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The health of the older segment of the population is affected by two types of problems: those that cause death and those that cause disability. Both types need to be studied. All levels of investigation, from basic clinical research to applied health services research, are needed. Areas of investigation must include the killer diseases (cardiovascular disease, cerebrovascular disease, and cancer) and disability-causing conditions, such as Alzheimer's disease and metabolic, genitourinary, musculoskeletal, and special sense disorders. Pharmacotherapeutics and disease management are also subjects that deserve attention. Problems related to race and gender differences, health services research, and technology development and assessment need to be addressed. Clinical investigators in geriatrics must be recruited and trained, and funding for their activities must be increased.

Study Objective: To evaluate the impact of a geriatric consultation team on the functional status of hospitalized elderly patients.Design: Randomized controlled clinical trial.Setting: University-affiliated referral Veterans Administration Medical Center.Patients: One hundred and seventy-eight hospitalized elderly men 75 years or older admitted to medical, surgical, and psychiatry services, but excluding patients admitted to intensive care units.Intervention: Eighty-eight intervention group patients received multidimensional evaluation by an interdisciplinary geriatric consultation team composed of a faculty geriatrician, geriatrics fellow, geriatric clinical nurse specialist, and a social worker trained in geriatrics. Results of the evaluation, including problem identification and recommendations, were given to the patients' physicians. Ninety control group patients received only usual care.Measurements and Main Results: Intervention and control groups were comparable initially. The major outcome variable was the Index of Independence in the Activities of Daily Living (ADL) (Katz). Thirty-nine percent of the total study population was functionally independent on admission, 27% required assistance with one to three ADL, 22% required assistance with four to six ADL, and 12% were completely dependent. Many patients remained unchanged from admission to discharge: intervention group, 38%; control group, 39%. In the intervention group, 34% improved and 28% declined; in the control group, 26% improved and 36% declined. Although these changes reflected a trend toward greater improvement in the intervention group, the results were not statistically significant.Conclusions: Among elderly patients entering an acute-care hospital, approximately 60% had some degree of, and one third had serious functional disability. Such patients are at risk for further decline during hospitalization. A geriatric consultation team was unable to alter the degree of functional decline. Geriatric units or consultation teams may have to offer direct preventive or restorative services in addition to advice if improvements are to be made. [ABSTRACT FROM AUTHOR]

Discusses the development of geriatric medicine in the United States. Inclusion of an offer of a certifying examination signifying special competence under the joint sponsorship of the American Board of Internal Medicine and the American Academy of Family Physicians; Finding that osteoporosis is a major cause of morbidity and mortality in elderly patients.