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Geriatric health maintenance

Mitchell T Heflin, MD, MHS
Section Editor
Kenneth E Schmader, MD
Deputy Editor
Judith A Melin, MA, MD, FACP


The profile of aging in the United States has changed dramatically over the last century. The average life expectancy at birth has increased from 47 years in 1900 to nearly 79 years in 2014. By 2030, the percentage of the population over 65 years of age will exceed 20 percent, or over 70 million people [1]. Worldwide, the number of adults over 60 years of age will top 2 billion by 2050 and will constitute over 20 percent of the world's population [2]. Projections based on current growth patterns indicate that the vast majority of these older adults will reside in less-developed countries (1.6 billion).

Definitions of health and wellbeing in late life have changed with the increase in life expectancy. Heart disease, cancer, and stroke have become the leading causes of death among older adults, while deaths due to infection have decreased. Adults surviving into late life suffer from high rates of chronic illness; 80 percent have at least one and 50 percent have at least two chronic conditions [1]. There is a strong association between the presence of geriatric syndromes (cognitive impairment, falls, incontinence, vision or hearing impairment, low body mass index [BMI], dizziness) and dependency in activities of daily living (relative risk 2.1 for one condition; 6.6 for three or more conditions) [3].

Decline in function and loss of independence are not an inevitable consequence of aging. Given the high prevalence and impact of chronic health problems among older patients, evidence-based interventions to address these problems become increasingly important to maximize both the quantity and quality of life for older adults.

The Assessing Care of Vulnerable Elders (ACOVE-3) project identifies quality indicators in the care of older adults, including recommendations for routine health maintenance [4]. Clinician experts serving as authors for this project have critically evaluated the evidence supporting these quality indicators. Their review, in conjunction with other sources, is used in the development of this discussion.

This topic offers a brief discussion of office-based assessments to identify and address common problems that are amenable to prevention or amelioration in older adults. An overview of preventive medicine for the general population is presented separately. (See "Preventive care in adults: Recommendations".)


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  1. Centers for Disease Control and Prevention and The Merck Company Foundation. The State of Aging and Health in America 2007. The Merck Company Foundation, Whitehouse Station, NJ 2007. Available at: http://www.cdc.gov/aging/pdf/saha_2007.pdf (Accessed on April 12, 2012).
  2. United Nations, Department of Economic and Social Affairs, Population Division. World Population Ageing 2013. http://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2013.pdf (Accessed on August 25, 2015).
  3. Cigolle CT, Langa KM, Kabeto MU, et al. Geriatric conditions and disability: the Health and Retirement Study. Ann Intern Med 2007; 147:156.
  4. Gnanadesigan N, Fung CH. Quality indicators for screening and prevention in vulnerable elders. J Am Geriatr Soc 2007; 55 Suppl 2:S417.
  5. Lee SJ, Leipzig RM, Walter LC. Incorporating lag time to benefit into prevention decisions for older adults. JAMA 2013; 310:2609.
  6. Schonberg MA, Leveille SG, Marcantonio ER. Preventive health care among older women: missed opportunities and poor targeting. Am J Med 2008; 121:974.
  7. Pham HH, Schrag D, Hargraves JL, Bach PB. Delivery of preventive services to older adults by primary care physicians. JAMA 2005; 294:473.
  8. Reuben DB. Medical care for the final years of life: "When you're 83, it's not going to be 20 years". JAMA 2009; 302:2686.
  9. Artaud F, Dugravot A, Sabia S, et al. Unhealthy behaviours and disability in older adults: three-City Dijon cohort study. BMJ 2013; 347:f4240.
  10. US Department of Health and Human Services. Healthy People 2010, conference edition. Washington DC: U.S. Department of Health and Human Services; 2000. Available at: www.healthypeople.gov (Accessed on December 21, 2007).
  11. King AC, Guralnik JM. Maximizing the potential of an aging population. JAMA 2010; 304:1944.
  12. Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation 2007; 116:1094.
  13. Province MA, Hadley EC, Hornbrook MC, et al. The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques. JAMA 1995; 273:1341.
