Clinical Approach: An Overview

  • Richard W. Besdine


Health and disease behavior in older adults refers both to differences in the way diseases behave when occurring in older persons, and to differences in the way older persons behave when afflicted with disease.1 Behavior is the summation of social, ethnic, psychological, and clinical influences. Perceived severity of illness, the impact of disease on everyday function, denial, and local resources for help all affect behavior.2,3


Nursing Home Oral Health Nursing Home Resident Giant Cell Arteritis Arch Neural 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Levkoff SE, Cleary PD, Wetle T, et al. Illness behavior in the aged. Implications for clinicians. J Am Geriatr Soc. 1988; 36: 622–629.PubMedGoogle Scholar
  2. 2.
    Mechanic D. Medical Sociology. 2nd ed. New York: Free Press; 1978.Google Scholar
  3. 3.
    Besdine RW, et al. Health and illness behaviors in elder veterans. In: Wette T, Rowe JW, eds. Older Veterans: Linking VA and Community Resources. Cambridge: Harvard University Press; 1984.Google Scholar
  4. 4.
    Levkoff SE, et al. Differences in the appraisal of health between aged and middle-aged adults. J Gerontol. 1987; 42: 114.PubMedCrossRefGoogle Scholar
  5. 5.
    Ferraro K. Self-ratings of health among the old and the old-old. J Health Soc Behay. 1980; 21: 377.CrossRefGoogle Scholar
  6. 6.
    Anderson WF. The prevention of illness in the elderly: the Rutherglen experiment in medicine in old age. In: Pro-ceedings of a Conference Held at the Royal College of Physicians of London. London: Pitman; 1966.Google Scholar
  7. 7.
    Williamson J, et al. Old people at home: their unreported needs. Lancet. 1964; 1: 1117–1120.PubMedCrossRefGoogle Scholar
  8. 8.
    Shanas E. The Health of Older People. Cambridge: Harvard University Press; 1961.Google Scholar
  9. 9.
    Brody EM. Tomorrow and tomorrow and tomorrow: toward squaring the suffering curve. In: Gaitz CM, et al., eds. Aging 2000: Our Health Care Destiny, II. New York: Springer-Verlag; 1985.Google Scholar
  10. 10.
    Lyness JM, Cox C, Curry J, et al. Older age and the underreporting of depressive symptoms. JAm Geriatr Soc. 1995; 43: 216–221.Google Scholar
  11. 11.
    Leventhal EA, Prohaska TR. Age, symptom interpretation and health behavior. J Am Geriatr Soc. 1986; 34: 185.PubMedGoogle Scholar
  12. 12.
    Costa PT Jr, McCrae RR. Somatic complaints in males as a function of age and neuroticism: a longitudinal analysis. J Behav Med. 1980; 3: 245.PubMedCrossRefGoogle Scholar
  13. 13.
    Stenback A, et al. Illness and health behavior in septuagenarians. Gerontologist. 1978; 33: 57.Google Scholar
  14. 14.
    Besdine RW. Clinical approach to the elderly patient. In: Rowe JW, Besdine RW, eds. Geriatric Medicine. 2nd ed. Boston: Little, Brown; 1988: 23–36.Google Scholar
  15. 15.
    Wilson LA, et al. Multiple disorders in the elderly. Lancet. 1962; 2: 841.PubMedCrossRefGoogle Scholar
  16. 16.
    Besdine RW. Geriatric medicine: an overview. Ann Rev Gerontol Geriatr. 1980; 1: 135.Google Scholar
  17. 17.
    Besdine RW. The educational utility of comprehensive functional assessment in the elderly. J Am Geriatr Soc. 1983; 31: 651.PubMedGoogle Scholar
  18. 18.
    Kane RA, Kane RL. Assessing the Elderly: A Practical Guide to Measurement. Lexington, MA: Lexington Books; 1981.Google Scholar
  19. 19.
    National Institutes of Health Consensus Development Conference Statement: geriatric assessment methods for clinical decision-making. J Am Geriatr Soc. 1988;36:342347.Google Scholar
  20. 20.
    Besdine RW, Wakefield KM, Williams TF. Assessing function in the elderly. Patient Care. 1988; 22: 69–79.Google Scholar
  21. 21.
    American College of Physicians, Health and Public Policy Committee. Comprehensive functional assessment for elderly patients. Ann Intern Med. 1988; 109: 70–72.Google Scholar
  22. 22.
