Ch.B. — Thu, 07Â FebÂ 2008 00:00:00 -05:00

A 65-year-old man reports a 6-month history of dizziness, light-headedness, weakness, and fatigue while upright. He takes no medication and has no personal or family history of neurologic disease. On...

ORIGINAL ARTICLE: Phenotype and Course of HutchinsonâGilford Progeria Syndrome

Thu, 07Â FebÂ 2008 00:00:00 -05:00

Background: HutchinsonâGilford progeria syndrome is a rare, sporadic, autosomal dominant syndrome that involves premature aging, generally leading to death at approximately 13 years of age due to myocardial infarction or...

PERSPECTIVE: HutchinsonâGilford Progeria Syndrome, Aging, and the Nuclear Lamina

Thu, 07Â FebÂ 2008 00:00:00 -05:00

We are living in a time that will probably be remembered as a golden age of discovery in human genetics. Most of the recent excitement has focused on the identification...

ORIGINAL ARTICLE: Endovascular vs. Open Repair of Abdominal Aortic Aneurysms in the Medicare Population

Thu, 31Â JanÂ 2008 00:00:00 -05:00

Background: Randomized trials have shown reductions in perioperative mortality and morbidity with endovascular repair of abdominal aortic aneurysm, as compared with open surgical repair. Longer-term survival rates, however, were similar...

IMAGES IN CLINICAL MEDICINE: Quinolone-Associated Rupture of the Achilles' Tendon

Harsha Vyas, M.D. and Guha Krishnaswamy, M.D. — Thu, 15Â NovÂ 2007 00:00:00 -05:00

An 81-year-old woman with rheumatoid arthritis, SjÃ¶gren's syndrome, and hypertension presented with swelling and pain in the area of the left heel, which had developed suddenly a week after a...

EDITORIAL: Zoledronic Acid and Secondary Prevention of Fractures

Karim Anton Calis, Pharm.D., M.P.H., and Frank Pucino, Pharm.D. — Thu, 01Â NovÂ 2007 00:00:00 -05:00

More than 300,000 hip fractures occur annually in the United States,1 the majority related to osteoporosis and falls in older people. Not surprisingly, the public health implications and economic burden...

ORIGINAL ARTICLE: Zoledronic Acid and Clinical Fractures and Mortality after Hip Fracture

Thu, 01Â NovÂ 2007 00:00:00 -05:00

Background: Mortality is increased after a hip fracture, and strategies that improve outcomes are needed.

Methods: In this randomized, double-blind, placebo-controlled trial, 1065 patients were assigned to receive yearly intravenous zoledronic...

EDITORIAL: Treatment of Neuropsychiatric Symptoms in Patients with Dementia

Kristine Yaffe, M.D. — Thu, 04Â OctÂ 2007 00:00:00 -05:00

Although cognitive deficits are the clinical hallmark of dementia syndromes, noncognitive symptoms are common and can dominate the disease course. These include a range of neuropsychiatric symptoms, such as agitation,...

EDITORIAL: Influenza â The Goal of Control

John D. Treanor, M.D. — Thu, 04Â OctÂ 2007 00:00:00 -05:00

Annual administration of inactivated influenza vaccine to older adults has long been recommended by public health authorities.1 The risks of influenza-related complications, hospitalizations, and deaths increase with age, as does...

CLINICAL PRACTICE: Osteoarthritis of the Hip

Nancy E. Lane, M.D. — Thu, 04Â OctÂ 2007 00:00:00 -05:00

A 70-year-old man reports a gradual onset of hip pain that has limited his activities for about a year. The pain initially occurred only with walking and was limited to...

ORIGINAL ARTICLE: Donepezil for the Treatment of Agitation in Alzheimer's Disease

Thu, 04Â OctÂ 2007 00:00:00 -05:00

Background: Agitation is a common and distressing symptom in patients with Alzheimer's disease. Cholinesterase inhibitors improve cognitive outcomes in such patients, but the benefits of these drugs for behavioral disturbances...

ORIGINAL ARTICLE: Effectiveness of Influenza Vaccine in the Community-Dwelling Elderly

Thu, 04Â OctÂ 2007 00:00:00 -05:00

Background: Reliable estimates of the effectiveness of influenza vaccine among persons 65 years of age and older are important for informed vaccination policies and programs. Short-term studies may provide misleading...

IMAGES IN CLINICAL MEDICINE: Purple Urine

Jooyun Lee, M.D. — Thu, 27Â SepÂ 2007 00:00:00 -05:00

A 76-year-old male nursing home resident with dementia and end-stage renal disease who was undergoing hemodialysis was admitted to the hospital after a syncopal episode that occurred during dialysis. Torsades...

EDITORIAL: Sex and Aging

John H.J. Bancroft, M.D. — Thu, 23Â AugÂ 2007 00:00:00 -05:00

Human beings are living longer, women more so than men. Among people 85 years of age and older, there are 4 men for every 10 women.1 What happens to sexuality...

CLINICAL PRACTICE: Isolated Systolic Hypertension in the Elderly

Aram V. Chobanian, M.D. — Thu, 23Â AugÂ 2007 00:00:00 -05:00

A 68-year-old accountant visits his physician. He was told a year earlier that his blood pressure was somewhat elevated and was advised to reduce salt intake and increase physical activity....

ORIGINAL ARTICLE: A Study of Sexuality and Health among Older Adults in the United States

Thu, 23Â AugÂ 2007 00:00:00 -05:00

Background: Despite the aging of the population, little is known about the sexual behaviors and sexual function of older people.

Methods: We report the prevalence of sexual activity, behaviors, and problems...

ORIGINAL ARTICLE: Complement C3 Variant and the Risk of Age-Related Macular Degeneration

Thu, 09Â AugÂ 2007 00:00:00 -05:00

Background: Age-related macular degeneration is the most common cause of blindness in Western populations. Susceptibility is influenced by age and by genetic and environmental factors. Complement activation is implicated in...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Changing the Trajectory of Cognitive Decline?

Marilyn S. Albert, Ph.D. — Thu, 02Â AugÂ 2007 00:00:00 -05:00

Delaying the onset of cognitive decline and reducing cognitive decline once it has begun have become increasingly important with the aging of the population. Age-related changes in cognitive functions such...

SPECIAL ARTICLE: Use of Health Services by Previously Uninsured Medicare Beneficiaries

Thu, 12Â JulÂ 2007 00:00:00 -05:00

Background: Previously uninsured adults who enroll in the Medicare program at the age of 65 years may have greater morbidity, requiring more intensive and costlier care over subsequent years, than...

CLINICAL PRACTICE: Osteopenia

Sundeep Khosla, M.D., and L. Joseph Melton III, M.D., M.P.H. — Thu, 31Â MayÂ 2007 00:00:00 -05:00

A 55-year-old asymptomatic woman, who is 5 years postmenopausal, is concerned about osteoporosis, since her mother had a hip fracture at the age of 70 years. The patient has no...

EDITORIAL: Clinical Trials in the Elderly â A Concept Comes of Age

Lillian L. Siu, M.D. — Thu, 12Â AprÂ 2007 00:00:00 -05:00

A well-conducted, randomized, controlled trial provides a high level of evidence to guide clinical management. Although this tenet is accepted in all fields of medicine, including oncology, considerable challenges are...

ORIGINAL ARTICLE: Radiotherapy for Glioblastoma in the Elderly

Thu, 12Â AprÂ 2007 00:00:00 -05:00

Background: There is no community standard for the treatment of glioblastoma in patients 70 years of age or older. We conducted a randomized trial that compared radiotherapy and supportive care...

CLINICAL PRACTICE: Management of Menopausal Symptoms

Deborah Grady, M.D., M.P.H. — Thu, 30Â NovÂ 2006 00:00:00 -05:00

A 51-year-old woman has frequent and distressing hot flushes that interfere with her work and sleep, and vaginal dryness that makes sexual intercourse with her husband uncomfortable. She is otherwise...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Stress, Aging, and Neurodegenerative Disease

Richard I. Morimoto, Ph.D. — Thu, 23Â NovÂ 2006 00:00:00 -05:00

Aging and stress, stress and aging â these two human conditions, when paired, can profoundly affect the quality of life. When events go awry, molecular processes take place that, over...

EDITORIAL: Aging and Fountain-of-Youth Hormones

Paul M. Stewart, M.D. — Thu, 19Â OctÂ 2006 00:00:00 -05:00

The search for eternal youth is vibrant in North America. In this search, it is all too easy to ascribe the aging process to endocrines. Although the secretion of growth...

IMAGES IN CLINICAL MEDICINE: Obturator Hernia

Daniel Kam Yin Chan, M.D., M.B., B.S. — Thu, 19Â OctÂ 2006 00:00:00 -05:00

A previously healthy 102-year-old woman was admitted with abdominal pain and a 3-day history of vomiting. She lived with relatives, but cared for herself, and was able to garden. There...

ORIGINAL ARTICLE: DHEA in Elderly Women and DHEA or Testosterone in Elderly Men

Thu, 19Â OctÂ 2006 00:00:00 -05:00

Background: Dehydroepiandrosterone (DHEA) and testosterone are widely promoted as antiaging supplements, but the long-term benefits, as compared with potential harm, are unknown.

Methods: We performed a 2-year, placebo-controlled, randomized, double-blind study...

EDITORIAL: Alzheimer's Disease â Clinical Trials and the Logic of Clinical Purpose

Jason Karlawish, M.D. — Thu, 12Â OctÂ 2006 00:00:00 -05:00

Agitation, aggression, delusions, and hallucinations are among the most common and disabling symptoms of Alzheimer's disease. These problems diminish the quality of life for both the patient and caregiver.1 They...

ORIGINAL ARTICLE: Effectiveness of Atypical Antipsychotic Drugs in Patients with Alzheimer's Disease

Thu, 12Â OctÂ 2006 00:00:00 -05:00

Background: Second-generation (atypical) antipsychotic drugs are widely used to treat psychosis, aggression, and agitation in patients with Alzheimer's disease, but their benefits are uncertain and concerns about safety have emerged....

EDITORIAL: A Very Effective Treatment for Neovascular Macular Degeneration

Edwin M. Stone, M.D., Ph.D. — Thu, 05Â OctÂ 2006 00:00:00 -05:00

Age-related macular degeneration, a potentially blinding disease, is now epidemic in the developed world. Roughly one in three people will be affected to some degree by the age of 75...

REVIEW ARTICLE: Age-Related Macular Degeneration

Paulus T.V.M. de Jong, M.D., Ph.D. — Thu, 05Â OctÂ 2006 00:00:00 -05:00

Since 1874, when it was first described in the medical literature as âsymmetrical central choroido-retinal disease occurring in senile persons,â1 age-related macular degeneration has also been referred to as senile,...

ORIGINAL ARTICLE: Ranibizumab versus Verteporfin for Neovascular Age-Related Macular Degeneration

Thu, 05Â OctÂ 2006 00:00:00 -05:00

Background: We compared ranibizumab â a recombinant, humanized, monoclonal antibody Fab that neutralizes all active forms of vascular endothelial growth factor A â with photodynamic therapy with verteporfin in the...

ORIGINAL ARTICLE: Ranibizumab for Neovascular Age-Related Macular Degeneration

Thu, 05Â OctÂ 2006 00:00:00 -05:00

Background: Ranibizumab â a recombinant, humanized, monoclonal antibody Fab that neutralizes all active forms of vascular endothelial growth factor A â has been evaluated for the treatment of neovascular age-related...

PERSPECTIVE: An Aging Un-American

Thu, 05Â OctÂ 2006 00:00:00 -05:00

My new patient barely returned my handshake. Instead, she hurried to the cramped center of the exam room and knelt on the yoga mat she had placed on the floor....

PERSPECTIVE: The Price of Sight â Ranibizumab, Bevacizumab, and the Treatment of Macular Degeneration

Thu, 05Â OctÂ 2006 00:00:00 -05:00

On June 30, 2006, the Food and Drug Administration (FDA) approved ranibizumab â which is manufactured by Genentech and marketed as Lucentis â for the treatment of neovascular age-related macular...