  14. Wolfson L, Whipple R, Derby C, et al. Balance and strength training in older adults: intervention gains and Tai Chi maintenance. J Am Geriatr Soc 1996; 44:498.
  15. Wolf SL, Barnhart HX, Kutner NG, et al. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. J Am Geriatr Soc 1996; 44:489.
  16. Doolan DM, Froelicher ES. Efficacy of smoking cessation intervention among special populations: review of the literature from 2000 to 2005. Nurs Res 2006; 55:S29.
  17. Burns DM. Cigarette smoking among the elderly: disease consequences and the benefits of cessation. Am J Health Promot 2000; 14:357.
  18. Health benefits of smoking cessation: a report of the Surgeon General 1990. Centers for Disease Control; Office on Smoking and Health, 1990.
  19. Russell MA, Wilson C, Taylor C, Baker CD. Effect of general practitioners' advice against smoking. Br Med J 1979; 2:231.
  20. Gellert C, Schöttker B, Brenner H. Smoking and all-cause mortality in older people: systematic review and meta-analysis. Arch Intern Med 2012; 172:837.
  21. Aspirin for the Prevention of Cardiovascular Disease: Preventive Medication. USPSTF. Release Date: March 2009. http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/aspirin-for-the-prevention-of-cardiovascular-disease-preventive-medication (Accessed on October 06, 2014).
  22. Elhassan A, Chow RD. Smoking cessation in the elderly. Clin Geriatr 2007; 15:38.
  23. Clinical guidelines for alcohol use disorders in older adults. American Geriatrics Society (AGS) Position Statement. American Geriatrics Society, New York 2003.
  24. Wilson SR, Knowles SB, Huang Q, Fink A. The prevalence of harmful and hazardous alcohol consumption in older U.S. adults: data from the 2005-2008 National Health and Nutrition Examination Survey (NHANES). J Gen Intern Med 2014; 29:312.
  25. Helping Patients Who Drink Too Much, a Clinician's Guide. 2005. Available at: www.niaaa.nih.gov/guide (Accessed on January 10, 2008).
  26. Ridker PM, Cook NR, Lee IM, et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med 2005; 352:1293.
  27. Wolff T, Miller T, Ko S. Aspirin for the primary prevention of cardiovascular events: an update of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2009; 150:405.
  28. Shrank WH, Polinski JM, Avorn J. Quality indicators for medication use in vulnerable elders. J Am Geriatr Soc 2007; 55 Suppl 2:S373.
  29. Bibbins-Domingo K, U.S. Preventive Services Task Force. Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2016; 164:836.
  30. Bhatt DL, Scheiman J, Abraham NS, et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation 2008; 118:1894.
  31. Centers for Disease Control and Prevention (CDC). Tetanus--Kansas, 1993. MMWR Morb Mortal Wkly Rep 1994; 43:309.
  32. Solomonova K, Vizev S. Secondary response to boostering by purified aluminium-hydroxide-adsorbed tetanus anatoxin in aging and in aged adults. Immunobiology 1981; 158:312.
  33. Balestra DJ, Littenberg B. Should adult tetanus immunization be given as a single vaccination at age 65? A cost-effectiveness analysis. J Gen Intern Med 1993; 8:405.
  34. Marlovits S, Stocker R, Efstratiou A, et al. Effect on diphtheria immunity of combined tetanus and diphtheria booster vaccination in adults. Eur J Clin Microbiol Infect Dis 2000; 19:506.
  35. http://www.cdc.gov/vaccines/recs/acip/slides-oct10.htm (Accessed on November 10, 2010).
  36. http://www.reuters.com/article/idUSTRE69Q5UL20101027 (Accessed on November 15, 2010).
  37. Centers for Disease Control and Prevention (CDC). Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine from the Advisory Committee on Immunization Practices, 2010. MMWR Morb Mortal Wkly Rep 2011; 60:13.
  38. Nichol KL, Margolis KL, Wuorenma J, Von Sternberg T. The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. N Engl J Med 1994; 331:778.
