Editorial  |   July 2006
Clinical Care for an Aging Population: Aging Successfully in the 21st Century
Author Notes
  • From the University of Medicine and Dentistry of New Jersey–School of Osteopathic Medicine in Stratford. Dr Cavalieri serves on the Editorial Board of JAOA—The Journal of the American Osteopathic Association. 
  • Address correspondence to Thomas A. Cavalieri, DO, 1 Medical Center Dr, Suite 305, Stratford, NJ 08084-1500. E-mail: 
Article Information
Geriatric Medicine
Editorial   |   July 2006
Clinical Care for an Aging Population: Aging Successfully in the 21st Century
The Journal of the American Osteopathic Association, July 2006, Vol. 106, 384-386. doi:
The Journal of the American Osteopathic Association, July 2006, Vol. 106, 384-386. doi:
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, 65.15 
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.1015 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: 
  • low probability of disease or avoidance of complications of chronic diseases with age;
  • high functional capacity—both physical and cognitive; and
  • active engagement with life, including interpersonal relationships and productive activity.
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.1719 Many studies have demonstrated a failure within the healthcare system to adequately manage pain and other symptoms at the end of life,2024 approach issues of advance care planning,2527 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. 
Lohr S. The nation: retirement ideal; the late, great “golden years.” New York Times. March 6, 2005. 4:1. Available at: Accessed June 27, 2006.
Queenan J, Gillion S, guests. Baby boomers turn 60. Talk of the Nation. National Public Radio. December 27, 2005. Available at: Accessed June 27, 2006.
Baby boomers turn 60 their way: they'll fight against aging and stay active. Good Morning America. ABC News. January 20, 2006. Available at: Accessed June 27, 2006.
Oldest baby boomers turn 60! [press release]. Washington DC: US Census Bureau; January 3, 2006. Available at: Accessed June 27, 2006.
Wiatrowski WJ. Changing retirement age: ups and downs. Monthly Labor Rev Online [serial online]. April 2001;124. Available at: Accessed June 27, 2006.
Federal Interagency Forum on Aging-Related Statistics. Population page. Older Americans 2004: key indicators of well-being Web site. Available at: Accessed June 27, 2006.
Administration on Aging. Future Growth page. September 9, 2004. A profile of older Americans: 2003 Web site. Available at: Accessed June 27, 2006.
Krach CA, Velkoff VA. Centenarians in the United States, 1990. US Census Bureau – Current Population Reports: Special Studies. Washington DC: US Department of Health and Human Services; 1990. Available at: Accessed June 27, 2006.
He W, Sengupta M, Velkoff VA, DeBarros KA. 65+ in the United States: 2005. US Census Bureau – Current Population Reports: Special Reports. Washington DC: US Government Printing Office; 2005. Available at: Accessed July 5, 2006.
Cutler DM. Declining disability among the elderly. Health Aff. November/December 2001;20:11–27. Available at: Accessed June 27, 2006.
Waidmann TA, Manton KG. International evidence on disability trends among the elderly. June 18, 1998. Washington DC: US Department of Health and Human Services; 1998. Available at: Accessed June 27, 2006.
Freedman VA, Martin LG, Schoeni RF. Recent trends in disability and functioning among older adults in the United States: a systematic review [published correction appears in JAMA. 2003;289:3242]. JAMA. 2002;288:3137 –3146.
Manton KG, Corder L, Stallard E. Chronic disability trends in elderly United States populations: 1982–1994. Proc Natl Acad Sci USA. 1997;94:2593–2598. Available at: Accessed July 5, 2006.
Manton KG, Gu X. Changes in the prevalence of chronic disability in the United States black and nonblack population above age 65 from 1982 to 1999. Proc Natl Acad Sci USA. 2001;98:6354–6359. Epub May 8, 2001. Available at: Accessed July 5, 2006.
Schoeni RF, Freedman VA, Wallace RB. Persistent, consistent, widespread, and robust? Another look at recent trends in old-age disability. J Gerontol B Psychol Sci Soc Sci. 2001;56:S206 –S218.
Rowe JW, Kahn RL. Successful aging [review]. Gerontol. 1997;37:433 –440.
Nichols KJ. Osteopathic medicine: providing “rest from pain” at end of life [editor's message]. J Am Osteopath Assoc. 2005;105(1 suppl 3):i,S1. Available at: Accessed June 27, 2006.
Nichols KJ, Galluzzi KE, Bates B, Husted BA, Leleszi JP, Simon K; for the American Osteopathic Association End of Life Care Committee. AOA's position against the use of placebos for pain management in end-of-life care. J Am Osteopath Assoc. 2005;105(1 suppl 3):S2–S5. Available at: Accessed June 27, 2006.
Jennings B, ed. Improving end of life care: why has it been so difficult? [preface]. Hastings Cent Rep. November/December(2005). ;35(special report):S2 –S4.
O'Neill TW, Roy DK. How many people develop fractures with what outcome? [review]. Best Pract Res Clin Rheumatol. 2005;19:879 –895.
Dahl JL. Effective pain management in terminal care [review]. Clin Geriatr Med. 1996;12:279 –300.
Borneman T, Ferrell BR. Ethical issues in pain management [review]. Clin Geriatr Med. 1996;12:615 –628.
Sheehan DC, Forman WB. Symptomatic management of the older person with cancer [review]. Clin Geriatr Med. 1997;13:203 –219.
Rousseau P. Nonpain symptom management in terminal care [review]. Clin Geriatr Med. 1996;12:313 –327.
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The SUPPORT Principal Investigators. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT) [published correction appears in JAMA. 1996;275:1232]. JAMA. 1995;274:1591 –1598.
von Gunten CF. Interventions to manage symptoms at the end of life. J Palliat Med. 2005;8(suppl 1):S88 –S94.
Weiner JS, Cole SA. Three principles to improve clinician communication for advance care planning: overcoming emotional, cognitive, and skill barriers [review]. J Palliat Med. 2004;7:817 –829.
Kahana B, Dan A, Kahana E, Kercher K. The personal and social context of planning for end-of-life care. JAm Geriatr Soc. 2004;52:1163 –1167.
Steier KJ, Singh G, Ullah A, Maneja J, Ha RS, Khan F. Venous thromboembolism: application and effectiveness of the American College of Chest Physicians 2001 guidelines for prophylaxis. J Am Osteopath Assoc. 2006;106:388 –395.
Rohr CI, Clements JM, Sarkar A. Treatment and prevention practices in postmenopausal women after bone mineral density screening at a community-based osteoporosis project. J Am Osteopath Assoc. 2006;106:396 –401.
Adams DH, Snedden DP. Misconceptions among elderly patients regarding survival outcomes of inpatient cardiopulmonary resuscitation affect do-not-resuscitate orders. J Am Osteopath Assoc. 2006;106:402 –404.
McFee RB, Caraccio TR. “Hang up your pocketbook” — an easy intervention for the granny syndrome: grandparents as a risk factor in unintentional pediatric exposures to pharmaceuticals. J Am Osteopath Assoc. 2006;106:405 –411.
Tran P, Schmidt K, Gallo J, Tuppo E, Scheinthal S, Chopra A, et al. Neuropsychiatric symptoms and medical illness in patients with dementia: an exploratory study. J Am Osteopath Assoc. 2006;106:412 –414.
Herring ME, Shah SK. Periodontal disease and control of diabetes mellitus. J Am Osteopath Assoc. 2006;106:416 –422.