Ambulatory Care of the Elderly

  • Nadine DubowitzEmail author
  • Sonika Pandey
  • Elizabeth L. Cobbs


  • Comprehensive geriatric assessment forms the basis of the medical approach to optimizing health and wellness for older adults.

  • Goals of medical care should be customized and balance risks and benefits in a person-centered frame.

  • Communication and health literacy are important components of effective ambulatory care.

  • Advance care planning discussion and documentation are an important element of comprehensive care of older persons.

  • Transition management and referrals to community resources are important components of ambulatory care.


  1. 1.
    Kinsella K, Wan H. US Census Bureau, international population reports, P95/09-1, an aging world: 2008. Washington, DC: US Government Printing Office; 2009.Google Scholar
  2. 2.
    Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55(5):780–91. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3. Accessed 10 Jan 16.
  4. 4.
  5. 5.
    Karp F, editor. A clinician’s handbook: talking with your older patient. USA: National Institute on Aging, National Institutes of Health, Department of Health and Human Services; 2008. Google Scholar
  6. 6.
    Katz S, Down TD, Cash HR, Grotz RC. Progress in the development of the index of ADL. Gerontologist. 1970;10:20.CrossRefPubMedGoogle Scholar
  7. 7.
    Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179.CrossRefPubMedGoogle Scholar
  8. 8.
    Hung WW, Ross JS, Boockvar KS, Siu AL. Recent trends in chronic disease, impairment and disability among older adults in the United States. BMC Geriatr. 2011;11:47.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Cohen HJ, et al. A controlled trial of inpatient and outpatient geriatric evaluation and management. N Engl J Med. 2002;346(12):905–12. 1 CrossRefPubMedGoogle Scholar
  10. 10.
    Elsawy B, Higgins K. The geriatric assessment. Am Fam Physician. 2011;83(1):48–56.PubMedGoogle Scholar
  11. 11.
    Tinetti ME, Inouye SK, Gill TM, Doucette JT. Shared risk factors for falls, incontinence, and functional dependence: unifying the approach to geriatric syndromes. JAMA. 1995;273(17):1348–53. CrossRefPubMedGoogle Scholar
  12. 12.
    Borson S, Scanian J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. Int J Geriatr Pyschiatry. 2000;15(11):1021–7. CrossRefGoogle Scholar
  13. 13.
    Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365(21):2002–12. CrossRefPubMedGoogle Scholar
  14. 14.
    American Geriatrics Society. Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46. CrossRefGoogle Scholar
  15. 15.
    McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635–45.CrossRefPubMedGoogle Scholar
  16. 16.
    WHO Global Report on Falls Prevention in Older Age. Ageing and life course, family and community health; 2007.Google Scholar
  17. 17.
    Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk M, Koch ML, Trainor K, Horwitz RI. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med. 1994;331(13):821–7. CrossRefPubMedGoogle Scholar
  18. 18.
    Leipzig RM, Whitlock EP, Wolff TA, Barton MB, Michael YL, Harris R, Petitti D, Wilt T, Siu A, US Preventive Services Task Force Geriatric Workgroup. Reconsidering the approach to prevention recommendations for older adults. Ann Intern Med. 2010;153(12):809–14.CrossRefPubMedGoogle Scholar
  19. 19.
    Gnanadesigan N, Fung CH. Quality indicators for screening and prevention in vulnerable elders. J Am Geriatr Soc. 2007;55(Suppl 2):5417–23.Google Scholar
  20. 20.
    McCarten JR, Anderson P, Kuskowski MA, SE MP, Borson S. Screening for cognitive impairment in an elderly veteran population: acceptability and results using different versions of the Mini-Cog. J Am Geriatr Soc. 2011;59(2):309–31. Scholar
  21. 21.
    Centers for Disease Control and Prevention and the Merck Company Foundation. The state of aging and health in America in 2007: executive summary. Whitehouse Station, NJ: The Merck Foundation; 2007.Google Scholar