  39. CDC's Advisory Committee on Immunization Practices (ACIP) recommends universal annual influenza vaccination. Available at: http://www.cdc.gov/media/pressrel/2010/r100224.htm (Accessed on May 16, 2010).
  40. Centers for Disease Control and Prevention. Active Bacterial Core Surveillance (ABCs) Report Emerging Infections Program Network: Streptococcus pneumoniae, 2010 (ORIG). http://www.cdc.gov/abcs/reports-findings/survreports/spneu10-orig.pdf (Accessed on March 21, 2013).
  41. Tomczyk S, Bennett NM, Stoecker C, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2014; 63:822.
  42. Kimberlin DW, Whitley RJ. Varicella-zoster vaccine for the prevention of herpes zoster. N Engl J Med 2007; 356:1338.
  43. Mitka M. FDA approves shingles vaccine: herpes zoster vaccine targets older adults. JAMA 2006; 296:157.
  44. Harpaz R, Ortega-Sanchez IR, Seward JF, Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2008; 57:1.
  45. Lal H, Cunningham AL, Godeaux O, et al. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med 2015; 372:2087.
  46. Oxman MN. Zoster vaccine: current status and future prospects. Clin Infect Dis 2010; 51:197.
  47. Walter LC, Covinsky KE. Cancer screening in elderly patients: a framework for individualized decision making. JAMA 2001; 285:2750.
  48. Albert RH, Clark MM. Cancer screening in the older patient. Am Fam Physician 2008; 78:1369.
  49. Clarfield AM. Screening in frail older people: an ounce of prevention or a pound of trouble? J Am Geriatr Soc 2010; 58:2016.
  50. Lansdorp-Vogelaar I, Gulati R, Mariotto AB, et al. Personalizing age of cancer screening cessation based on comorbid conditions: model estimates of harms and benefits. Ann Intern Med 2014; 161:104.
  51. Alibhai SMH, Horgan AM. Cancer screening in older adults: What to do when we don't know. J Geriatr Oncol 2011; 2:149.
  52. Snyder AH, Magnuson A, Westcott AM. Cancer Screening in Older Adults. Med Clin North Am 2016; 100:1101.
  53. Smith RA, Cokkinides V, Eyre HJ. Cancer screening in the United States, 2007: a review of current guidelines, practices, and prospects. CA Cancer J Clin 2007; 57:90.
  54. http://www.uspreventiveservicestaskforce.org/prostatecancerscreening/prostatefinalrs.htm (Accessed on May 21, 2012).
  55. Screening for prostate cancer. American College of Physicians. Ann Intern Med 1997; 126:480.
  56. Hugosson J, Carlsson S, Aus G, et al. Mortality results from the Göteborg randomised population-based prostate-cancer screening trial. Lancet Oncol 2010; 11:725.
  57. Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009; 360:1320.
  58. Nyström L, Rutqvist LE, Wall S, et al. Breast cancer screening with mammography: overview of Swedish randomised trials. Lancet 1993; 341:973.
  59. Olsen O, Gøtzsche PC. Cochrane review on screening for breast cancer with mammography. Lancet 2001; 358:1340.
  60. Pace LE, Keating NL. A systematic assessment of benefits and risks to guide breast cancer screening decisions. JAMA 2014; 311:1327.
  61. Walter LC, Schonberg MA. Screening mammography in older women: a review. JAMA 2014; 311:1336.
  62. Schonberg MA, Hamel MB, Davis RB, et al. Development and evaluation of a decision aid on mammography screening for women 75 years and older. JAMA Intern Med 2014; 174:417.
  63. Braithwaite D, Zhu W, Hubbard RA, et al. Screening outcomes in older US women undergoing multiple mammograms in community practice: does interval, age, or comorbidity score affect tumor characteristics or false positive rates? J Natl Cancer Inst 2013; 105:334.
  64. AGS list for Choosing Wisely, Feb 2014 http://www.americangeriatrics.org/press/news_press_releases/id:4775 (Accessed on April 28, 2014).
  65. Sawaya GF, Sung HY, Kearney KA, et al. Advancing age and cervical cancer screening and prognosis. J Am Geriatr Soc 2001; 49:1499.
