The July theme of JAOA—The Journal of the American Osteopathic Association focuses on healthcare issues for older and elderly persons, an especially timely issue. As noted widely in the public media, as of January 1, 2006— and at a rate of nearly 8,000 a day—the nation's 75 million “baby boomers” have begun turning 60. Within a few short years, they will reach traditional retirement age, 65.^1–5 

As this demographic group ages, the boom has more frequently been referred to as a less hopeful (and less dignified) “shift.” Starting in 2011, our nation will see a substantial increase in the number of older and elderly adults. By 2030, at an estimated 71.5 million strong, the older population is projected to be twice as large as it was in 2000.^6,7 Although the older population comprised 12.4% of the population in the United States in 2000, by the year 2030, this demographic segment will represent approximately 20% of the American population.⁷ The most rapidly growing segment of the population for many decades to come will continue to be what demographers refer to as the “oldest old” (ie, >85 y). In 2002, approximately 5 million Americans were in this age group; by 2030, that number will nearly double.⁷ Experts are now guessing that the number of centenarians will increase to about 800,000 by the year 2050, representing a sixteen-fold increase from the year 2000, when this group numbered 50,000.⁸ As the mean life expectancy continues to increase, baby boomers can expect to live well into their 80s.⁹ 

At the first White House Conference on Aging in 1961, President John F. Kennedy stated that, “adding years to people's lives through the magic of science and medicine, however impressive, [is] an insufficient ambition for American society.” “Our objective,” he urged, “must be to add new life to those years.”¹ 

As physicians study, discuss, and learn more about healthcare for an aging population, we may begin to wonder: Have we produced an older and sicker population—or, have we created an older and healthier population? 

In fact, there is ample evidence to demonstrate that the rate of disability is declining among the elderly population over time.^10–15 These data indicate that, as those living in industrialized nations age, our lives are often more functional, in terms of physical and cognitive abilities, than those of our predecessors decades before.⁹ 

Anecdotal evidence suggests that people across the nation would like to live longer if those years can be productive and healthy. Thus, it can be said that people would not like simply to live longer; they would like to age successfully.¹⁶ While the precise definition and description of this goal is still evolving in the hands of older adults and the Baby Boom generation, three components of successful aging have clearly been articulated elsewhere and entail maintaining¹⁶: 

Coupled with the evolving goal of aging successfully, there has also been an outcry among the public and their healthcare providers for improving end-of-life care.^17–19 Many studies have demonstrated a failure within the healthcare system to adequately manage pain and other symptoms at the end of life,^20–24 approach issues of advance care planning,^25–27 and honor advance directives.^25,26,28,29 

The articles published in this theme issue of The Journal address many topics that will help osteopathic physicians promote successful aging for their patients, from fostering ongoing quality improvements in healthcare throughout the aging process to identifying information important to decision-making processes at the end of life. 

In their original contribution, Kenneth J. Steier, DO, MHA, and colleagues³⁰ report a lack of compliance with appropriate venous thromboembolism prophylaxis in high-risk patients. Most of the patients studied were elderly, and immobility was their principle risk factor. The authors call for enhanced compliance with prophylaxis interventions. In addition, Steier and coauthors suggest that the current 2001 guidelines may be suboptimal and should be reassessed. 

Improvements in osteoporosis treatment and prevention could have a significant impact on the quality of life for elderly persons and their caregivers, as well as public health implications.²⁰ For this reason, Christine I. Rohr, DO, and coinvestigators³¹ seek to elucidate the effectiveness of another prevention model. In their original contribution, Rohr and colleagues report on the results of a telephone survey designed to assess the impact of patient education efforts in conjunction with a community-wide osteoporosis screening program that made use of dual-energy x-ray absorptiometry for patient assessment, diagnosis, and treatment plans. With the exception of patients who required physician care for diagnosed osteoporosis, the amount of calcium supplementation with over-the-counter products increased for patients after this preventive intervention. In patients for whom recommended interventions required physician follow-up, there was no improvement in levels of self-care. 

In their survey-based original contribution, Derrick H. Adams, DO, and David P. Snedden, BS,³² describe how most elderly patients overestimate their chances of survival to discharge after inpatient cardiopulmonary resuscitation (CPR). However, this misplaced faith in the powers of technology—based mainly on information gleaned from television medical dramas—is not necessarily reflected in this group's decisions on end-of-life care as documented through the use of standing do-not-resuscitate orders. The authors call for physicians to provide more community and patient education on end-of-life issues. 

Robin B. McFee, DO, MPH, DABPM, and Thomas R. Caraccio, PharmD, DABAT,³³ relate the issue of polypharmacy in elderly patients to pediatric intoxications. Their original contribution reports that easy access to grandparents' medications is the leading cause for 10% to 20% of unintentional pediatric intoxications. The authors conclude that “the granny syndrome”—an original description of a new pattern of injury—is, therefore, a preventable toxic exposure when appropriate steps are taken to limit children's access to medications. 

The brief report included in this theme issue of the JAOA identifies a significant relationship between several neuropsychiatric symptoms and the degree of medical illness present in patients with a diagnosis of dementia. Peter Tran, DO, and colleagues³⁴ conclude that recognition of comorbid conditions in patients with dementia will likely assist physicians in diagnosis and treatment, and can improve quality of life for patients and their caregivers. 

Finally, in their clinical practice article, Marvin E. Herring, MD, and Shiwan K. Shah, DO,³⁵ report on the impact of oral health in elderly patients. Herring and Shah discuss how oral health assessment and management is frequently ignored in the primary care setting, especially in patients who have been diagnosed as having diabetes mellitus. While 7.6% of the overall population shares this diagnosis, the majority of these cases is in the elderly population. This cutting-edge research suggests primary care approaches to evaluation and management of periodontal disease as a way to improve outcomes for patients diagnosed as having diabetes mellitus. Certainly, proper oral health can improve nutrition in patients' later years and enhance quality of life. 

As the osteopathic medical profession moves forward, enhancing patients' quality of life and, in the process, helping the nation as a whole age successfully, more osteopathic medical research is required to enhance our body of working knowledge in this population. Likewise, additional original investigations are needed to identify ways to enhance clinical care at the end of life. Clearly, osteopathic medicine is making viable contributions in promoting successful aging and improving quality of care at the end of life.