ORIGINAL ARTICLE: Overweight, Obesity, and Mortality in a Large Prospective Cohort of Persons 50 to 71 Years Old

Thu, 24Â AugÂ 2006 00:00:00 -05:00

Background: Obesity, defined by a body-mass index (BMI) (the weight in kilograms divided by the square of the height in meters) of 30.0 or more, is associated with an increased...

PERSPECTIVE: Overweight and Mortality among Baby Boomers â Now We're Getting Personal

Thu, 24Â AugÂ 2006 00:00:00 -05:00

I am a baby boomer, and my body-mass index (BMI) is 27.3. I am also an epidemiologist, so for both personal and professional reasons, I have closely followed the sometimes...

SPECIAL ARTICLE: Gradient of Disability across the Socioeconomic Spectrum in the United States

Thu, 17Â AugÂ 2006 00:00:00 -05:00

Background: Although the relationship between extreme poverty and poor health among older adults has long been recognized, less attention has been devoted to investigating whether a gradient in disability exists...

EDITORIAL: Vitamin B, Folic Acid, and the Prevention of Dementia

Robert Clarke, M.D. — Thu, 29Â JunÂ 2006 00:00:00 -05:00

Finding treatments for the prevention of dementia is an important challenge for medical research.1 Dementia currently affects about 4.5 million persons in the United States, and many more have cognitive...

ORIGINAL ARTICLE: A Controlled Trial of Homocysteine Lowering and Cognitive Performance

Thu, 29Â JunÂ 2006 00:00:00 -05:00

Background: The results of observational studies suggest that plasma homocysteine concentrations are inversely related to cognitive function in older people. Our objective was to test the hypothesis that lowering the...

IMAGES IN CLINICAL MEDICINE: Patent Ductus Arteriosus in an Elderly Man

Edsel Maurice T. Salvana, M.D. — Thu, 08Â JunÂ 2006 00:00:00 -05:00

An apparently healthy 62-year-old man was admitted because of a one-month history of progressive dyspnea on exertion. He reported leg edema, but no orthopnea or paroxysmal nocturnal dyspnea. On physical...

REVIEW ARTICLE: Bone Quality â The Material and Structural Basis of Bone Strength and Fragility

Ego Seeman, M.D., M.B., B.S., and Pierre D. Delmas, M.D., Ph.D. — Thu, 25Â MayÂ 2006 00:00:00 -05:00

Progress in understanding the pathogenesis of bone fragility is hampered by the inaccessibility of bone for investigation. Bone densitometry is an effective, noninvasive, and quantitative method for the assessment of...

ORIGINAL ARTICLE: Effect of Introduction of the Pneumococcal Conjugate Vaccine on Drug-Resistant

Thu, 06Â AprÂ 2006 00:00:00 -05:00

Background: Five of seven serotypes in the pneumococcal conjugate vaccine, introduced for infants in the United States in 2000, are responsible for most penicillin-resistant infections. We examined the effect of...

ORIGINAL ARTICLE: Prevalence of Monoclonal Gammopathy of Undetermined Significance

Thu, 30Â MarÂ 2006 00:00:00 -05:00

Background: The prevalence of monoclonal gammopathy of undetermined significance (MGUS), a premalignant plasma-cell disorder, among persons 50 years of age or older has not been accurately determined. We used sensitive...

ORIGINAL ARTICLE: Outpatient Gatifloxacin Therapy and Dysglycemia in Older Adults

Thu, 30Â MarÂ 2006 00:00:00 -05:00

Background: Gatifloxacin has been associated with both hypoglycemia and hyperglycemia. We examined dysglycemia-related health outcomes associated with various antibiotics in a population of approximately 1.4 million Ontario, Canada, residents 66...

IMAGES IN CLINICAL MEDICINE: Giant Ganglion Cyst

Neil J. Mortimer, M.R.C.P. and Graham A. Johnston, M.R.C.P. — Thu, 16Â MarÂ 2006 00:00:00 -05:00

A 90-year-old woman presented with a one-month history of a rapidly enlarging cystic lesion on the flexor aspect of her left fifth finger. The lesion was tender and caused impairment...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2006 â A 71-Year-Old Woman with Crohn's Disease and Altered Mental Status

Thu, 16Â MarÂ 2006 00:00:00 -05:00

A 71-year-old woman was admitted to the hospital because of left-sided weakness and a mass in the brain. She had had Crohn's disease for many years but was in her...

REVIEW ARTICLE: Delirium in Older Persons

Sharon K. Inouye, M.D., M.P.H. — Thu, 16Â MarÂ 2006 00:00:00 -05:00

Delirium, an acute decline in attention and cognition, is a common, life-threatening, and potentially preventable clinical syndrome among persons who are 65 years of age or older. The development of...

ORIGINAL ARTICLE: Maintenance Treatment of Major Depression in Old Age

Thu, 16Â MarÂ 2006 00:00:00 -05:00

Background: Elderly patients with major depression, including those having a first episode, are at high risk for recurrence of depression, disability, and death.

Methods: We tested the efficacy of maintenance paroxetine...

EDITORIAL: The Long and the Short of Bone Therapy

Michael P. Whyte, M.D. — Thu, 23Â FebÂ 2006 00:00:00 -05:00

In 2004, the Surgeon General's report on bone health highlighted osteoporosis as an important and growing national medical problem.1 The authors of this report recognized that identification and treatment of...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 6-2006 â A 71-Year-Old Woman with Urinary Incontinence and a Mass in the Bladder

Thu, 23Â FebÂ 2006 00:00:00 -05:00

Dr. Donald S. Kaufman: A 71-year-old woman was referred to this hospital for a second opinion on the management of a malignant tumor of the urinary bladder. Urinary incontinence had...

CLINICAL PRACTICE: Osteoarthritis of the Knee

David T. Felson, M.D., M.P.H. — Thu, 23Â FebÂ 2006 00:00:00 -05:00

A 66-year-old woman who is overweight reports bilateral knee pain of gradual onset during the past several months that increasingly has limited her activities. Last week, when walking down the...

ORIGINAL ARTICLE: Denosumab in Postmenopausal Women with Low Bone Mineral Density

Thu, 23Â FebÂ 2006 00:00:00 -05:00

Background: Receptor activator of nuclear factor-ÎºB ligand (RANKL) is essential for osteoclast differentiation, activation, and survival. The fully human monoclonal antibody denosumab (formerly known as AMG 162) binds RANKL with...

SPECIAL ARTICLE: Mortality after the Hospitalization of a Spouse

Nicholas A. Christakis, M.D., Ph.D., M.P.H., and Paul D. Allison, Ph.D. — Thu, 16Â FebÂ 2006 00:00:00 -05:00

Background: The illness of a spouse can affect the health of a caregiving partner. We examined the association between the hospitalization of a spouse and a partner's risk of death...

ORIGINAL ARTICLE: Saw Palmetto for Benign Prostatic Hyperplasia

Thu, 09Â FebÂ 2006 00:00:00 -05:00

Background: Saw palmetto is used by over 2 million men in the United States for the treatment of benign prostatic hyperplasia and is commonly recommended as an alternative to drugs...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Concentric Calcification

Dong Hoon Daniel Kim, M.D. and Victor L. Yu, M.D. — Thu, 02Â FebÂ 2006 00:00:00 -05:00

An elderly man reported having recurrent hematuria over a period of two years. He had undergone transurethral resection of the prostate because of benign prostatic hypertrophy two years earlier. He...

EDITORIAL: Maximizing the Success of Transplantation with Kidneys from Older Donors

Francis L. Delmonico and James F. Burdick — Thu, 26Â JanÂ 2006 00:00:00 -05:00

In this issue of the Journal, Remuzzi et al.1 report on the important challenge of maximizing success when transplanting kidneys from older donors while minimizing poor outcomes due to the...

ORIGINAL ARTICLE: Long-Term Outcome of Renal Transplantation from Older Donors

Thu, 26Â JanÂ 2006 00:00:00 -05:00

Background: Long-term survival of kidney grafts from older donors is inferior to that of grafts from younger donors. We sought to determine whether selecting older kidneys according to their histologic...

PERSPECTIVE: Promise and Perils for Patients and Physicians

Thu, 29Â DecÂ 2005 00:00:00 -05:00

On January 1, 2006, the Medicare Prescription Drug Improvement and Modernization Act (MMA) will become a fact of life for 42 million Medicare beneficiaries and their physicians. For the past...

PERSPECTIVE: A Prescription for a Modern Medicare Program

Thu, 29Â DecÂ 2005 00:00:00 -05:00

This year, Medicare introduced the prescription-drug benefit â the most significant change in Medicare coverage since the program's inception. As part of a broader strategy for ensuring that Medicare keeps...

IMAGES IN CLINICAL MEDICINE: Pemphigus Foliaceus

Sarah Johnston, M.R.C.P., M.R.C.Path. and Cameron Kennedy, F.R.C.P. — Thu, 15Â DecÂ 2005 00:00:00 -05:00

A 63-year-old man presented with a nine-year history of relapsing pemphigus foliaceus that had become refractory to therapy. After treatment with plasma exchange and oral corticosteroids, his disease flared in...

ORIGINAL ARTICLE: Risk of Death in Elderly Users of Conventional vs. Atypical Antipsychotic Medications

Thu, 01Â DecÂ 2005 00:00:00 -05:00

Background: Recently, the Food and Drug Administration (FDA) issued an advisory stating that atypical antipsychotic medications increase mortality among elderly patients. However, the advisory did not apply to conventional antipsychotic...

PERSPECTIVE: Observational Studies of Drugs and Mortality

Wayne A. Ray, Ph.D. — Thu, 01Â DecÂ 2005 00:00:00 -05:00

Randomized controlled trials of therapies for the primary and secondary prevention of cardiovascular disease increasingly are powered to study overall mortality. The interventions frequently treat asymptomatic risk factors among high-risk...

PERSPECTIVE: Aftershocks

Edward D. Frohlich, M.D., Ochsner Clinic Foundation, New Orleans — Thu, 13Â OctÂ 2005 00:00:00 -05:00

When Hurricane Katrina hit, my wife and I responded in a fashion common to many New Orleans residents: we âvertically evacuatedâ to the lower floors of one of the city's...

SOUNDING BOARD: Medicare and Cost-Effectiveness Analysis

Thu, 06Â OctÂ 2005 00:00:00 -05:00

The Medicare program has been a notable holdout in the global movement toward the use of cost-effectiveness analysis to inform health care decisions. Unlike the reimbursement authorities in Canada and...

REVIEW ARTICLE: Sick Chaperones, Cellular Stress, and Disease

Alberto J.L. Macario, M.D., and Everly Conway de Macario, Ph.D. — Thu, 06Â OctÂ 2005 00:00:00 -05:00

Cells maintain a complete set of functionally competent proteins normally and in the face of injury or stress with the use of various mechanisms, including systems of proteins called molecular...

EDITORIAL: Health Disparities â Less Talk, More Action

Nicole Lurie, M.D., M.S.P.H. — Thu, 18Â AugÂ 2005 00:00:00 -05:00

During the past decade, hundreds of articles have been published documenting the existence of racial and ethnic disparities in health and health care â a data deluge that has led...

SPECIAL ARTICLE: Trends in the Quality of Care and Racial Disparities in Medicare Managed Care

Thu, 18Â AugÂ 2005 00:00:00 -05:00

Background: Since 1997, all managed-care plans administered by Medicare have reported on quality-of-care measures from the Health Plan Employer Data and Information Set (HEDIS). Studies of early data found that...

SPECIAL ARTICLE: Racial Trends in the Use of Major Procedures among the Elderly

Thu, 18Â AugÂ 2005 00:00:00 -05:00

Background: Differences in the use of major procedures according to patients' race are well known. Whether national and local initiatives to reduce these differences have been successful is unknown.