  66. Fletcher A. Screening for cancer of the cervix in elderly women. Lancet 1990; 335:97.
  67. Sherlaw-Johnson C, Gallivan S, Jenkins D. Withdrawing low risk women from cervical screening programmes: mathematical modelling study. BMJ 1999; 318:356.
  68. Fahs MC, Mandelblatt J, Schechter C, Muller C. Cost effectiveness of cervical cancer screening for the elderly. Ann Intern Med 1992; 117:520.
  69. Power EJ. Pap smears, elderly women, and Medicare. Cancer Invest 1993; 11:164.
  70. Celentano DD, Shapiro S, Weisman CS. Cancer preventive screening behavior among elderly women. Prev Med 1982; 11:454.
  71. Mandelblatt J, Schechter C, Fahs M, Muller C. Clinical implications of screening for cervical cancer under Medicare. The natural history of cervical cancer in the elderly: what do we know? What do we need to know? Am J Obstet Gynecol 1991; 164:644.
  72. Weinrich S, Coker AL, Weinrich M, et al. Predictors of Pap smear screening in socioeconomically disadvantaged elderly women. J Am Geriatr Soc 1995; 43:267.
  73. Gluck ME, Wagner JL, Duffy BM. The use of preventive services by the elderly. Preventive Health Services under Medicare series, Paper 2. Office of Technology Assessment; Washington, DC 1989.
  74. National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365:395.
  75. Pinsky PF, Gierada DS, Hocking W, et al. National Lung Screening Trial findings by age: Medicare-eligible versus under-65 population. Ann Intern Med 2014; 161:627.
  76. Parker SL, Tong T, Bolden S, Wingo PA. Cancer statistics, 1996. CA Cancer J Clin 1996; 46:5.
  77. US Preventive Services Task Force (USPSTF). Screening for High Blood Pressure. Available at: www.ahrq.gov/clinic/uspstf07/hbp/hbprs.htm (Accessed on January 21, 2009).
  78. Min LC, Mehrotra R, Fung CH. Quality indicators for the care of hypertension in vulnerable elders. J Am Geriatr Soc 2007; 55 Suppl 2:S359.
  79. Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358:1887.
  80. Beckett N, Peters R, Tuomilehto J, et al. Immediate and late benefits of treating very elderly people with hypertension: results from active treatment extension to Hypertension in the Very Elderly randomised controlled trial. BMJ 2011; 344:d7541.
  81. SPRINT Research Group, Wright JT Jr, Williamson JD, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med 2015; 373:2103.
  82. Gueyffier F, Bulpitt C, Boissel JP, et al. Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials. INDANA Group. Lancet 1999; 353:793.
  83. Oates DJ, Berlowitz DR, Glickman ME, et al. Blood pressure and survival in the oldest old. J Am Geriatr Soc 2007; 55:383.
  84. Tinetti ME, Han L, Lee DS, et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med 2014; 174:588.
  85. Odden MC, Peralta CA, Haan MN, Covinsky KE. Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med 2012; 172:1162.
  86. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311:507.
  87. Appel LJ, Espeland MA, Easter L, et al. Effects of reduced sodium intake on hypertension control in older individuals: results from the Trial of Nonpharmacologic Interventions in the Elderly (TONE). Arch Intern Med 2001; 161:685.
  88. Ali R, Alexander KP. Statins for the primary prevention of cardiovascular events in older adults: a review of the evidence. Am J Geriatr Pharmacother 2007; 5:52.
  89. Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002; 360:1623.
  90. Strandberg TE, Kolehmainen L, Vuorio A. Evaluation and treatment of older patients with hypercholesterolemia: a clinical review. JAMA 2014; 312:1136.
  91. Ashton HA, Buxton MJ, Day NE, et al. The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet 2002; 360:1531.
  92. Kim LG, P Scott RA, Ashton HA, et al. A sustained mortality benefit from screening for abdominal aortic aneurysm. Ann Intern Med 2007; 146:699.