    Applegate WB, Blass JP, Williams TF. Instruments for the functional assessment of older patients. N Engl J Med. 1990; 322: 1207–1214.PubMedCrossRefGoogle Scholar
  23. 23.
    Hodkinson HM. Non-specific presentation of illness. Br Med J. 1973; 4: 94.PubMedCrossRefGoogle Scholar
  24. 24.
    Bayer AJ, et al. Changing presentation of myocardial infarction with increasing old age. J Am Geriatr Soc. 1986; 34: 263.PubMedGoogle Scholar
  25. 25.
    Kannel WB, Abbott RD. Incidence and prognosis of unrecognized myocardial infarction. N Engl J Med. 1984; 311: 1144.PubMedCrossRefGoogle Scholar
  26. 26.
    Doucet J, Trivalle CH, Chassagne PH, et al. Does age play a role in clinical presentation of hypothyroidism? J Am Geriatr Soc. 1994; 42: 984–986.PubMedGoogle Scholar
  27. 27.
    Osier W. Principle and Practice of Medicine. New York: D. Appleton & Co.; 1982: 95.Google Scholar
  28. 28.
    Podolsky S. Hyperosmolar nonketotic coma in the elderly diabetic. Med Clin North Am. 1978; 62: 815.PubMedGoogle Scholar
  29. 29.
    Wachtel TJ, et al. Prognostic factors in the diabetic hyperosmolar state. JAm Geriatr Soc. 1987; 35 (8): 737–741.Google Scholar
  30. 30.
    Thomas FB, et al. Apathetic thyrotoxicosis: a distinctive clinical and laboratory entity. Ann Intern Med. 1970; 72: 679.PubMedGoogle Scholar
  31. 31.
    Arie, T. Pseudodementia [Editorial]. Br Med J. 1983; 286: 1301.CrossRefGoogle Scholar
  32. 32.
    Kiloh LG. Pseudo-dementia. Acta Psychiatr Neurol. 1961; 37: 336.CrossRefGoogle Scholar
  33. 33.
    Reding M, Haycox J, Blass J. Depression in patients referred to a dementia clinic: a three-year prospective study. Arch Neurol. 1985; 42: 894.PubMedCrossRefGoogle Scholar
  34. 34.
    Lachs M, Feinstein A, Cooney L, et al. A simple procedure for general screening of functional disability in elderly patients. Ann Intern Med. 1990; 112: 699–706.PubMedGoogle Scholar
  35. 35.
    Lagaay AM, van der Meij JC, Hijmans W. Validation of medical history taking as part of a population based survey in subjects aged 85 and over. Br Med J. 1992; 304: 1091 1092.Google Scholar
  36. 36.
    Davis PB, Robins LN. History-taking in the elderly with and without cognitive impairment. J Am Geriatr Soc. 1989; 37 (3): 249–255.PubMedGoogle Scholar
  37. 37.
    Greeene MG, Majerovitz SD, Adelman RD, Rizzo C. The effects of the presence of a third person on the physician-older patient medical interview. J Am Geriatr Soc. 1994; 42: 413–419.Google Scholar
  38. 38.
    Fried LP, et al. Diagnosis of illness presentation in the elderly. JAm Geriatr Soc. 1991; 39: 117–23.Google Scholar
  39. 39.
    Nolan L, O’Malley K. Prescribing for the elderly, Part I: sensitivity of the elderly to adverse drug reactions. J Am Geriatr Soc. 1988; 36: 142–149.PubMedGoogle Scholar
  40. 40.
    Montamat SC, Cusack BJ, Vestal RE. Management of drug therapy in the elderly. N Engl J Med. 1989;321:303309.Google Scholar
  41. 41.
    Beers MH, Ouslander JG, Fingold SF, et al. Inappropriate medication prescribing in skilled-nursing facilities. Ann Intern Med. 1992; 117: 684–689.PubMedGoogle Scholar
  42. 42.
    Berkman LF. Social networks, support, and health: taking the next step forward. Am J Epidemiol. 1986; 123: 559.PubMedGoogle Scholar
  43. 43.
    Morley JE. Why do physicians fail to recognize and treat malnutrition in older persons? J Am Geriatr Soc. 1991; 39: 1139–1140.PubMedGoogle Scholar
  44. 44.
    Detsky AS, Smalley PS, Chang J. Is this patient malnourished? JAMA. 1994; 271: 54–58.PubMedCrossRefGoogle Scholar
  45. 45.