Methods: We...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: An Aggrecanase and Osteoarthritis

Gerard Karsenty, M.D., Ph.D. — Thu, 04Â AugÂ 2005 00:00:00 -05:00

The study of degenerative diseases is often neglected by basic scientists, probably because these complicated pathophysiological conditions are considered to be mere consequences of aging. But there is an urgent...

EDITORIAL: Where Does Fitness Fit In?

William E. Kraus, M.D., and Pamela S. Douglas, M.D. — Thu, 04Â AugÂ 2005 00:00:00 -05:00

Cardiorespiratory fitness, as measured by a number of relatively simple and inexpensive clinical maneuvers, provides strong and independent prognostic information about the overall risk of illness and death, especially that...

ORIGINAL ARTICLE: The Prognostic Value of a Nomogram for Exercise Capacity in Women

Thu, 04Â AugÂ 2005 00:00:00 -05:00

Background: Recent studies have demonstrated that exercise capacity is an independent predictor of mortality in women. Normative values of exercise capacity for age in women have not been well established....

EDITORIAL: Pacemaker Selection â The Changing Definition of Physiologic Pacing

Kenneth A. Ellenbogen, M.D., and Mark A. Wood, M.D. — Thu, 14Â JulÂ 2005 00:00:00 -05:00

Almost 50 years after the first report of the use of cardiac pacing, in the Journal,1 pacing is playing an increasingly important role in the management of cardiac disease. Cardiologists...

CLINICAL PRACTICE: Screening for Osteoporosis

Lawrence G. Raisz, M.D. — Thu, 14Â JulÂ 2005 00:00:00 -05:00

At her annual visit, a 60-year-old woman asks her physician whether she should have a bone-density test to screen for osteoporosis. The patient went through menopause at age 52 and...

ORIGINAL ARTICLE: Single-Chamber versus Dual-Chamber Pacing for High-Grade Atrioventricular Block

Thu, 14Â JulÂ 2005 00:00:00 -05:00

Background: In the treatment of atrioventricular block, dual-chamber cardiac pacing is thought to confer a clinical benefit as compared with single-chamber ventricular pacing, but the supporting evidence is mainly from...

EDITORIAL: Mild Cognitive Impairment â No Benefit from Vitamin E, Little from Donepezil

Deborah Blacker, M.D., Sc.D. — Thu, 09Â JunÂ 2005 00:00:00 -05:00

In this issue of the Journal, Petersen et al. present the long-awaited results of a randomized, placebo-controlled trial of donepezil, a standard therapy for Alzheimer's disease, and the widely used...

ORIGINAL ARTICLE: Vitamin E and Donepezil for the Treatment of Mild Cognitive Impairment

Thu, 09Â JunÂ 2005 00:00:00 -05:00

Background: Mild cognitive impairment is a transitional state between the cognitive changes of normal aging and early Alzheimer's disease.

Methods: In a double-blind study, we evaluated subjects with the amnestic subtype...

EDITORIAL: VaricellaâZoster Virus Vaccine â Grown-ups Need It, Too

Donald H. Gilden, M.D. — Thu, 02Â JunÂ 2005 00:00:00 -05:00

A few years ago, I had zoster (shingles) â no surprise, since I was over 60 years of age, and zoster is usually a disease of later life. Fortunately, both...

ORIGINAL ARTICLE: A Vaccine to Prevent Herpes Zoster and Postherpetic Neuralgia in Older Adults

Thu, 02Â JunÂ 2005 00:00:00 -05:00

Background: The incidence and severity of herpes zoster and postherpetic neuralgia increase with age in association with a progressive decline in cell-mediated immunity to varicellaâzoster virus (VZV). We tested the...

PERSPECTIVE: Aging, Immunity, and the VaricellaâZoster Virus

Ann Arvin, M.D. — Thu, 02Â JunÂ 2005 00:00:00 -05:00

Older people and their physicians are all too well acquainted with herpes zoster â commonly called shingles, from the Latin cingulum, or âgirdle.â Most recognize that aging creates a special...

EDITORIAL: Chronic Kidney Disease in the Elderly â How to Assess Risk

Lesley A. Stevens, M.D., and Andrew S. Levey, M.D. — Thu, 19Â MayÂ 2005 00:00:00 -05:00

Chronic kidney disease is an important problem in the elderly and is associated with a high risk of kidney failure, cardiovascular disease, and death.12 The disorder is indicated either by...

ORIGINAL ARTICLE: Cystatin C and the Risk of Death and Cardiovascular Events among Elderly Persons

Thu, 19Â MayÂ 2005 00:00:00 -05:00

Background: 05051931.xml 05051931.xml Cystatin C is a serum measure of renal function that appears to be independent of age, sex, and lean muscle mass. We compared creatinine and cystatin C...

EDITORIAL: RSV Infection â Not for Kids Only

Sanjay Sethi, M.D., and Timothy F. Murphy, M.D. — Thu, 28Â AprÂ 2005 00:00:00 -05:00

It is ironic that respiratory syncytial virus (RSV) infection in adults, though recognized for several decades, has been overlooked, at least in part, because of the importance of RSV in...

ORIGINAL ARTICLE: Respiratory Syncytial Virus Infection in Elderly and High-Risk Adults

Thu, 28Â AprÂ 2005 00:00:00 -05:00

Background: Respiratory syncytial virus (RSV) is an increasingly recognized cause of illness in adults. Data on the epidemiology and clinical effects in community-dwelling elderly persons and high-risk adults can help...

SPECIAL REPORT: A Potential Decline in Life Expectancy in the United States in the 21st Century

Thu, 17Â MarÂ 2005 00:00:00 -05:00

Forecasts of life expectancy are an important component of public policy that influence age-based entitlement programs such as Social Security and Medicare. Although the Social Security Administration recently raised its...

EDITORIAL: Deadweight? â The Influence of Obesity on Longevity

Samuel H. Preston, Ph.D. — Thu, 17Â MarÂ 2005 00:00:00 -05:00

Obesity has clearly become a major personal and public health problem for Americans; it affects many aspects of our society. In this issue of the Journal, Olshansky et al.1 make...

ORIGINAL ARTICLE: Family-Based Association between Alzheimer's Disease and Variants in

Thu, 03Â MarÂ 2005 00:00:00 -05:00

Background: Recent analyses suggest that the known Alzheimer's disease genes account for less than half the genetic variance in this disease. The gene encoding ubiquilin 1 (UBQLN1) is one of...

PERSPECTIVE: Genetic Factors in Alzheimer's Disease

Thomas D. Bird, M.D. — Thu, 03Â MarÂ 2005 00:00:00 -05:00

Nearly 100 years ago, Alois Alzheimer described the clinical and pathological characteristics of a 50-year-old woman with the dementing illness that now bears his name.1 She had no family history...

PERSPECTIVE: Geriatrics in the United States â Baby Boomers' Boon?

Leslie S. Libow, M.D. — Thu, 24Â FebÂ 2005 00:00:00 -05:00

The graying of America, a triumph of medical and cultural advances, has caught us unprepared. Our economic system, burdened with Social Security, Medicare, and extended retirement years, is shaking. Our...

REVIEW ARTICLE: Memory Dysfunction

Andrew E. Budson, M.D., and Bruce H. Price, M.D. — Thu, 17Â FebÂ 2005 00:00:00 -05:00

Memory function is vulnerable to a variety of pathologic processes including neurodegenerative diseases, strokes, tumors, head trauma, hypoxia, cardiac surgery, malnutrition, attention-deficit disorder, depression, anxiety, the side effects of medication,...

EDITORIAL: Alcohol Consumption and Cognition

Denis A. Evans, M.D., and Julia L. Bienias, Sc.D. — Thu, 20Â JanÂ 2005 00:00:00 -05:00

Loss of cognitive function in old age, especially severe cognitive loss due to Alzheimer's disease, is a serious public health problem that will only increase as the number of people...

ORIGINAL ARTICLE: Effects of Moderate Alcohol Consumption on Cognitive Function in Women

Thu, 20Â JanÂ 2005 00:00:00 -05:00

Background: The adverse effects of excess alcohol intake on cognitive function are well established, but the effect of moderate consumption is uncertain.

Methods: Between 1995 and 2001, we evaluated cognitive function...

EDITORIAL: A New Treatment for Ocular Neovascularization

Frederick L. Ferris III, M.D. — Thu, 30Â DecÂ 2004 00:00:00 -05:00

Neovascularization leads to blindness in a large number of ocular disorders, most notably age-related macular degeneration, diabetic retinopathy, retinopathy of prematurity, and other vascular occlusive diseases. Various versions of scatter-photocoagulation...

ORIGINAL ARTICLE: Pegaptanib for Neovascular Age-Related Macular Degeneration

Thu, 30Â DecÂ 2004 00:00:00 -05:00

Background: Pegaptanib, an antiâvascular endothelial growth factor therapy, was evaluated in the treatment of neovascular age-related macular degeneration.

Methods: We conducted two concurrent, prospective, randomized, double-blind, multicenter, dose-ranging, controlled clinical trials...

PERSPECTIVE: Advanced Maternal Age â How Old Is Too Old?

Linda J. Heffner, M.D., Ph.D. — Thu, 04Â NovÂ 2004 00:00:00 -05:00

The past decade has seen a remarkable shift in the demographics of childbearing in the United States. The number of first births per 1000 women 35 to 39 years of...

PERSPECTIVE: Financing Medicare in the Next Administration

Joseph P. Newhouse, Ph.D. — Thu, 21Â OctÂ 2004 00:00:00 -05:00

Because of its size and political impact, Medicare will rank high on the domestic policy agenda of any incoming administration. When that administration assumes office in January 2005, Medicare will...

ORIGINAL ARTICLE: Lumpectomy plus Tamoxifen with or without Irradiation in Women 70 Years of Age or Older with Early Breast Cancer

Thu, 02Â SepÂ 2004 00:00:00 -05:00

Background: In women 70 years of age or older who have early breast cancer, it is unclear whether lumpectomy plus tamoxifen is as effective as lumpectomy followed by tamoxifen plus...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2004 â A 79-Year-Old Woman with Disturbances in Gait, Cognition, and Autonomic Function

Thu, 26Â AugÂ 2004 00:00:00 -05:00

A 79-year-old woman was evaluated in a neurology clinic because of difficulty walking and cognitive changes.

The patient had been well until 18 months earlier, when she began to fall occasionally....

ORIGINAL ARTICLE: Missense Variations in the Fibulin 5 Gene and Age-Related Macular Degeneration

Thu, 22Â JulÂ 2004 00:00:00 -05:00

Background: Age-related macular degeneration (AMD) is the most common cause of irreversible vision loss in the developed world. The study of a rare mendelian form of macular degeneration implicated fibulin...

PERSPECTIVE: Age-Related Macular Degeneration and the Extracellular Matrix

Lincoln V. Johnson, Ph.D., and Don H. Anderson, Ph.D. — Thu, 22Â JulÂ 2004 00:00:00 -05:00

Macular degeneration is a class of blinding disorders characterized by changes in the macula, the central area of the neural retina that is responsible for high-acuity vision (see Figure 1)....

REVIEW ARTICLE: Alzheimer's Disease

Jeffrey L. Cummings, M.D. — Thu, 01Â JulÂ 2004 00:00:00 -05:00

Alzheimer's disease is a progressive and fatal neurodegenerative disorder manifested by cognitive and memory deterioration, progressive impairment of activities of daily living, and a variety of neuropsychiatric symptoms and behavioral...

CLINICAL PRACTICE: Palliative Care

R. Sean Morrison, M.D., and Diane E. Meier, M.D. — Thu, 17Â JunÂ 2004 00:00:00 -05:00

An 85-year-old man with New York Heart Association class IV heart failure, hypertension, and moderate Alzheimer's disease is admitted to the hospital after a hip fracture. His postoperative course is...

IMAGES IN CLINICAL MEDICINE: A Calcified Pelvic Mass

Friedrich Koehler, M.D. and Dietmar Kivelitz, M.D. — Thu, 03Â JunÂ 2004 00:00:00 -05:00

An 88-year-old woman who had been found on the floor next to her wheelchair in the nursing home was referred to our institution because of upper gastrointestinal bleeding. On physical...