  93. Scott RA, Wilson NM, Ashton HA, Kay DN. Influence of screening on the incidence of ruptured abdominal aortic aneurysm: 5-year results of a randomized controlled study. Br J Surg 1995; 82:1066.
  94. Siu AL, U S Preventive Services Task Force. Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2015; 163:861.
  95. Manton KG. A longitudinal study of functional change and mortality in the United States. J Gerontol 1988; 43:S153.
  96. Reuben DB, Rubenstein LV, Hirsch SH, Hays RD. Value of functional status as a predictor of mortality: results of a prospective study. Am J Med 1992; 93:663.
  97. Studenski S, Perera S, Patel K, et al. Gait speed and survival in older adults. JAMA 2011; 305:50.
  98. Kuo HK, Scandrett KG, Dave J, Mitchell SL. The influence of outpatient comprehensive geriatric assessment on survival: a meta-analysis. Arch Gerontol Geriatr 2004; 39:245.
  99. Cohen HJ, Feussner JR, Weinberger M, et al. A controlled trial of inpatient and outpatient geriatric evaluation and management. N Engl J Med 2002; 346:905.
  100. Gallo JJ, Reichel W, Andersen L. Handbook of Geriatric Assessment, Aspen Publishers, Rockville, MD 1988.
  101. Patterson CJ. Detecting cognitive impairment in the elderly. In: Preventing Disease: Beyond the Rhetoric, Goldbloom RB, Lawrence RS (Eds), Springer-Verlag, New York 1990. p.150.
  102. McLean S. Assessing dementia. Part I: Difficulties, definitions and differential diagnosis. Aust N Z J Psychiatry 1987; 21:142.
  103. Lin JS, O'Connor E, Rossom RC, et al. Screening for cognitive impairment in older adults: A systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2013; 159:601.
  104. Holsinger T, Deveau J, Boustani M, Williams JW Jr. Does this patient have dementia? JAMA 2007; 297:2391.
  105. Feil DG, MacLean C, Sultzer D. Quality indicators for the care of dementia in vulnerable elders. J Am Geriatr Soc 2007; 55 Suppl 2:S293.
  106. Jorm AF. The Informant Questionnaire on cognitive decline in the elderly (IQCODE): a review. Int Psychogeriatr 2004; 16:275.
  107. Petersen RC, Stevens JC, Ganguli M, et al. Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001; 56:1133.
  108. Knopman DS, DeKosky ST, Cummings JL, et al. Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001; 56:1143.
  109. Canadian Task Force on Preventive Health Care, Pottie K, Rahal R, et al. Recommendations on screening for cognitive impairment in older adults. CMAJ 2016; 188:37.
  110. Moyer VA, U.S. Preventive Services Task Force. Screening for cognitive impairment in older adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 160:791.
  111. Gallo JJ, Rabins PV, Lyketsos CG, et al. Depression without sadness: functional outcomes of nondysphoric depression in later life. J Am Geriatr Soc 1997; 45:570.
  112. Depression Guidelines Panel. Depression in Primary Care: Volume 1, Detection and Diagnosis, Clinical Practice Guideline, No. 5. US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Rockville, MD 1993.
  113. US Preventive Services Task Force. Guide to Clinical Preventive Services. Available at: www.ahrq.gov/clinic/uspstfix.htm (Accessed on December 19, 2007).
  114. Nakajima GA, Wenger NS. Quality indicators for the care of depression in vulnerable elders. J Am Geriatr Soc 2007; 55 Suppl 2:S302.
  115. Trivedi DP, Doll R, Khaw KT. Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ 2003; 326:469.
  116. Gourlay ML, Fine JP, Preisser JS, et al. Bone-density testing interval and transition to osteoporosis in older women. N Engl J Med 2012; 366:225.
  117. Berry SD, Samelson EJ, Pencina MJ, et al. Repeat bone mineral density screening and prediction of hip and major osteoporotic fracture. JAMA 2013; 310:1256.
  118. US Preventive Services Task Force (USPSTF). Screening for Osteoporosis. Available at: www.ahrq.gov/clinic/uspstf/uspsoste.htm (Accessed on December 21, 2007).
