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New Frontiers in

Geriatrics Research
New Frontiers in
Geriatrics Research
An Agenda for Surgical and
Related Medical Specialties
David H. Solomon, MD, MACP, Editor
Joseph LoCicero III, MD, FACS, Associate Editor
Ronnie Ann Rosenthal, MD, FACS, Associate Editor

A Project of
The American Geriatrics Society
and
The John A. Hartford Foundation
PUBLISHED BY THE AMERICAN GERIATRICS SOCIETY
New York, NY, USA
This publication was prepared by the American Geriatrics Society as a service to health
care providers involved in the care of older persons. Funding provided by The John A.
Hartford Foundation made the development of this publication possible.
New Frontiers in Geriatrics Research is independently prepared and published. All
decisions regarding its content are solely the responsibility of the authors and editors.
Their decisions are not subject to any form of approval by other interests or organizations.
No responsibility is assumed by the authors or the American Geriatrics Society for any
injury or damage to persons or property, as a matter of product liability, negligence,
warrant, or otherwise, arising out of the use or application of any methods, products,
instructions, or ideas contained herein. No guarantee, endorsement, or warranty of any
kind, express or implied (including specifically no warrant of merchantability or fitness
for a particular purpose) is given by the Society in connection with any information
contained herein. Independent verification of any diagnosis, treatment, or drug use or
dosage should be obtained. No test or procedure should be performed unless, in the judg-
ment of an independent, qualified physician, it is justified in the light of the risk involved.

Citation: Solomon DH, LoCicero J 3rd, Rosenthal RA, eds.


New Frontiers in Geriatrics Research:
An Agenda for Surgical and Related Medical Specialties. 2004.

Copyright © 2004 by the American Geriatrics Society


All rights reserved. Except where authorized, no part of this publication may be
reproduced, stored in a retrieval system, or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise without prior written
permission of the American Geriatrics Society, Empire State Building, Suite 801, 350
Fifth Avenue, New York, NY 10118.

ISBN 1–886775–11–7
Printed in the U.S.A.

iv
To our older patients
and to those dedicated to providing the best care for them

v
CONTENTS

Acknowledgments ix
Chapter
1. Introduction by David H. Solomon, MD, MACP;
Joseph LoCicero III, MD, FACS; Ronnie Ann Rosenthal, MD, FACS 1
2. Geriatric Anesthesia by David J. Cook, MD 9
3. Geriatric Emergency Medicine by Scott T. Wilber, MD, FACEP 53
4. Geriatric General Surgery by Walter E. Pofahl II, MD, FACS 85
5. Geriatric General Thoracic Surgery by Joseph LoCicero III, MD, FACS;
John Yee, MD 111
6. Geriatric Cardiac Surgery by Nicola Francalancia, MD;
Joseph LoCicero III, MD, FACS 147
7. Geriatric Ophthalmology by Andrew G. Lee, MD;
Anne Louise Coleman, MD, PhD 177
8. Geriatric Otolaryngology by Hinrich Staecker, MD, PhD 203
9. Geriatric Gynecology by Karen L. Miller, MD; Morton A. Stenchever, MD;
Holly E. Richter, PhD, MD; Evelyn C. Granieri, MD, MPH, MSEd;
William C. Andrews, MD, FACOG, FRCOG 225
10. Geriatric Urology by Tomas L. Griebling, MD 269
11. Geriatric Orthopedics by Susan Day, MD 303
12. Geriatric Rehabilitation by Helen Hoenig, MD, MPH;
Hilary C. Siebens, MD 339
13. Cross-Cutting Issues by Joseph LoCicero III, MD, FACS with
Arlene S. Bierman, MD, MS; Anne Louise Coleman, MD, PhD;
Marion Danis, MD; George W. Drach, MD; Lowell W. Gerson, PhD;
Laura C. Hanson, MD, MPH; Robert R. Karpman, MD, MBA;
Andrew G. Lee, MD; Steven M. Parnes, MD; Walter J. Pories, MD, FACS;
G. Alec Rooke, MD, PhD; Hilary C. Siebens, MD;
Morton A. Stenchever, MD 369
Index 421