  22. 22.
    Institute of Medicine. Health literacy: a prescription to end confusion. Washington, DC: National Academies Press; 2004.Google Scholar
  23. 23.
    Village to Village Network in the US.
  24. 24.
    Counsell SR, Callahan CM, Clark DO, Wanzhu T, Buttar AB, Stump TE, Ricketts GD. Geriatric care management for low-income seniors – a randomized controlled trial. JAMA. 2007;298(22):2623–33. doi: 10.1001/jama.298.22.2623. CrossRefPubMedGoogle Scholar
  25. 25.
    Hesselink G, Schoonhoven L, Barach P, Spijker A, Gademan P, Kalkman C, Liefers J, Vernooij-Dassen M, Wolldersheim H. Improving patient handovers from hospital to primary care: a systematic review. Ann Intern Med. 2012;157(6):417–28.CrossRefPubMedGoogle Scholar
  26. 26.
    Edes T, Kinosian B, Vuckovic NH, Nichols LO, Becker MM, Hossain M. Better access, quality, and cost for clinically complex veterans with home-based primary care. J Am Geriatr Soc. 2014;62(10):1954–61.CrossRefPubMedGoogle Scholar
  27. 27.
    Wenger NS, Roth CP, Shekelle P, ACOVE Investigators. Introduction to the assessing care of vulnerable elders-3 quality indicator measurement set. J Am Geriatr Soc. 2007;55(Suppl 2):S247–52. PubMed PMID: 17910544CrossRefPubMedGoogle Scholar
  28. 28.
    Counsell SR, Callahan CM, Tu W, et al. Cost analysis of the Geriatric Resources for Assessment and Care of Elders care management intervention. J Am Geriatr Soc. 2009;57(8):1420–6.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Brown RS, Peikes D, Peterson G, et al. Six features of Medicare Coordinated Care Demonstration programs that cut hospital admissions of high-risk patients. Health Aff (Millwood). 2012;31(6):1156–66.CrossRefGoogle Scholar
  30. 30.
    James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC, Svetkey LP, Taler SJ, Townsend RR, Wright JT, Narva AS, Ortiz E. 2014 evidence-based guidelines for the management of high blood pressure in adult: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20. doi: 10.1001/jama.2013.284427.CrossRefPubMedGoogle Scholar
  31. 31. American Diabetes Association, Standards of Medical Care in Diabetes – 2016. J Clin Appl Res Educ. 2016;39(Suppl 1).
  32. 32.
    2011 World Health Oganization. European report on preventing elder maltreatment at Accessed 31 Jan 2016.Google Scholar
  33. 33.
    Hoover RM, Polson M. Detecting elder abuse and neglect: assessment and intervention. Am Fam Physician. 2014;89(6):453–60.PubMedGoogle Scholar
  34. 34.
    Burnett J, Regev T, Pickens S, Pratt LL, Aung K, Moore J, Dyer CB. Social networks: a profile of the elderly who self-neglect. J Elder Abuse Negl. 2006;18(4):35–49.CrossRefPubMedGoogle Scholar
  35. 35.
    Dyer CB, Pickens S, Birnett J. Vulnerable elders. When it is no longer safe to live alone. JAMA. 2007;298(12):1448–50.CrossRefPubMedGoogle Scholar
  36. 36.
    Mosqueda L, Dong X. Elder abuse and self-neglect: “I don’t care anything about going to the doctor, to be honest…”. JAMA. 2011;306(5):532–40. PubMed PMID: 21813431CrossRefPubMedGoogle Scholar
  37. 37.
    Tariq SH, Tumosa N, Chibnall JT, Perry MH, Morley JE. Comparison of the Saint Louis University Mental Status Examination and the Mini-Mental State Examination for detecting dementia and mild neurocognitive disorder: a pilot study. Am Ger Psychiatry. 2006;14(11):900–10.CrossRefGoogle Scholar
  38. 38.
    Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment (MoCA): a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695–9.CrossRefPubMedGoogle Scholar

Copyright information

© The Editor(s)  2018

Authors and Affiliations

  • Nadine Dubowitz
    • 1
    • 2
    Email author
  • Sonika Pandey
    • 1
    • 2
  • Elizabeth L. Cobbs
    • 1
    • 2
  1. 1.Washington DC Veterans Affairs Medical CenterWashington, DCUSA
  2. 2.George Washington UniversityWashington, DCUSA

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