  119. Draft Recommendation Statement: Impaired Visual Acuity in Older Adults: Screening. US Preventive Services Task Force. July 2015. http://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement161/impaired-visual-acuity-in-older-adults-screening (Accessed on August 25, 2015).
  120. Popelka MM, Cruickshanks KJ, Wiley TL, et al. Low prevalence of hearing aid use among older adults with hearing loss: the Epidemiology of Hearing Loss Study. J Am Geriatr Soc 1998; 46:1075.
  121. Yueh B, Shekelle P. Quality indicators for the care of hearing loss in vulnerable elders. J Am Geriatr Soc 2007; 55 Suppl 2:S335.
  122. Genther DJ, Frick KD, Chen D, et al. Association of hearing loss with hospitalization and burden of disease in older adults. JAMA 2013; 309:2322.
  123. Lin FR, Yaffe K, Xia J, et al. Hearing loss and cognitive decline in older adults. JAMA Intern Med 2013; 173:293.
  124. Moyer VA, U.S. Preventive Services Task Force. Screening for hearing loss in older adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2012; 157:655.
  125. Pirozzo S, Papinczak T, Glasziou P. Whispered voice test for screening for hearing impairment in adults and children: systematic review. BMJ 2003; 327:967.
  126. Chou R, Dana T, Bougatsos C, et al. Screening adults aged 50 years or older for hearing loss: a review of the evidence for the U.S. preventive services task force. Ann Intern Med 2011; 154:347.
  127. Clinical Preventive Services Self-Evaluation Module, Appendix a-1, American Board of Internal Medicine.
  128. Geriatrics Review Syllabus Supplement, 1993-1994 ed, Reuben DB, Yoshikawa TT, Besdine RW (Eds), American Geriatrics Society, New York 1993. p.172.
  129. Sullivan DH. Impact of nutritional status on health outcomes of nursing home residents. J Am Geriatr Soc 1995; 43:195.
  130. Reuben DB. Quality indicators for the care of undernutrition in vulnerable elders. J Am Geriatr Soc 2007; 55 Suppl 2:S438.
  131. Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357:266.
  132. Bischoff-Ferrari HA, Dawson-Hughes B, Orav EJ, et al. Monthly High-Dose Vitamin D Treatment for the Prevention of Functional Decline: A Randomized Clinical Trial. JAMA Intern Med 2016; 176:175.
  133. Jackson RD, LaCroix AZ, Gass M, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 2006; 354:669.
  134. Avenell A, Gillespie WJ, Gillespie LD, O'Connell D. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev 2009; :CD000227.
  135. Bischoff-Ferrari HA, Willett WC, Orav EJ, et al. A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med 2012; 367:40.
  136. Mursu J, Robien K, Harnack LJ, et al. Dietary supplements and mortality rate in older women: the Iowa Women's Health Study. Arch Intern Med 2011; 171:1625.
  137. Campbell AJ, Borrie MJ, Spears GF. Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol 1989; 44:M112.
  138. Tinetti MD. Falls. In: Geriatric Medicine, 2nd ed, Cassel CK, et al. (Eds), Springer-Verlag, New York 1990. p.528.
  139. Michael YL, Whitlock EP, Lin JS, et al. Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2010; 153:815.
  140. Tinetti ME, Baker DI, McAvay G, et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 1994; 331:821.
  141. Ganz DA, Bao Y, Shekelle PG, Rubenstein LZ. Will my patient fall? JAMA 2007; 297:77.
  142. Guralnik JM, Ferrucci L, Simonsick EM, et al. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 1995; 332:556.
  143. Chang JT, Ganz DA. Quality indicators for falls and mobility problems in vulnerable elders. J Am Geriatr Soc 2007; 55 Suppl 2:S327.
  144. Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc 2001; 49:664.
  145. Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the "get-up and go" test. Arch Phys Med Rehabil 1986; 67:387.
  146. Okumiya K, Matsubayashi K, Nakamura T, et al. The timed "up & go" test is a useful predictor of falls in community-dwelling older people. J Am Geriatr Soc 1998; 46:928.