    Corti M-C, Guralnik JM, Salive ME, et al. Serum albumin level and physical disability as predictors of mortality in older persons. JAMA. 1994; 272: 1036–1042.PubMedCrossRefGoogle Scholar
  46. 46.
    Graham K. Identifying and measuring alcohol abuse among the elderly: serious problems with existing instrumentation. J Stud Alcohol. 1986; 47: 322–325.PubMedGoogle Scholar
  47. 47.
    Adams WL, Yuan Z, Barboriak JJ, et al. Alcohol-related hospitalizations of elderly people. JAMA. 1993; 270 (10): 1222–1225.PubMedCrossRefGoogle Scholar
  48. 48.
    Naik PC, Jones RG. Alcohol histories taken from elderly people on admission. Br Med J. 1994; 308: 248.CrossRefGoogle Scholar
  49. 49.
    Buchsbaum DG, Buchanan RG, Welsh J, et al. Screening for drinking disorders in the elderly using the CAGE questionnaire. J Am Geriatr Soc. 1992; 40 (7): 662–665.PubMedGoogle Scholar
  50. 50.
    LaCroix AZ, Lang J, Scherr P, et al. Smoking and mortality among older men and women in three communities. N Engl J Med. 1991; 324: 1619–1625.PubMedCrossRefGoogle Scholar
  51. 51.
    Kawachi I, Colditz GA, Stampfer MJ, et al. Smoking cessation and decreased risk of stroke in women. JAMA. 1993; 269: 232–236.PubMedCrossRefGoogle Scholar
  52. 52.
    Bretschneider JG, McCoy NL. Sexual interest and behavior in healthy 80 to 102 year olds. Arch Sex Behay. 1988; 17: 109–129.CrossRefGoogle Scholar
  53. 53.
    Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Geronto 1. 1994; 49: M85 - M94.Google Scholar
  54. 54.
    Reuben DB, Siu AL, Kimpau S. The predictive validity of self-report and performance-based measures of function and health. J Gerontol. 1992;47:M106-M 110.Google Scholar
  55. 55.
    Katz S, Ford AB, Moskowitz RW, et al. Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963; 185: 914–919.PubMedCrossRefGoogle Scholar
  56. 56.
    Cassell EJ. Art of medicine. In: Reich Warret T, ed. Encyclopedia of Bioethics, III. New York: Simon & Schuster, Macmillan; 1995: 1674–1679.Google Scholar
  57. 57.
    Prochazka AV, deRois S, Holdcrost C, et al. Observer variation in Osler’s maneuver, abstracted. Clin Res. 1987; 35: 756.Google Scholar
  58. 58.
    McFadden JP, Price RC, Eastwood HD, et al. Raised respiratory rate in elderly patients: a valuable physical sign. Br Med J. 1982; 284: 626–627.CrossRefGoogle Scholar
  59. 59.
    Hunder G, Bloch DA, Michel BA, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum. 1990; 33: 1122 1128.Google Scholar
  60. 60.
    Swan IRC, Browning GG. The whispered voice as a screening test for hearing impairment. J R Coll Gen Pract. 1985; 35: 197.PubMedGoogle Scholar
  61. 61.
    Lichtenstein MJ, Bess FH, Logan SA. Validation of screening tools for identifying hearing-impaired elderly in primary care. JAMA. 1988; 259: 2875–2878.PubMedCrossRefGoogle Scholar
  62. 62.
    Gordon SR, Jahnigen DW. Oral assessment of the dentulous elderly patient. J Am Geriatr Soc. 1986; 34: 276–281.PubMedGoogle Scholar
  63. 63.
    Ruiswyk JV, Noble H, Sigmann P. The natural history of carotid bruits in elderly persons. Ann Intern Med. 1990; 112: 340–343.PubMedGoogle Scholar
  64. 64.
    Heyman A, et al. Risk of stroke in asymptomatic persons with cervical arterial bruits. N Engl J Med. 1980; 302: 838.PubMedCrossRefGoogle Scholar
  65. 65.
    Mandelblatt JS, Wheat ME, Monane M, et al. Breast cancer screening for elderly women with and without comorbid conditions. Ann Intern Med. 1992; 116: 722–730.PubMedGoogle Scholar
  66. 66.
    Horm JW, Asire AJ, Young JL, et al. SEER Program: Cancer Incidence and Mortality in the US, 1973–1981. NIH publication 85–1837. Bethesda, MD: Department of Health and Human Services; 1985.Google Scholar
  67. 67.
    Yancik R, Ries LG, Yates JW. Breast cancer in aging women. Cancer. 1989; 63: 976–981.PubMedCrossRefGoogle Scholar
  68. 68.
