General Considerations

The geriatric patient is an individual 65 years of age or older. Among such individuals, there is considerable variation in general health, mental status, functional ability, personal and social resources, marital status, living arrangements, creativity, and social integration. The age range of this rapidly growing population spans more than 40 years. The world's geriatric population is currently increasing at a rate of 2.5% per year—significantly faster than the total population. Between 1900 and 2000, the number of Americans older than 65 years increased from a little more than 3 million to 35 million. Since 1960, the geriatric population has grown 107%, in comparison with 50% for the U.S. population as a whole. From 2000 to 2040, in the United States, the number of people 65 years of age or older is projected to increase from 34.8 million to 77.2 million. It is estimated that in the developed nations of the world, there are 146 million people 65 years of age and older. This group will increase to 232 million by the year 2020.

A decreasing rate of mortality, especially from heart disease and stroke, and a reduction in risk factors such as smoking, high blood pressure, and high serum cholesterol levels have contributed to this increased survival.

The population older than 85 years of age represents the fastest-growing segment of the U.S. population. This ''graying of America'' is expected to continue. By the year 2020, one fifth of the population will be older than 65 years of age. These statistics are extremely important in view of the cost of medical care for this population. Currently, 32% of all health-care dollars is spent on the geriatric population, which constitutes only 12% of the total population.

Some other statistics are important. Eighty-nine percent of the elderly are white. Elderly women outnumber elderly men 1.5:1 overall and 3:1 among individuals 95 years of age and older. African Americans constitute 12% of the total U.S. population but only 8% of the older age groups. In 1986, most older men (77%) were married, whereas most older women (52%) were widows. Fifteen percent of older men live alone, in comparison with 40% of women. Nursing home residents account for 5% of the population older than 65 years. Approximately 12% of the population older than 65 years of age continue to work;25% are self-employed, in comparison with 10% of the total population. Five percent of the geriatric population—nearly 1 million individuals—are victimized by abuse or neglect. The U.S. Bureau of the Census estimates that 1 million Americans will be 100 years of age or older by the year 2050 and that nearly 2 million will be that age by the year 2080.

Falls are the leading cause of death from injury in individuals 65 years of age and older. Two thirds of reported injury-related deaths in patients 85 years of age and older are caused by falls. Falls are a leading cause of traumatic brain injuries. Approximately 3% to 5% of falls in older adults cause fractures. On the basis of the 2000 census, this translates to 360,000 to 480,000 fall-related fractures each year. Of all fall-related fractures, hip fractures cause the greatest number of deaths and lead to the most severe health problems and reductions in quality of life. In 1991, Medicare costs for hip fractures were estimated to be $2.9 billion. A fear of falling is also common;50% to 60% of all patients older than 65 years of age have this fear.

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