CLINICAL PROBLEM-SOLVING: Forgotten but Not Gone

Ashish K. Jha, M.D., Kaveh G. Shojania, M.D., and Sanjay Saint, M.D., M.P.H. — Thu, 03Â JunÂ 2004 00:00:00 -05:00

A 74-year-old man was brought to the emergency department after being found confused and incapacitated at home. The patient lived in a residential hotel and had previously been healthy and...

SOUNDING BOARD: Medicare Coverage for Technological Innovations â Time for New Criteria?

Muriel R. Gillick, M.D. — Thu, 20Â MayÂ 2004 00:00:00 -05:00

While Congress was publicly debating a prescription-drug benefit for older patients last year, the Medicare program quietly announced plans to provide coverage for three invasive, high-cost procedures that potentially could...

EDITORIAL: Why Medicare Has Not Established Criteria for Coverage Decisions

Sean R. Tunis, M.D. — Thu, 20Â MayÂ 2004 00:00:00 -05:00

Decisions about medical coverage by Medicare specify the forms of technology and services that the program will pay for on behalf of its 42 million beneficiaries. These decisions often have...

ORIGINAL ARTICLE: Homocysteine as a Predictive Factor for Hip Fracture in Older Persons

Thu, 13Â MayÂ 2004 00:00:00 -05:00

Background: The increased prevalence of osteoporosis among people with homocystinuria suggests that a high serum homocysteine concentration may weaken bone by interfering with collagen cross-linking, thereby increasing the risk of...

ORIGINAL ARTICLE: Homocysteine Levels and the Risk of Osteoporotic Fracture

Thu, 13Â MayÂ 2004 00:00:00 -05:00

Background: Very high plasma homocysteine levels are characteristic of homocystinuria, a rare autosomal recessive disease accompanied by the early onset of generalized osteoporosis. We therefore hypothesized that mildly elevated homocysteine...

CLINICAL PRACTICE: Treatment of Photoaging

Robert S. Stern, M.D. — Thu, 08Â AprÂ 2004 00:00:00 -05:00

A 45-year-old fair-skinned woman has noted increasing sallowness, roughness, fine wrinkles, and mottled hyperpigmentation on her face. She is bothered by these changes and is worried about the development of...

HEALTH POLICY REPORT: The New Medicare Prescription-Drug Benefit â A Pure Power Play

John K. Iglehart — Thu, 19Â FebÂ 2004 00:00:00 -05:00

Every so often, U.S. presidents pursue goals that turn the political orthodoxy of the time on its head. Memorable modern examples include the historic move by Richard M. Nixon to...

REVIEW ARTICLE: Management of Overactive Bladder

Joseph G. Ouslander, M.D. — Thu, 19Â FebÂ 2004 00:00:00 -05:00

Overactive bladder is a symptom complex that includes urinary urgency with or without urge incontinence, urinary frequency (voiding eight or more times in a 24-hour period), and nocturia (awakening two...

PERSPECTIVE:

Sen. Edward M. KennedyRep. Bill Thomas — Thu, 19Â FebÂ 2004 00:00:00 -05:00

The Republican Medicare bill is wrong for senior citizens, wrong for Medicare, and wrong for the country. Its inadequate and badly designed drug benefit is a Trojan horse created with...

REVIEW ARTICLE: Risks of Testosterone-Replacement Therapy and Recommendations for Monitoring

Ernani Luis Rhoden, M.D., and Abraham Morgentaler, M.D. — Thu, 29Â JanÂ 2004 00:00:00 -05:00

Hypogonadism is a clinical condition in which low levels of serum testosterone are found in association with specific signs and symptoms, including diminished libido and sense of vitality, erectile dysfunction,...

PERSPECTIVE: Hypogonadism in Elderly Men â What to Do Until the Evidence Comes

Peter J. Snyder, M.D. — Thu, 29Â JanÂ 2004 00:00:00 -05:00

Testosterone treatment for elderly men made the news again recently, when the Institute of Medicine Committee on Assessing the Need for Clinical Trials of Testosterone Replacement Therapy issued its long-awaited...

SPECIAL ARTICLE: Use of High-Cost Operative Procedures by Medicare Beneficiaries Enrolled in For-Profit and Not-for-Profit Health Plans

Eric C. Schneider, M.D., Alan M. Zaslavsky, Ph.D., and Arnold M. Epstein, M.D. — Thu, 08Â JanÂ 2004 00:00:00 -05:00

Background: It is widely believed that for-profit health plans are more likely than not-for-profit health plans to respond to financial incentives by restricting access to care, especially access to high-cost...

PERSPECTIVE: Advance Care Planning

Muriel R. Gillick, M.D. — Thu, 01Â JanÂ 2004 00:00:00 -05:00

One hundred years ago, the odds that a visit to the doctor would result in a measurable improvement in a patient's condition were slim. But the mere fact that modern...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 37-2003 â A 79-Year-Old Man with Coronary Artery Disease, Peripheral Vascular Disease, End-Stage Renal Disease, and Abdominal Pain and Distention

Peter B. Kelsey, M.D., Steven Chen, M.D., and Gregory Y. Lauwers, M.D. — Thu, 27Â NovÂ 2003 00:00:00 -05:00

A 79-year-old man was admitted to the hospital because of occlusion at a vascular access site in the right forearm for hemodialysis and worsening intermittent claudication.

There was a history of...

ORIGINAL ARTICLE: Lp(a) Lipoprotein, Vascular Disease, and Mortality in the Elderly

Thu, 27Â NovÂ 2003 00:00:00 -05:00

Background: As compared with what is known about predictors of vascular events in middle-aged persons, less is known about these events in the elderly. Lp(a) lipoprotein, which plays an important...

SPECIAL ARTICLE: End-of-Life Care and the Effects of Bereavement on Family Caregivers of Persons with Dementia

Thu, 13Â NovÂ 2003 00:00:00 -05:00

Background: Although family caregiving has been intensively studied in the past decade, little attention has been paid to the impact of end-of-life care on caregivers who are family members of...

IMAGES IN CLINICAL MEDICINE: Arthritis Mutilans

Robert Monger, M.D. and Virginia Hrywnak, D.O. — Thu, 13Â NovÂ 2003 00:00:00 -05:00

A 94-year-old woman had rheumatoid arthritis that was diagnosed when she was 8 years old. She had not sought treatment for arthritis until she was in her 60s, and by...

PERSPECTIVE: Costs to Society of Family Caregiving for Patients with End-Stage Alzheimer's Disease

Holly G. Prigerson, Ph.D. — Thu, 13Â NovÂ 2003 00:00:00 -05:00

Recent estimates indicate that the prevalence of Alzheimer's disease is increasing at an alarming rate, and with that increase comes a dramatic upsurge in the cost of this disease to...

PERSPECTIVE: Tools of the Trade

Danielle Ofri, M.D., Ph.D. — Thu, 30Â OctÂ 2003 00:00:00 -05:00

I grasped the list of patients, fingering the crispness of the sheet that represented my first day of service on the medical wards. I knew that the sheet would soon...

SPECIAL ARTICLE: Hospital Use and Survival among Veterans Affairs Beneficiaries

Thu, 23Â OctÂ 2003 00:00:00 -05:00

Background: Initiatives to reduce hospital care were part of the reorganization of the Department of Veterans Affairs (VA) medical care system undertaken in the mid-1990s. We examined changes in the...

REVIEW ARTICLE: Primary Progressive Aphasia â A Language-Based Dementia

M.-Marsel Mesulam, M.D. — Thu, 16Â OctÂ 2003 00:00:00 -05:00

Dementia is a generic term used to designate chronically progressive brain disease that impairs intellect and behavior to the point where customary activities of daily living become compromised.12 In some...

SPECIAL ARTICLE: Racial, Ethnic, and Geographic Disparities in Rates of Knee Arthroplasty among Medicare Patients

Thu, 02Â OctÂ 2003 00:00:00 -05:00

Background: There are large variations in the use of knee arthroplasty among Medicare enrollees according to race or ethnic group and sex. Are racial and ethnic disparities more pronounced in...

EDITORIAL: Disability and the Future of Medicare

David M. Cutler, Ph.D. — Thu, 11Â SepÂ 2003 00:00:00 -05:00

The forecast aging of the United States â the doubling of the share of the population over 65 years of age in the next 75 years1 â will have profound...

CLINICAL PRACTICE: Early Alzheimer's Disease

Claudia H. Kawas, M.D. — Thu, 11Â SepÂ 2003 00:00:00 -05:00

A 72-year-old, college-educated woman comes in for the evaluation of mild memory loss that has been gradually progressing for the past two years. The patient lives alone, drives her own...

SPECIAL ARTICLE: Health, Life Expectancy, and Health Care Spending among the Elderly

Thu, 11Â SepÂ 2003 00:00:00 -05:00

Background: Life expectancy among the elderly has been improving for many decades, and there is evidence that health among the elderly is also improving. We estimated the relation of health...

CLINICAL PRACTICE: Care of Patients Receiving Long-Term Anticoagulant Therapy

Sam Schulman, M.D. — Thu, 14Â AugÂ 2003 00:00:00 -05:00

A 75-year-old man with diabetes mellitus is found to have chronic atrial fibrillation, and warfarin therapy is begun for the prevention of thromboembolic stroke. How should the anticoagulant therapy be...

CLINICAL PROBLEM-SOLVING: A Wrinkle in Time

Sigall Kassutto, M.D., and Marshall A. Wolf, M.D. — Thu, 07Â AugÂ 2003 00:00:00 -05:00

An 86-year-old man presented with abdominal discomfort and fever. His medical history was notable for long-standing hypertension, mild chronic renal insufficiency, coronary-artery bypass surgery, and abdominal-aortic-aneurysm repair seven years earlier,...

SPECIAL ARTICLE: Nurses' Experiences with Hospice Patients Who Refuse Food and Fluids to Hasten Death

Thu, 24Â JulÂ 2003 00:00:00 -05:00

Background: Voluntary refusal of food and fluids has been proposed as an alternative to physician-assisted suicide for terminally ill patients who wish to hasten death. There are few reports of...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2003 â A 72-Year-Old Man with Repetitive Strokes in the Posterior Circulation

Thu, 10Â JulÂ 2003 00:00:00 -05:00

A 72-year-old, right-handed man was admitted to the hospital because of recurrent neurologic symptoms.

The patient had been well until 10 days earlier, when he briefly had numbness of the right...

ORIGINAL ARTICLE: Leisure Activities and the Risk of Dementia in the Elderly

Thu, 19Â JunÂ 2003 00:00:00 -05:00

Background: Participation in leisure activities has been associated with a lower risk of dementia. It is unclear whether increased participation in leisure activities lowers the risk of dementia or participation...

PERSPECTIVE: Use It or Lose It â Do Effortful Mental Activities Protect against Dementia?

Joseph T. Coyle, M.D. — Thu, 19Â JunÂ 2003 00:00:00 -05:00

The past 15 years, since the cloning of the gene for amyloid precursor protein, have witnessed breathtaking advances in our understanding of the pathophysiology of Alzheimer's disease, the most common...

ORIGINAL ARTICLE: Effectiveness of Pneumococcal Polysaccharide Vaccine in Older Adults

Thu, 01Â MayÂ 2003 00:00:00 -05:00

Background: Streptococcus pneumoniae is the chief cause of pneumonia in older adults, but it remains unclear whether use of the pneumococcal polysaccharide vaccine alters the overall risk of community-acquired pneumonia....

REVIEW ARTICLE: Alzheimer's Disease and Parkinson's Disease

Robert L. Nussbaum, M.D., and Christopher E. Ellis, Ph.D. — Thu, 03Â AprÂ 2003 00:00:00 -05:00

The incidence of many common diseases is increased among the relatives of affected patients, but the pattern of inheritance rarely follows Mendel's laws. Instead, such common diseases are thought to...