    Fleg JL, Kennedy HL. Long-term prognostic significance of ambulatory electrocardiographic findings in apparently healthy subjects >_60 years of age. Am J Cardiol. 1992; 70: 748–751.PubMedCrossRefGoogle Scholar
  69. 69.
    Aronow WS, Mercando AD, Epstein S. Prevalence of arrhythmias detected by 24-hour ambulatory electrocardiography and value of antiarrhythmic therapy in elderly patients with unexplained syncope. Am J Cardiol. 1992; 70: 408–410.PubMedCrossRefGoogle Scholar
  70. 70.
    Lembo NJ, Dell’ltalia LJ, Crawford MH, et al. Bedside diagnosis of systolic murmurs. N Engl J Med. 1988; 318: 1572–1578.PubMedCrossRefGoogle Scholar
  71. 71.
    Leach RM, McBrien DJ. Brachioradial delay: a new clinical indicator of the severity of aortic stenosis. Lancet. 1990; 335: 119–201.CrossRefGoogle Scholar
  72. 72.
    Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. N Engl J Med. 1993; 328: 1365–1371. (Also see related editorial: Winawer SJ. Colorectal cancer screening comes of age. N Engl J Med. 1993;328:1416–1417.)Google Scholar
  73. 73.
    Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med. 1993; 329: 1977–1981.PubMedCrossRefGoogle Scholar
  74. 74.
    Podsiadlo D, Richardson S. The timed “up & go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr. 1991; 39: 142–148.Google Scholar
  75. 75.
    Tinetti ME, Ginter SF. Identifying mobility dysfunctions in elderly patients: standard neuromuscular examination or direct assessment? JAMA. 1988; 259: 1190–1193.PubMedCrossRefGoogle Scholar
  76. 76.
    Reuben DB, Siu AL. An objective measure of physical function of elderly outpatients, the physical performance test. J Am Geriatr Soc. 1990; 38: 1105–1112.PubMedGoogle Scholar
  77. 77.
    Odenheimer G, Funkenstein H, Beckett L, et al. Comparison of neurologic changes in `successfully aging’ persons vs the total aging population. Arch Neurol. 1994; 51: 573580.Google Scholar
  78. 78.
    Thomas RJ. Blinking and the release reflexes: are they clinically useful? J Am Geriatr Soc. 1994; 42: 609–613.PubMedGoogle Scholar
  79. 79.
    Forstl H, Burns A, Levy R, et al. Neurologic signs in Alzheimer’s disease. Results of a prospective clinical and neuropathological study. Arch Neurol. 1992; 49: 1038 1042.Google Scholar
  80. 80.
    Backine S, Lacomblez L, Palisson E, et al. Relationship between primitive refelxes, extra-pyramidal signs, reflective apraxia and severity of cognitive impairment in dementia of the Alzheimer’s type. Acta Neurol Scand. 1989; 79: 38–46.CrossRefGoogle Scholar
  81. 81.
    Jenkyn LR, Reeves AG, Warren T, et al. Neurologic signs in senescence. Arch Neurol. 1985; 42: 1154–1157.PubMedCrossRefGoogle Scholar
  82. 82.
    Forgotten symptoms and primitive signs [Editorial]. Lancet. 1987; 1 (8537): 841–842.Google Scholar
  83. 83.
    Impallomeni M, Kenny RA, Flynn MD, et al. The elderly and their ankle jerks. Lancet. 1984; 1 (8378): 670–672.PubMedCrossRefGoogle Scholar
  84. 84.
    Fries JF, Bloch DA, Harrington BA, Richardson N, et al. Two-year results of a randomized controlled trial of a health promotion program in a retiree population: the Bank of America study. Am J Med. 1993; 94: 455–462.PubMedCrossRefGoogle Scholar
  85. 85.
    Fries JF, Koop CE, Beadle CE, et al. Reducing health care costs by reducing the need and demand for medical services. N Engl J Med. 1993; 329: 321–325.PubMedCrossRefGoogle Scholar
  86. 86.
    DHSS, USPHS. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. DHSS publication (PHS) 91–50212. Washington, DC: US Government Printing Office; 1991.Google Scholar
  87. 87.
    Institute of Medicine. The Second Fifty Years: Promoting Health and Preventing Disability. Washington, DC: National Academy Press; 1991.Google Scholar
  88. 88.
    SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA. 1991;265:3255–3264.Google Scholar
  89. 89.