  147. Thom D. Variation in estimates of urinary incontinence prevalence in the community: effects of differences in definition, population characteristics, and study type. J Am Geriatr Soc 1998; 46:473.
  148. Lifford KL, Curhan GC, Hu FB, et al. Type 2 diabetes mellitus and risk of developing urinary incontinence. J Am Geriatr Soc 2005; 53:1851.
  149. Brandeis GH, Baumann MM, Hossain M, et al. The prevalence of potentially remediable urinary incontinence in frail older people: a study using the Minimum Data Set. J Am Geriatr Soc 1997; 45:179.
  150. Roberts RO, Jacobsen SJ, Rhodes T, et al. Urinary incontinence in a community-based cohort: prevalence and healthcare-seeking. J Am Geriatr Soc 1998; 46:467.
  151. Fung CH, Spencer B, Eslami M, Crandall C. Quality indicators for the screening and care of urinary incontinence in vulnerable elders. J Am Geriatr Soc 2007; 55 Suppl 2:S443.
  152. Willlams CM. Using medications appropriately in older adults. Am Fam Physician 2002; 66:1917.
  153. Essentials of Clinical Geriatrics, 4th ed., Kane R, Ouslander J, Abrass I (Eds), McGraw-Hill, New York 1999. p.379.
  154. American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012; 60:616.
  155. Kramarow E, Chen LH, Hedegaard H, Warner M. Deaths from unintentional injury among adults aged 65 and over: United States, 2000-2013. NCHS Data Brief 2015; :199.
  156. Turner S, Arthur G, Lyons RA, et al. Modification of the home environment for the reduction of injuries. Cochrane Database Syst Rev 2011; :CD003600.
  157. Wang CC, Carr DB, Older Drivers Project. Older driver safety: a report from the older drivers project. J Am Geriatr Soc 2004; 52:143.
  158. Physician's Guide to Assessing and Counseling Older Drivers. Available at: www.ama-assn.org/ama/pub/category/10791.html (Accessed on October 12, 2011).
  159. Reger MA, Welsh RK, Watson GS, et al. The relationship between neuropsychological functioning and driving ability in dementia: a meta-analysis. Neuropsychology 2004; 18:85.
  160. Dubinsky RM, Stein AC, Lyons K. Practice parameter: risk of driving and Alzheimer's disease (an evidence-based review): report of the quality standards subcommittee of the American Academy of Neurology. Neurology 2000; 54:2205.
  161. Centers for Disease Control and Prevention (CDC). Social support and health-related quality of life among older adults--Missouri, 2000. MMWR Morb Mortal Wkly Rep 2005; 54:433.
  162. Lachs MS, Pillemer K. Elder abuse. Lancet 2004; 364:1263.
  163. Dong X, Simon M, Mendes de Leon C, et al. Elder self-neglect and abuse and mortality risk in a community-dwelling population. JAMA 2009; 302:517.
  164. Aravanis S, Adelman R, Breckman R. Diagnostic and Treatment Guidelines on Elder Abuse and Neglect, American Medical Association, Chicago 1992.
  165. Centers for Medicare and Medicaid Services. Frequently asked questions about billing the physician fee schedule for advance care planning services. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/FAQ-Advance-Care-Planning.pdf (Accessed on June 29, 2016).
  166. US Department of Health and Human Services. Healthy People 2010, conference edition. US Department of Health and Human Services, Washington, DC 2000. Available at: www.healthypeople.gov (Accessed on December 21, 2007).
  167. Centers for Disease Control and Prevention, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion. The State of Aging and Health in America 2013. http://www.cdc.gov/features/agingandhealth/state_of_aging_and_health_in_america_2013.pdf (Accessed on August 25, 2015).
  168. Wenger NS, Roth CP, Shekelle P, ACOVE Investigators. Introduction to the assessing care of vulnerable elders-3 quality indicator measurement set. J Am Geriatr Soc 2007; 55 Suppl 2:S247.
  169. www.americangeriatrics.org/products/positionpapers/index.shtml#1 (Accessed on January 15, 2008).
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