ORIGINAL ARTICLE: Memantine in Moderate-to-Severe Alzheimer's Disease

Thu, 03Â AprÂ 2003 00:00:00 -05:00

Background: Overstimulation of the N-methyl-D-aspartate (NMDA) receptor by glutamate is implicated in neurodegenerative disorders. Accordingly, we investigated memantine, an NMDA antagonist, for the treatment of Alzheimer's disease.

Methods: Patients with moderate-to-severe...

ORIGINAL ARTICLE: Influenza Vaccination and Reduction in Hospitalizations for Cardiac Disease and Stroke among the Elderly

Thu, 03Â AprÂ 2003 00:00:00 -05:00

Background: Upper respiratory tract illnesses have been associated with an increased risk of ischemic heart disease and stroke. During two influenza seasons, we assessed the influence of vaccination against influenza...

EDITORIAL: âSilentâ Strokes and Dementia

John P. Blass, M.D., Ph.D., and Rajiv R. Ratan, M.D., Ph.D. — Thu, 27Â MarÂ 2003 00:00:00 -05:00

An epidemiologic study by Vermeer et al. in this issue of the Journal indicates that âsilentâ strokes are a risk factor for dementia.1 Recurrent strokes during the three to four...

ORIGINAL ARTICLE: Silent Brain Infarcts and the Risk of Dementia and Cognitive Decline

Thu, 27Â MarÂ 2003 00:00:00 -05:00

Background: Silent brain infarcts are frequently seen on magnetic resonance imaging (MRI) in healthy elderly people and may be associated with dementia and cognitive decline.

Methods: We studied the association between...

PERSPECTIVE: Can Growth Hormone Prevent Aging?

Mary Lee Vance, M.D. — Thu, 27Â FebÂ 2003 00:00:00 -05:00

Does growth hormone prevent aging? An article by Rudman et al. that appeared in the Journal in 19901 reported the effect on body composition of administering human growth hormone for...

ORIGINAL ARTICLE: A Comparison of Outcomes with Angiotensin-ConvertingâEnzyme Inhibitors and Diuretics for Hypertension in the Elderly

Thu, 13Â FebÂ 2003 00:00:00 -05:00

Background: Treatment of hypertension with diuretics, beta-blockers, or both leads to improved outcomes. It has been postulated that agents that inhibit the reninâangiotensin system confer benefit beyond the reduction of...

CLINICAL PRACTICE: Preventing Falls in Elderly Persons

Mary E. Tinetti, M.D. — Thu, 02Â JanÂ 2003 00:00:00 -05:00

A 79-year-old woman with a history of congestive heart failure, arthritis, depression, and difficulty sleeping presents for a follow-up visit. She takes several prescription medications, including an antidepressant, a diuretic,...

ORIGINAL ARTICLE: Abnormality of Gait as a Predictor of Non-Alzheimer's Dementia

Thu, 28Â NovÂ 2002 00:00:00 -05:00

Background: Neurologic abnormalities affecting gait occur early in several types of non-Alzheimer's dementias, but their value in predicting the development of dementia is uncertain.

Methods: We analyzed the relation between neurologic...

SPECIAL ARTICLE: Specialty of Ambulatory Care Physicians and Mortality among Elderly Patients after Myocardial Infarction

Thu, 21Â NovÂ 2002 00:00:00 -05:00

Background: The outcome after myocardial infarction may be influenced by the type of physician providing ambulatory care.

Methods: We studied 35,520 patients 65 years of age or older who were hospitalized...

ORIGINAL ARTICLE: A Program to Prevent Functional Decline in Physically Frail, Elderly Persons Who Live at Home

Thu, 03Â OctÂ 2002 00:00:00 -05:00

Background: Functional decline in physically frail, elderly persons is associated with substantial morbidity. It is uncertain whether such functional decline can be prevented.

Methods: We randomly assigned 188 persons 75 years...

REVIEW ARTICLE: Tinnitus

Alan H. Lockwood, M.D., Richard J. Salvi, Ph.D., and Robert F. Burkard, Ph.D. — Thu, 19Â SepÂ 2002 00:00:00 -05:00

Tinnitus is a common yet poorly understood disorder. Data from the National Center for Health Statistics show that tinnitus is more common in men than women and increases in prevalence...

REVIEW ARTICLE: Polymyalgia Rheumatica and Giant-Cell Arteritis

Thu, 25Â JulÂ 2002 00:00:00 -05:00

Polymyalgia rheumatica and giant-cell arteritis are closely related conditions that affect persons of middle age and older and frequently occur together. Many authorities consider them to be different phases of...

REVIEW ARTICLE: Heat Stroke

Abderrezak Bouchama, M.D., and James P. Knochel, M.D. — Thu, 20Â JunÂ 2002 00:00:00 -05:00

Heat stroke is a life-threatening illness characterized by an elevated core body temperature that rises above 40Â°C and central nervous system dysfunction that results in delirium, convulsions, or coma.1 02062024.xml...

EDITORIAL: Autonomy Reconsidered

Thu, 04Â AprÂ 2002 00:00:00 -05:00

In 2001, 50 percent of deaths of Medicare beneficiaries occurred in hospitals, often after stays in intensive care units, visits to multiple physicians in the months before death, and enormous...

SPECIAL ARTICLE: Understanding the Treatment Preferences of Seriously Ill Patients

Thu, 04Â AprÂ 2002 00:00:00 -05:00

Background: The questions patients are asked about their preferences with regard to life-sustaining treatment usually focus on specific interventions, but the outcomes of treatment and their likelihood affect patients' preferences.

Methods:...

PERSPECTIVE: The Ethics of Partial-Liver Donation

Thu, 04Â AprÂ 2002 00:00:00 -05:00

Living donors have participated in solid-organ transplantation throughout the 48 years since Dr. Joseph Murray successfully performed kidney transplantation between identical twins. Kidney transplantation from living, unrelated donors is no...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 9-2002 â An 80-Year-Old Woman with Sudden Unilateral Blindness

Don C. Bienfang and Diane Karluk — Thu, 21Â MarÂ 2002 00:00:00 -05:00

An 80-year-old woman was admitted to the hospital because of sudden unilateral blindness.

The patient had a long history of medical problems. These included hypertension; mitral and tricuspid regurgitation, which had...

SPECIAL ARTICLE: A Controlled Trial of Inpatient and Outpatient Geriatric Evaluation and Management

Thu, 21Â MarÂ 2002 00:00:00 -05:00

Background: Over the past 20 years, both inpatient units and outpatient clinics have developed programs for geriatric evaluation and management. However, the effects of these interventions on survival and functional...

PERSPECTIVE: Specialized Care for Elderly Patients

Thu, 21Â MarÂ 2002 00:00:00 -05:00

Twenty-five years ago, the specialty of geriatrics barely existed in American medicine. There was, however, a growing awareness that increasing numbers of people in developed countries were living into their...

EDITORIAL: Controlling Spending for Prescription Drugs

Thu, 14Â MarÂ 2002 00:00:00 -05:00

It is not surprising that spending for prescription drugs is the fastest-growing component of health care in the United States. Just 12 years ago, prescription drugs accounted for 6 percent...

SPECIAL ARTICLE: Compliance among Pharmacies in California with a Prescription-Drug Discount Program for Medicare Beneficiaries

Thu, 14Â MarÂ 2002 00:00:00 -05:00

Background: Several states have developed prescription-drug discount programs for Medicare beneficiaries. In California, Senate Bill 393, enacted in 1999, requires pharmacies participating in the state Medicaid program (Medi-Cal) to charge...

PERSPECTIVE: The Prescription-Drug Problem

Thu, 14Â MarÂ 2002 00:00:00 -05:00

The soaring cost of prescription drugs has caused two interrelated problems â the expense for those who can afford to pay for them and the limited access to medications for...

ORIGINAL ARTICLE: A Long-Term Study of Prognosis in Monoclonal Gammopathy of Undetermined Significance

Thu, 21Â FebÂ 2002 00:00:00 -05:00

Background: A monoclonal gammopathy of undetermined significance (MGUS) occurs in up to 2 percent of persons 50 years of age or older. Reliable predictors of progression have not been identified,...

ORIGINAL ARTICLE: Plasma Homocysteine as a Risk Factor for Dementia and Alzheimer's Disease

Thu, 14Â FebÂ 2002 00:00:00 -05:00

Background: 02021427.xml In cross-sectional studies, elevated plasma homocysteine levels have been associated with poor cognition and dementia. Studies of newly diagnosed dementia are required in order to establish whether the...

ORIGINAL ARTICLE: CHOP Chemotherapy plus Rituximab Compared with CHOP Alone in Elderly Patients with Diffuse Large-B-Cell Lymphoma

Thu, 24Â JanÂ 2002 00:00:00 -05:00

Background: The standard treatment for patients with diffuse large-B-cell lymphoma is cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). Rituximab, a chimeric monoclonal antibody against the CD20 B-cell antigen, has therapeutic activity...

EDITORIAL: Do Nonsteroidal Antiinflammatory Drugs Reduce the Risk of Alzheimer's Disease?

Thu, 22Â NovÂ 2001 00:00:00 -05:00

In this issue of the Journal, in 't Veld and colleagues1 report the results of a long-term prospective study of the relation between the use of nonsteroidal antiinflammatory drugs (NSAIDs)...

ORIGINAL ARTICLE: Nonsteroidal Antiinflammatory Drugs and the Risk of Alzheimer's Disease

Thu, 22Â NovÂ 2001 00:00:00 -05:00

Background: Previous studies have suggested that the use of nonsteroidal antiinflammatory drugs (NSAIDs) may help to prevent Alzheimer's disease. The results, however, have been inconsistent.

Methods: We studied the association between...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2001 â An 81-Year-Old Man with Hypothermia, Bradycardia, and Confusion

Steven K. Grinspoon and E. Tessa Hedley-White — Thu, 15Â NovÂ 2001 00:00:00 -05:00

An 81-year-old man was transferred to the hospital because of bradycardia, hypothermia, and increasing confusion.

A platelet count of 85,000 per cubic millimeter had been discovered five years before admission, but...

EDITORIAL: Anemia, Transfusion, and Mortality

Thu, 25Â OctÂ 2001 00:00:00 -05:00

Questions surrounding the risks and costs associated with blood transfusion have led to a reevaluation of clinical transfusion practices during the past 15 years.1 Guidelines for blood transfusion have been...

ORIGINAL ARTICLE: Blood Transfusion in Elderly Patients with Acute Myocardial Infarction

Thu, 25Â OctÂ 2001 00:00:00 -05:00

Background: Anemia may have adverse effects in patients with coronary artery disease. However, the benefit of blood transfusion in elderly patients with acute myocardial infarction and various degrees of anemia...

EDITORIAL: Older Age â Not a Barrier to Cancer Treatment

Thu, 11Â OctÂ 2001 00:00:00 -05:00

More than half of all new cancers in the United States occur in patients 65 years of age or older.1 The incidence of cancer in this age group is 11...

SPECIAL ARTICLE: Lack of Health Insurance and Decline in Overall Health in Late Middle Age

Thu, 11Â OctÂ 2001 00:00:00 -05:00

Background: The number of adults in their 50s and 60s in the United States who do not have health insurance is increasing. This group may be particularly vulnerable to the...

ORIGINAL ARTICLE: A Pooled Analysis of Adjuvant Chemotherapy for Resected Colon Cancer in Elderly Patients

Thu, 11Â OctÂ 2001 00:00:00 -05:00

Background: Adjuvant chemotherapy is standard treatment for patients with resected colon cancer who are at high risk for recurrence, but the efficacy and toxicity of such treatment in patients more...

EDITORIAL: Can Estrogen or Selective Estrogen-Receptor Modulators Preserve Cognitive Function in Elderly Women?

Thu, 19Â AprÂ 2001 00:00:00 -05:00

The use of estrogen-replacement therapy has been associated with a lower risk of Alzheimer's disease1 and preserved or enhanced cognitive performance in postmenopausal women.2 Despite the consistency of these observations,...