    Sagie A, Larson MG, Levy D. The natural history of bor-derline isolated systolic hypertension. N Engl J Med.1993;329:1912–1917.Google Scholar
  90. 90.
    Neaton JD, Grimm RH, Prineas RJ, et al. Treatment of mild hypertension study: final results. JAMA. 1993;270:713–724.Google Scholar
  91. 91.
    Curfman GD. The health benefits of exercise. N Engl J Med. 1993; 328: 574–576.PubMedCrossRefGoogle Scholar
  92. 92.
    Centers for Disease Control and Prevention, American College of Sports Medicine. Physical activity and public health. JAMA. 1995; 273: 402–407.Google Scholar
  93. 93.
    Marottoli RA, Cooney LM, Wagner DR, et al. Predictors of automobile crashes and moving violations among elder drivers. Ann Intern Med. 1994;121:842–846.Google Scholar
  94. 94.
    Butler JC, Breiman RF, Campbell JF, et al. Pneumococcal polysaccharide vaccine efficacy: an evaluation of current recommendations. JAMA. 1993;270:1826–1831.Google Scholar
  95. 95.
    Nichol KL, Margolis KL, Wuorenma J, et al. Efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. N Engl J Med. 1994; 331: 778–784.PubMedCrossRefGoogle Scholar
  96. 96.
    Govaert Th ME, Thijs CTMCN, Masurel N, et al. The efficacy of influenza vaccination in elderly individuals. JAMA. 1994; 272 (21): 1661–1665.CrossRefGoogle Scholar
  97. 97.
    Mullooly JP, Bennett MD, Hornbrook MC, et al. Influ-enza vaccination programs for elderly persons: cost effectieness in a health maintenance organization. AnnIntern Med. 1994; 121: 947–952.Google Scholar
  98. 98.
    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: 405–412.PubMedCrossRefGoogle Scholar
  99. 99.
    Gergen PJ, McQuillan GM, Kiely M, et al. A population-based serologic survey of immunity to tetanus in the United States. N Engl J Med. 1995;332:761–766.Google Scholar
  100. 100.
    Aloia JF, Aswani A, Yeh JK, et al. Calcium tion with and without hormone replacement therapy to prevent postmenopausal bone loss. Ann Intern Med. 1994; 120: 97–103.PubMedGoogle Scholar
  101. 101.
    Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med. 1992;327:1637–1642.Google Scholar
  102. 102.
    Cauley JA, Seeley DG, Ensrud K, et al. Estrogen replace-ment therapy and fractures in older women. Ann Intern Med. 1995;122:9–16.Google Scholar
  103. 103.
    Stampfer MJ, Colditz GA, Willett WC, et al. Postmeno-pausal estrogen therapy and cardiovascular disease.N Engl J Med. 1991;325:756–762.Google Scholar
  104. 104.
    Colditz GA, Hankinson ScD, Hunter DJ, et al. The use of estrogens and progestins and the risk of breast cancer in postmenopausal women. N Engl J Med. 1995; 332 (24): 1589–1593.PubMedCrossRefGoogle Scholar
  105. 105.
    Stanford JL, Weiss NS, Voight LF, et al. Combined estro-gen and progestin hormone replacement therapy in rela-tion to risk of breast cancer in middle-aged women.JAMA. 1995;274:137–142.Google Scholar
  106. 106.
    Judge JO, Underwood M, Gennosa T. Exercise to im-prove gait velocity in older persons. Arch Phys MedRehabil. 1993;74:400–406.Google Scholar
  107. 107.
    Gurwitz JH, Avorn J. The ambiguous relation between aging and adverse drug reactions. Ann Intern Med. 1991;114(11):956–966.Google Scholar
  108. 108.
    Tinetti ME, Baker DI, McAvay G, et al. A multifactorial intervention to reduce the risk of falling among people living in the community. N Engl J Med. 1994; 331: 821–827.PubMedCrossRefGoogle Scholar
  109. 109.
    Nevitt MC, Cummings SR, Kidd S, Black D. for recurrent nonsyncopal falls: a prospective study. JAMA. 1989;261:2663–2668.Google Scholar
  110. 110.
    Willcox SM, Himmelstein DU, Woolhandler S. Inappro-priate drug prescribing for the community-dwelling JAMA. 1994;272:292–296.Google Scholar
  111. 111.
    House JS, Landis KR, Umberson D. Social relationships and health. Science. 1988; 241: 540–545.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Richard W. Besdine

There are no affiliations available

Personalised recommendations