ORIGINAL ARTICLE: Cognitive Function in Postmenopausal Women Treated with Raloxifene

Thu, 19Â AprÂ 2001 00:00:00 -05:00

Background: In postmenopausal women, estrogen may have a beneficial effect on cognition or reduce the risk of decline in cognitive function. Whether raloxifene, a selective estrogen-receptor modulator, might have similar...

EDITORIAL: Aging and the Public Health Effects of Dementia

Thu, 12Â AprÂ 2001 00:00:00 -05:00

Dementia, and Alzheimer's disease in particular, is one of the principal causes of disability and decreased quality of life among the elderly and a leading obstacle to successful aging.12 In...

ORIGINAL ARTICLE: A Reevaluation of the Duration of Survival after the Onset of Dementia

Thu, 12Â AprÂ 2001 00:00:00 -05:00

Background: Dementia shortens life expectancy; estimates of median survival after the onset of dementia have ranged from 5 to 9.3 years. Previous studies of people with existing dementia, however, may...

ORIGINAL ARTICLE: Effect of Risedronate on the Risk of Hip Fracture in Elderly Women

Thu, 01Â FebÂ 2001 00:00:00 -05:00

Background: Risedronate increases bone mineral density in elderly women, but whether it prevents hip fracture is not known.

Methods: We studied 5445 women 70 to 79 years old who had osteoporosis...

SPECIAL ARTICLE: Outcome of Myocardial Infarction in Veterans Health Administration Patients as Compared with Medicare Patients

Thu, 28Â DecÂ 2000 00:00:00 -05:00

Background: Some have the opinion that patients cared for in Veterans Health Administration (VHA) hospitals receive care of poorer quality than those cared for in non-VHA institutions. To assess the...

EDITORIAL: Hip Protectors â A Breakthrough in Fracture Prevention

Thu, 23Â NovÂ 2000 00:00:00 -05:00

Hip fractures are one of the most devastating and costly problems commonly faced by elderly people. Each year in the United States, more than 300,000 people 65 years old or...

ORIGINAL ARTICLE: Prevention of Hip Fracture in Elderly People with Use of a Hip Protector

Thu, 23Â NovÂ 2000 00:00:00 -05:00

Background: Hip fractures are common in frail elderly adults worldwide. We investigated the effect of an anatomically designed external hip protector on the risk of these age-related fractures.

Methods: We randomly...

EDITORIAL: Detection of Preclinical Alzheimer's Disease

Thu, 17Â AugÂ 2000 00:00:00 -05:00

Alzheimer's disease is a chronic disorder with a gradual onset and slowly progressive course that is characterized by an inevitable deterioration in cognitive function. To develop new methods to prevent...

ORIGINAL ARTICLE: Patterns of Brain Activation in People at Risk for Alzheimer's Disease

Thu, 17Â AugÂ 2000 00:00:00 -05:00

Background: The Îµ4 allele of the apolipoprotein E gene (APOE) is the chief known genetic risk factor for Alzheimer's disease, the most common cause of dementia late in life. To...

ORIGINAL ARTICLE: Genetic and Environmental Factors in Age-Related Nuclear Cataracts in Monozygotic and Dizygotic Twins

Thu, 15Â JunÂ 2000 00:00:00 -05:00

Background: Age-related cataracts are a major public health problem. The relative importance of genes and environment in the causation of nuclear cataracts, the most common form of age-related cataracts, is...

ORIGINAL ARTICLE: Hemodynamic Effects of Sildenafil in Men with Severe Coronary Artery Disease

Thu, 01Â JunÂ 2000 00:00:00 -05:00

Background: The cardiovascular effects of sildenafil are important because of the frequent presence of underlying cardiac disease in men with erectile dysfunction and reports indicating serious cardiac events temporally associated...

SPECIAL ARTICLE: The Effect of Longevity on Spending for Acute and Long-Term Care

Brenda C. Spillman, Ph.D., and James Lubitz, M.P.H. — Thu, 11Â MayÂ 2000 00:00:00 -05:00

Background: The proportion of the population made up of elderly persons in the United States is projected to increase from 13 percent of the population in 2000 to 20 percent...

SOUNDING BOARD: Death and the Research Imperative

Thu, 02Â MarÂ 2000 00:00:00 -05:00

For several years, there has been an awareness of the often harmful power of the âtechnological imperativeâ in the care of dying patients â that is, the compulsive use of...

REVIEW ARTICLE: Age-Related Macular Degeneration

Thu, 17Â FebÂ 2000 00:00:00 -05:00

Age-related macular degeneration, a deterioration of the central portion of the retina, is the chief cause of severe and irreversible loss of vision in developed countries.12 There is no effective...

EDITORIAL: More Preoperative Assessment by Physicians and Less by Laboratory Tests

Thu, 20Â JanÂ 2000 00:00:00 -05:00

The conclusion of the elegant study by Schein et al.1 in this issue of the Journal seems obvious from their data: we should stop ordering routine preoperative laboratory tests for...

ORIGINAL ARTICLE: The Value of Routine Preoperative Medical Testing before Cataract Surgery

Thu, 20Â JanÂ 2000 00:00:00 -05:00

Background: Routine preoperative medical testing is commonly performed in patients scheduled to undergo cataract surgery, although the value of such testing is uncertain. We performed a study to determine whether...

SPECIAL ARTICLE: Underrepresentation of Patients 65 Years of Age or Older in Cancer-Treatment Trials

Thu, 30Â DecÂ 1999 00:00:00 -05:00

Background: Studies have documented the underrepresentation of women and blacks in clinical trials, and their recruitment is now federally mandated. However, little is known about the level of participation of...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Immunologic Treatment of Alzheimer's Disease

Thu, 25Â NovÂ 1999 00:00:00 -05:00

The recent report by Schenk et al.1 raises the hope of a vaccine for Alzheimer's disease. This report has justifiably received wide attention in both the scientific and lay media....

REVIEW ARTICLE: Treatment of Alzheimer's Disease

Richard Mayeux, M.D., and Mary Sano, Ph.D. — Thu, 25Â NovÂ 1999 00:00:00 -05:00

Alzheimer's disease, which is characterized by progressive loss of memory and cognitive function, affects 15 million people worldwide. The incidence increases steadily from 0.5 percent per year at the age...

HEALTH POLICY REPORT: Long-Term Care for Frail Elderly People â The On Lok Model

Thomas Bodenheimer, M.D. — Thu, 21Â OctÂ 1999 00:00:00 -05:00

In January 1999, President Bill Clinton placed the issue of long-term care on the nation's health care agenda. He proposed that families be given a $1,000 annual tax credit to...

SPECIAL ARTICLE: Assistance from Family Members, Friends, Paid Care Givers, and Volunteers in the Care of Terminally Ill Patients

Thu, 23Â SepÂ 1999 00:00:00 -05:00

Background: In addition to medical care, dying patients often need many types of assistance, including help with transportation, nursing care, homemaking services, and personal care. We interviewed terminally ill adults...

ORIGINAL ARTICLE: Association of Aortic-Valve Sclerosis with Cardiovascular Mortality and Morbidity in the Elderly

Thu, 15Â JulÂ 1999 00:00:00 -05:00

Background: Although aortic-valve stenosis is clearly associated with adverse cardiovascular outcomes, it is unclear whether valve sclerosis increases the risk of cardiovascular events.

Methods: We assessed echocardiograms obtained at base line...

SPECIAL ARTICLE: The Association between Hospital Volume and Survival after Acute Myocardial Infarction in Elderly Patients

Thu, 27Â MayÂ 1999 00:00:00 -05:00

Background: Patients with chest pain thought to be due to acute coronary ischemia are typically taken by ambulance to the nearest hospital. The potential benefit of field triage directly to...

SOUNDING BOARD: Geriatrics and the Limits of Modern Medicine

Thu, 22Â AprÂ 1999 00:00:00 -05:00

Like a number of geriatricians, I have come to believe that modern medicine does not work well for old people. Old patients serve as a mirror, reflecting the limitations and...

EDITORIAL: Managing Psychosis in Patients with Parkinson's Disease

Thu, 11Â MarÂ 1999 00:00:00 -05:00

Managing psychosis is one of the most difficult challenges in the care of patients with Parkinson's disease. This complication occurs in 10 to 15 percent of such patients and consists...

ORIGINAL ARTICLE: Low-Dose Clozapine for the Treatment of Drug-Induced Psychosis in Parkinson's Disease

The Parkinson Study Group — Thu, 11Â MarÂ 1999 00:00:00 -05:00

Background: Drug-induced psychosis is a difficult problem to manage in patients with Parkinson's disease. Multiple open-label studies have reported that treatment with clozapine at low doses ameliorates psychosis without worsening...

SOUNDING BOARD: Inadequate Prescription-Drug Coverage for Medicare Enrollees â A Call to Action

Thu, 04Â MarÂ 1999 00:00:00 -05:00

The demise of both the Medicare Catastrophic Coverage Act of 19881 and the 1993 Clinton plan for health care reform23 resulted in missed opportunities to correct a glaring defect in...

EDITORIAL: Geriatrics, Prevention, and the Remodeling of Medicare

Thu, 04Â MarÂ 1999 00:00:00 -05:00

Geriatric medicine has focused primarily on the management of acute and chronic diseases in frail older persons, with much less emphasis on the promotion of health and the prevention of...

ORIGINAL ARTICLE: Effects of Calcium-Channel Blockade in Older Patients with Diabetes and Systolic Hypertension

Thu, 04Â MarÂ 1999 00:00:00 -05:00

Background: Recent reports suggest that calcium-channel blockers may be harmful in patients with diabetes and hypertension. We previously reported that antihypertensive treatment with the calcium-channel blocker nitrendipine reduced the risk...

ORIGINAL ARTICLE: A Multicomponent Intervention to Prevent Delirium in Hospitalized Older Patients

Thu, 04Â MarÂ 1999 00:00:00 -05:00

Background: Since in hospitalized older patients delirium is associated with poor outcomes, we evaluated the effectiveness of a multicomponent strategy for the prevention of delirium.

Methods: We studied 852 patients 70...

SPECIAL ARTICLE: Effects of Admission to a Teaching Hospital on the Cost and Quality of Care for Medicare Beneficiaries

Donald H. Taylor, Jr., Ph.D., David J. Whellan, M.D., and Frank A. Sloan, Ph.D. — Thu, 28Â JanÂ 1999 00:00:00 -05:00

Background: and Methods: We studied the effects of admission to a teaching hospital on the cost and quality of care for patients covered by Medicare (age, 65 years old or...

ORIGINAL ARTICLE: Carotid-Artery Intima and Media Thickness as a Risk Factor for Myocardial Infarction and Stroke in Older Adults

Thu, 07Â JanÂ 1999 00:00:00 -05:00

Background: The combined thickness of the intima and media of the carotid artery is associated with the prevalence of cardiovascular disease. We studied the associations between the thickness of the...

REVIEW ARTICLE: Medical Management of Glaucoma

Wallace L.M. Alward, M.D. — Thu, 29Â OctÂ 1998 00:00:00 -05:00

Glaucoma is the leading cause of irreversible blindness in the world. It is estimated that by the year 2000, 66.8 million people will be affected, of whom 6.7 million will...

SPECIAL ARTICLE: Benefit of a Favorable Cardiovascular Risk-Factor Profile in Middle Age with Respect to Medicare Costs

Thu, 15Â OctÂ 1998 00:00:00 -05:00

Background: People without major risk factors for cardiovascular disease in middle age live longer than those with unfavorable risk-factor profiles. It is not known whether such low-risk status also results...

EDITORIAL: Depression in the Elderly â Falls and Pitfalls

Thu, 24Â SepÂ 1998 00:00:00 -05:00

Committing a patient to a course of drug therapy, particularly a long-term one, often represents a delicate balancing act in which the physician must juggle estimates of benefit and risk...

ORIGINAL ARTICLE: Antidepressants and the Risk of Falls among Nursing Home Residents

Thu, 24Â SepÂ 1998 00:00:00 -05:00

Background: In nursing home residents, the use of tricyclic and other heterocyclic antidepressants is associated with an increased risk of falls. The newer selective serotonin-reuptakeâinhibitor antidepressants are largely free of...

ORIGINAL ARTICLE: Endogenous Hormones and the Risk of Hip and Vertebral Fractures among Older Women

Thu, 10Â SepÂ 1998 00:00:00 -05:00

Background: and Methods: In postmenopausal women, the serum concentrations of endogenous sex hormones and vitamin D might influence the risk of hip and vertebral fractures. In a study of a...

SPECIAL ARTICLE: Gains in Life Expectancy from Medical Interventions â Standardizing Data on Outcomes

Janice C. Wright, Ph.D., and Milton C. Weinstein, Ph.D. — Thu, 06Â AugÂ 1998 00:00:00 -05:00

Background: The gain in life expectancy is an important measure of the effectiveness of medical interventions, but its interpretation requires that it be placed in context. The interpretation of gains...

EDITORIAL: Pneumococcal Outbreaks in Nursing Homes

Thu, 25Â JunÂ 1998 00:00:00 -05:00

Last winter, the Texas Department of Health called me about an outbreak of pneumococcal pneumonia at a nursing home. When I mentioned the outbreak to my daughter, a third-year medical...

ORIGINAL ARTICLE: An Outbreak of Multidrug-Resistant Pneumococcal Pneumonia and Bacteremia among Unvaccinated Nursing Home Residents

Thu, 25Â JunÂ 1998 00:00:00 -05:00

Background: Outbreaks of pneumococcal disease are uncommon and have occurred mainly in institutional settings. Epidemic, invasive, drug-resistant pneumococcal disease has not been seen among adults in the United States. In...

EDITORIAL: Patients with Multiple Chronic Conditions â How Many Medications Are Enough?

Thu, 21Â MayÂ 1998 00:00:00 -05:00

How many medications are optimal for a patient with multiple medical problems? Prescribing too many increases the likelihood of side effects, drug interactions, and poor compliance. Prescribing too few may...

SPECIAL ARTICLE: The Treatment of Unrelated Disorders in Patients with Chronic Medical Diseases

Donald A. Redelmeier, M.D., Siew H. Tan, M.A., and Gillian L. Booth, M.D. — Thu, 21Â MayÂ 1998 00:00:00 -05:00

Background: Patients can have several illnesses concurrently, yet some of these diseases may be neglected if one problem consumes attention. We conducted a population-based analysis in Ontario, Canada â where...

EDITORIAL: A Pill for Impotence

Thu, 14Â MayÂ 1998 00:00:00 -05:00

Impotence â the preferred term is now erectile dysfunction â is a common problem, especially among older men,1 and if it is not caused by psychological problems it certainly can...

ORIGINAL ARTICLE: Oral Sildenafil in the Treatment of Erectile Dysfunction

Thu, 14Â MayÂ 1998 00:00:00 -05:00

Background: Sildenafil is a potent inhibitor of cyclic guanosine monophosphate in the corpus cavernosum and therefore increases the penile response to sexual stimulation. We evaluated the efficacy and safety of...

SOUNDING BOARD: Medicare Policy for Future Generations â A Search for a Permanent Solution

Thu, 30Â AprÂ 1998 00:00:00 -05:00

The combination of escalating health costs per retiree and the pending retirement of the baby-boom generation makes the preservation of Medicare benefits for our children as well as our parents...

EDITORIAL: Do Patients Prefer Physiologic Pacing?

Thu, 16Â AprÂ 1998 00:00:00 -05:00

Cardiac pacemakers have become increasingly sophisticated during their half-century of clinical use. Each new component has been designed to simulate normal physiology more precisely. Is such complexity necessary? In this...

ORIGINAL ARTICLE: Quality of Life and Clinical Outcomes in Elderly Patients Treated with Ventricular Pacing as Compared with Dual-Chamber Pacing

Thu, 16Â AprÂ 1998 00:00:00 -05:00

Background: Standard clinical practice permits the use of either single-chamber ventricular pacemakers or dual-chamber pacemakers for most patients who require cardiac pacing. Ventricular pacemakers are less expensive, but dual-chamber pacemakers...

EDITORIAL: Aging Better

Thu, 09Â AprÂ 1998 00:00:00 -05:00

Eighteen years ago, the Journal published an article entitled âAging, Natural Death, and the Compression of Morbidity,â which has been widely cited and hotly debated ever since.1 The author, James...

EDITORIAL: The Search for Glaucoma Genes â Implications for Pathogenesis and Disease Detection

Thu, 09Â AprÂ 1998 00:00:00 -05:00

Glaucoma is the second leading cause of blindness in the world after cataract, affecting approximately 70 million people, about half of whom are estimated to have open-angle glaucoma.1 Nearly as...

SPECIAL ARTICLE: Aging, Health Risks, and Cumulative Disability

Thu, 09Â AprÂ 1998 00:00:00 -05:00

Background: Persons with lower health risks tend to live longer than those with higher health risks, but there has been concern that greater longevity may bring with it greater disability....

ORIGINAL ARTICLE: Effects of Walking on Mortality among Nonsmoking Retired Men

Thu, 08Â JanÂ 1998 00:00:00 -05:00

Background: The potential benefit of low-intensity activity in terms of longevity among older men has not been clearly documented. We examined the association between walking and mortality in a cohort...

IMAGES IN CLINICAL MEDICINE: Poor Skin Turgor

Oscar M. Aguilar, M.D. and Mariano Albertal, M.D. — Thu, 01Â JanÂ 1998 00:00:00 -05:00

Figure 1. A 74-year-old man was found unconscious at home and brought to the emergency department. He was obtunded and moved only with painful stimuli. His blood pressure was 95/55...

ORIGINAL ARTICLE: The Effect of Age on the Association between Body-Mass Index and Mortality

Thu, 01Â JanÂ 1998 00:00:00 -05:00

Background: The effect of age on optimal body weight is controversial, and few studies have had adequate numbers of subjects to analyze mortality as a function of body-mass index across...

EDITORIAL: Can House Calls Survive?

Thu, 18Â DecÂ 1997 00:00:00 -05:00

The number of house calls has been steadily declining for decades. The house call is now barely perceptible as a part of what American physicians do. Despite the aging of...

SPECIAL ARTICLE: House Calls to the Elderly â A Vanishing Practice among Physicians

Gregg S. Meyer, M.D., and Robert V. Gibbons, M.D., M.P.H. — Thu, 18Â DecÂ 1997 00:00:00 -05:00

Background: Despite the growth in other home health care services, the number of house calls by physicians has declined dramatically during this century. We determined the frequency of house calls...

SPECIAL ARTICLE: The Effect of Different Diagnostic Criteria on the Prevalence of Dementia

Thu, 04Â DecÂ 1997 00:00:00 -05:00

Background: There are several widely used sets of criteria for the diagnosis of dementia, but little is known about their degree of agreement and their effects on estimates of the...

EDITORIAL: Understanding Premature Skin Aging

Thu, 13Â NovÂ 1997 00:00:00 -05:00

Dermatologists see many patients seeking help because of skin aging. Sagging and wrinkling of the skin can be the signs of time spent on the beach in younger years or...

ORIGINAL ARTICLE: Pathophysiology of Premature Skin Aging Induced by Ultraviolet Light

Thu, 13Â NovÂ 1997 00:00:00 -05:00

Background: Long-term exposure to ultraviolet irradiation from sunlight causes premature skin aging (photoaging), characterized in part by wrinkles, altered pigmentation, and loss of skin tone. Photoaged skin displays prominent alterations...

SPECIAL ARTICLE: Falls, Injuries Due to Falls, and the Risk of Admission to a Nursing Home

Mary E. Tinetti, M.D., and Christianna S. Williams, M.P.H. — Thu, 30Â OctÂ 1997 00:00:00 -05:00

Background: Falls warrant investigation as a risk factor for nursing home admission because falls are common and are associated with functional disability and because they may be preventable.

Methods: We conducted...

REVIEW ARTICLE: Caloric Intake and Aging

Richard Weindruch, Ph.D., and Rajindar S. Sohal, Ph.D. — Thu, 02Â OctÂ 1997 00:00:00 -05:00

In postindustrial societies, overeating, inactivity, and obesity have emerged as new challenges in public health.12 Considerable effort is now being devoted to determining the pathophysiologic consequences of overeating. Several lines...

ORIGINAL ARTICLE: Effect of Calcium and Vitamin D Supplementation on Bone Density in Men and Women 65 Years of Age or Older

Thu, 04Â SepÂ 1997 00:00:00 -05:00

Background: Inadequate dietary intake of calcium and vitamin D may contribute to the high prevalence of osteoporosis among older persons.

Methods: We studied the effects of three years of dietary supplementation...

SPECIAL ARTICLE: Use of Cardiac Procedures and Outcomes in Elderly Patients with Myocardial Infarction in the United States and Canada

Thu, 22Â MayÂ 1997 00:00:00 -05:00

Background: Acute myocardial infarction is a leading cause of morbidity and mortality in the United States and Canada. We performed a population-based study to compare the use of cardiac procedures...

EDITORIAL: Aging, Amyloid, and Cardiomyopathy

Thu, 13Â FebÂ 1997 00:00:00 -05:00

In past decades, rheumatic heart disease, syphilitic heart disease, hypertensive heart disease, and even nutritional deficiencies were common enough for physicians to consider these diagnoses in patients presenting with congestive...

ORIGINAL ARTICLE: Treatment of Men with Erectile Dysfunction with Transurethral Alprostadil

Thu, 02Â JanÂ 1997 00:00:00 -05:00

Background: Erectile dysfunction in men is common. We evaluated a system by which alprostadil (prostaglandin E1) is delivered transurethrally to treat this disorder.

Methods: Alprostadil was delivered transurethrally in a double-blind,...

SOUNDING BOARD: Controlling the Costs of Health Care for the Elderly â Fair Means and Foul

Thu, 05Â SepÂ 1996 00:00:00 -05:00

The prospect of a Medicare Trust Fund bankrupt by 2001 and of staggering deficits in the decades thereafter, as the baby-boom generation retires, is bound to preoccupy everyone, young and...

ORIGINAL ARTICLE: Invasive Group A Streptococcal Infections in Ontario, Canada

Thu, 22Â AugÂ 1996 00:00:00 -05:00

Background: Several reports suggest that the incidence of invasive group A streptococcal infections, including streptococcal toxic shock syndrome and necrotizing fasciitis, is increasing.

Methods: During 1992 and 1993 we conducted prospective,...

REVIEW ARTICLE: Evaluation of Dementia

David S. Geldmacher, M.D., and Peter J. Whitehouse, M.D., Ph.D. — Thu, 01Â AugÂ 1996 00:00:00 -05:00

Dementia is the clinical syndrome characterized by acquired losses of cognitive and emotional abilities severe enough to interfere with daily functioning and the quality of life. The term does not...

REVIEW ARTICLE: Evaluation of Dementia

David S. Geldmacher, M.D., and Peter J. Whitehouse, M.D., Ph.D. — Thu, 01Â AugÂ 1996 00:00:00 -05:00

Dementia is the clinical syndrome characterized by acquired losses of cognitive and emotional abilities severe enough to interfere with daily functioning and the quality of life. The term does not...

EDITORIAL: Caring at the End of Our Lives

Thu, 18Â JulÂ 1996 00:00:00 -05:00

Growing up in West Virginia, I would hear older folks say, âMr. Jones is failing now.â They meant that he had entered the final phase of disease and was now...

SPECIAL ARTICLE: Survival of Medicare Patients after Enrollment in Hospice Programs

Background: Each year more than 220,000 Medicare beneficiaries receive care from hospice programs designed to enhance the quality of the end of life. Enrollment requires certification by a physician that...

ORIGINAL ARTICLE: Heat-Related Deaths during the July 1995 Heat Wave in Chicago

Thu, 11Â JulÂ 1996 00:00:00 -05:00

Background: During a record-setting heat wave in Chicago in July 1995, there were at least 700 excess deaths, most of which were classified as heat-related. We sought to determine who...

EDITORIAL: Killing Heat

Thu, 11Â JulÂ 1996 00:00:00 -05:00

Heatstroke is common and often deadly. The pathophysiology of the syndrome is understood, and effective treatment has been well defined.123 Clinicians know that patients' chances of survival depend on prompt...

EDITORIAL: Home Alone, and in Danger

Thu, 27Â JunÂ 1996 00:00:00 -05:00

For anyone who has ever worked in an emergency room, the presentation is all too familiar. The ambulance brings in a patient who is stuporous and dehydrated, often with decubitus...

SPECIAL ARTICLE: Persons Found in Their Homes Helpless or Dead

Thu, 27Â JunÂ 1996 00:00:00 -05:00

Background: Health care providers and providers of emergency services are sometimes called to help with people who are found alone in their homes either helpless or dead. It is not...

REVIEW ARTICLE: Hip Fracture

Joseph D. Zuckerman, M.D. — Thu, 06Â JunÂ 1996 00:00:00 -05:00

Hip fractures, particularly in older persons, result in problems that extend far beyond the orthopedic injury, with repercussions in the areas of medicine, rehabilitation, psychiatry, social work, and health care...

SOUNDING BOARD: On Behalf of Older Women â Another Reason to Protect Medicare and Medicaid

Thu, 21Â MarÂ 1996 00:00:00 -05:00

Old age is a territory populated largely by women. Because women outlive men by an average of seven years, the ratio of women to men increases sharply among the elderly....

EDITORIAL: When a Mind Dies

Thu, 21Â MarÂ 1996 00:00:00 -05:00

After a certain age, when people forget something they may say jokingly, Is this the first sign of dementia? Some may laugh, but the laughter is uncomfortable. Dementia is too...

ORIGINAL ARTICLE: Prevalence of Parkinsonian Signs and Associated Mortality in a Community Population of Older People

Thu, 11Â JanÂ 1996 00:00:00 -05:00

Background: Older people frequently have signs of parkinsonism, but information about the prevalence of parkinsonism and mortality among those with the condition in the community is limited.

Methods: A stratified random...

EDITORIAL: Living with Parkinson's Disease

Thu, 11Â JanÂ 1996 00:00:00 -05:00

It has been more than 20 years since I first learned that I had Parkinson's disease. I had complained for about six months of aching discomfort in my right arm,...

NEJM â Collection Updates for Aging/Geriatrics

REVIEW ARTICLE: Alzheimer's Disease

SPECIAL ARTICLE: Increased Ambulatory Care Copayments and Hospitalizations among the Elderly

IMAGES IN CLINICAL MEDICINE: Anterior Sternal Dislocation

CORRESPONDENCE: Older Age and a Reduced Likelihood of 2009 H1N1 Virus Infection

CORRESPONDENCE: Loss of Independence in Patients Starting Dialysis at 80 Years of Age or Older

EDITORIAL: Dialysis in Frail Elders â A Role for Palliative Care

EDITORIAL: Dying from Dementia

ORIGINAL ARTICLE: Functional Status of Elderly Adults before and after Initiation of Dialysis

ORIGINAL ARTICLE: The Clinical Course of Advanced Dementia

REVIEW ARTICLE: DNA Damage, Aging, and Cancer

ORIGINAL ARTICLE: High-Dose Daunorubicin in Older Patients with Acute Myeloid Leukemia

ORIGINAL ARTICLE: Longitudinal Modeling of Age-Related Memory Decline and the Îµ4 Effect

ORIGINAL ARTICLE: Epidemiologic Study of In-Hospital Cardiopulmonary Resuscitation in the Elderly

EDITORIAL: Cool with Plaques and Tangles

ORIGINAL ARTICLE: Age, Neuropathology, and Dementia

ORIGINAL ARTICLE: Adjuvant Chemotherapy in Older Women with Early-Stage Breast Cancer

CORRESPONDENCE: Outcome of Renal Transplantation from Very Old Donors

EDITORIAL: The Growth of Hospitalists and the Changing Face of Primary Care

SPECIAL ARTICLE: Growth in the Care of Older Patients by Hospitalists in the United States

ORIGINAL ARTICLE: Breast Cancer after Use of Estrogen plus Progestin in Postmenopausal Women

IMAGES IN CLINICAL MEDICINE: Occult Hip Fracture

PERSPECTIVE: Screening for Prostate Cancer among Men 75 Years of Age or Older

PERSPECTIVE: Home Delivery â Bringing Primary Care to the Housebound Elderly

EDITORIAL: Treating Low Sexual Desire â New Findings for Testosterone in Women

ORIGINAL ARTICLE: Testosterone for Low Libido in Postmenopausal Women Not Taking Estrogen

ORIGINAL ARTICLE: Toll-like Receptor 3 and Geographic Atrophy in Age-Related Macular Degeneration

ORIGINAL ARTICLE: Incidental Meniscal Findings on Knee MRI in Middle-Aged and Elderly Persons

EDITORIAL: Tibolone and the Promise of Ideal Hormone-Replacement Therapy

ORIGINAL ARTICLE: The Effects of Tibolone in Older Postmenopausal Women

BOOK REVIEW:

ORIGINAL ARTICLE: Effect of Dissemination of Evidence in Reducing Injuries from Falls

REVIEW ARTICLE: Age-Related Macular Degeneration

EDITORIAL: Bona Fide Genetic Associations with Bone Mineral Density

IMAGES IN CLINICAL MEDICINE: The Aorta in Osteoporosis

ORIGINAL ARTICLE: Multiple Genetic Loci for Bone Mineral Density and Fractures

CLINICAL PRACTICE: Rotator-Cuff Failure

ORIGINAL ARTICLE: Use of Multiple Biomarkers to Improve the Prediction of Death from Cardiovascular Causes

PERSPECTIVE: Planning for the Future â Long-Term Care and the 2008 Election

EDITORIAL: Treating Hypertension in the Very Old

ORIGINAL ARTICLE: Treatment of Hypertension in Patients 80 Years of Age or Older

CLINICAL PRACTICE: Osteoporosis in Men

CLINICAL PRACTICE: Hormonal Contraception in Women of Older Reproductive Age

CLINICAL PRACTICE: Lumbar Spinal Stenosis

CLINICAL PRACTICE: Neurogenic Orthostatic Hypotension

ORIGINAL ARTICLE: Phenotype and Course of HutchinsonâGilford Progeria Syndrome

PERSPECTIVE: HutchinsonâGilford Progeria Syndrome, Aging, and the Nuclear Lamina

ORIGINAL ARTICLE: Endovascular vs. Open Repair of Abdominal Aortic Aneurysms in the Medicare Population

IMAGES IN CLINICAL MEDICINE: Quinolone-Associated Rupture of the Achilles' Tendon

EDITORIAL: Zoledronic Acid and Secondary Prevention of Fractures

ORIGINAL ARTICLE: Zoledronic Acid and Clinical Fractures and Mortality after Hip Fracture

EDITORIAL: Treatment of Neuropsychiatric Symptoms in Patients with Dementia

EDITORIAL: Influenza â The Goal of Control

CLINICAL PRACTICE: Osteoarthritis of the Hip

ORIGINAL ARTICLE: Donepezil for the Treatment of Agitation in Alzheimer's Disease

ORIGINAL ARTICLE: Effectiveness of Influenza Vaccine in the Community-Dwelling Elderly

IMAGES IN CLINICAL MEDICINE: Purple Urine

EDITORIAL: Sex and Aging

CLINICAL PRACTICE: Isolated Systolic Hypertension in the Elderly

ORIGINAL ARTICLE: A Study of Sexuality and Health among Older Adults in the United States

ORIGINAL ARTICLE: Complement C3 Variant and the Risk of Age-Related Macular Degeneration

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Changing the Trajectory of Cognitive Decline?

SPECIAL ARTICLE: Use of Health Services by Previously Uninsured Medicare Beneficiaries

CLINICAL PRACTICE: Osteopenia

EDITORIAL: Clinical Trials in the Elderly â A Concept Comes of Age

ORIGINAL ARTICLE: Radiotherapy for Glioblastoma in the Elderly

CLINICAL PRACTICE: Management of Menopausal Symptoms

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Stress, Aging, and Neurodegenerative Disease

EDITORIAL: Aging and Fountain-of-Youth Hormones

IMAGES IN CLINICAL MEDICINE: Obturator Hernia

ORIGINAL ARTICLE: DHEA in Elderly Women and DHEA or Testosterone in Elderly Men

EDITORIAL: Alzheimer's Disease â Clinical Trials and the Logic of Clinical Purpose

ORIGINAL ARTICLE: Effectiveness of Atypical Antipsychotic Drugs in Patients with Alzheimer's Disease

EDITORIAL: A Very Effective Treatment for Neovascular Macular Degeneration

REVIEW ARTICLE: Age-Related Macular Degeneration

ORIGINAL ARTICLE: Ranibizumab versus Verteporfin for Neovascular Age-Related Macular Degeneration

ORIGINAL ARTICLE: Ranibizumab for Neovascular Age-Related Macular Degeneration

PERSPECTIVE: An Aging Un-American

PERSPECTIVE: The Price of Sight â Ranibizumab, Bevacizumab, and the Treatment of Macular Degeneration

ORIGINAL ARTICLE: Overweight, Obesity, and Mortality in a Large Prospective Cohort of Persons 50 to 71 Years Old

NEJM â Collection Updates for Aging/Geriatrics

EDITORIAL: Dialysis in Frail Elders â A Role for Palliative Care

PERSPECTIVE: Home Delivery â Bringing Primary Care to the Housebound Elderly

EDITORIAL: Treating Low Sexual Desire â New Findings for Testosterone in Women

PERSPECTIVE: Planning for the Future â Long-Term Care and the 2008 Election

ORIGINAL ARTICLE: Phenotype and Course of HutchinsonâGilford Progeria Syndrome

PERSPECTIVE: HutchinsonâGilford Progeria Syndrome, Aging, and the Nuclear Lamina

EDITORIAL: Influenza â The Goal of Control

EDITORIAL: Clinical Trials in the Elderly â A Concept Comes of Age

EDITORIAL: Alzheimer's Disease â Clinical Trials and the Logic of Clinical Purpose

PERSPECTIVE: The Price of Sight â Ranibizumab, Bevacizumab, and the Treatment of Macular Degeneration

PERSPECTIVE: Overweight and Mortality among Baby Boomers â Now We're Getting Personal

REVIEW ARTICLE: Bone Quality â The Material and Structural Basis of Bone Strength and Fragility

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2006 â A 71-Year-Old Woman with Crohn's Disease and Altered Mental Status

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 6-2006 â A 71-Year-Old Woman with Urinary Incontinence and a Mass in the Bladder

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Concentric Calcification

EDITORIAL: Health Disparities â Less Talk, More Action

EDITORIAL: Pacemaker Selection â The Changing Definition of Physiologic Pacing

EDITORIAL: Mild Cognitive Impairment â No Benefit from Vitamin E, Little from Donepezil

EDITORIAL: VaricellaâZoster Virus Vaccine â Grown-ups Need It, Too

PERSPECTIVE: Aging, Immunity, and the VaricellaâZoster Virus

EDITORIAL: Chronic Kidney Disease in the Elderly â How to Assess Risk

EDITORIAL: RSV Infection â Not for Kids Only

EDITORIAL: Deadweight? â The Influence of Obesity on Longevity

PERSPECTIVE: Geriatrics in the United States â Baby Boomers' Boon?

PERSPECTIVE: Advanced Maternal Age â How Old Is Too Old?

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2004 â A 79-Year-Old Woman with Disturbances in Gait, Cognition, and Autonomic Function

SOUNDING BOARD: Medicare Coverage for Technological Innovations â Time for New Criteria?