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ACKNOWLEDGMENTS

THE JOHN A. HARTFORD FOUNDATION


We are indebted to The John A. Hartford Foundation for their unswerving commitment to
“improving the quality and financing of health care and assisting the health care system to
accommodate the nation’s aging population.” The innovative programs developed with
their support will provide better health care for current and future generations of older
adults.
We are grateful for the wisdom and guidance provided by Laura A. Robbins, Senior
Program Officer for the Increasing Geriatrics Expertise in Surgical and Related Medical
Specialties (Geriatrics for Specialists) project from its inception through October 2003.
We thank the members of the Board of Trustees and Cory H. Rieder, EdD, Donna
Regenstreif, PhD, Christopher A. Langston, PhD, and the rest of the staff at The John A.
Hartford Foundation for their continuing guidance and support of our efforts to improve
the care provided to older adults by surgical and related medical specialists.
For additional information about The John A. Hartford Foundation, located in New York
City, please visit their Web site at http://www.jhartfound.org/

PROJECT PARTICIPANTS
Many talented and knowledgeable people have collaborated to make this publication pos-
sible. Each has made a substantial contribution to the development of the research agenda,
and we thank the following people for dedicating their time and effort to complete the
tasks that made this volume possible:

Anesthesiology
David J. Cook, MD, Content Expert
Associate Professor of Anesthesiology
Mayo Clinic and Foundation
Rochester, MN
G. Alec Rooke, MD, PhD, Senior Writer
Professor of Anesthesiology
University of Washington School of Medicine
Veterans Affairs Puget Sound Health Care System
Seattle, WA
Jerry Reves, MD, At-large Leader
VP for Medical Affairs and Dean, College of Medicine
Medical University of South Carolina
Charleston, SC

ix
Jeffrey H. Silverstein, MD, At-large Leader
Associate Professor of Anesthesiology, Surgery, and Geriatrics & Adult Development
Associate Dean for Research
Mount Sinai School of Medicine
Vice Chairman for Research
Department of Anesthesiology
New York, NY

Emergency Medicine
Scott T. Wilber, MD, FACEP, Content Expert
Assistant Professor of Emergency Medicine
Northeastern Ohio Universities College of Medicine
Rootstown, OH
Associate Director
Emergency Medicine Research Center
Summa Health System
Akron, OH
Lowell W. Gerson, PhD, Senior Writer
Professor of Epidemiology and Associate Director
Division of Community Health Sciences
Northeastern Ohio University College of Medicine
Rootstown, OH
Stephen W. Meldon, MD, At-large Leader
Associate Professor
CWRU Department of Emergency Medicine at MetroHealth Medical Center
Cleveland, OH
Arthur B. Sanders, MD, At-large Leader
Professor, Department of Emergency Medicine
University of Arizona College of Medicine
Tucson, AZ

General Surgery
Walter E. Pofahl II, MD, FACS, Content Expert
Associate Professor
Chief, Division of General Surgery
Brody School of Medicine
East Carolina University
Greenville, NC
Walter J. Pories, MD, FACS, Senior Writer
Professor of Surgery and Biochemistry
East Carolina University
Department of Surgery
Greenville, NC

x
J. Patrick O’Leary, MD, At-large Leader
The Isidore Cohn Jr. Professor and Chairman
Department of Surgery
Louisiana State University School of Medicine
New Orleans, LA
Ronnie Ann Rosenthal, MD, FACS, At-large Leader and Associate-Editor
Associate Professor of Surgery
Yale University School of Medicine
Chief, Surgical Service, Veterans Affairs Connecticut Healthcare System
New Haven, CT

Geriatrics
John R. Burton, MD, Consultant to Orthopedic Surgery
Project Co-Director 1998-2003, Project Director 2003-2005
Mason F. Lord Professor of Medicine
Division of Geriatric Medicine and Gerontology
Johns Hopkins University School of Medicine
Baltimore, MD
Colleen Christmas, MD, Consultant to Anesthesiology
Director, Hip Fracture and Geriatric Consultation Service
Assistant Professor of Medicine
Division of Geriatric Medicine
Johns Hopkins University
Baltimore, MD
Evelyn C. Granieri, MD, MPH, MSEd, Consultant to Gynecology
Associate Professor of Geriatric Medicine
Mount Sinai School of Medicine
Chief, Geriatrics Services
Bronx Veterans Affairs Medical Center
Bronx, NY
Dennis W. Jahnigen, MD (deceased, Project Director 1994-1998)
Goodstein Professor of Geriatric Medicine
Director of the Center on Aging
University of Colorado Health Sciences Center (UCHSC)
Denver, CO
Paul R. Katz, MD, Consultant to General Surgery
Professor of Medicine
University of Rochester School of Medicine and Dentistry
Medical Director, Monroe Community Hospital
Rochester, NY
Brenda K. Keller, MD, Consultant to Ophthalmology
Assistant Professor
Section of Geriatrics and Gerontology
University of Nebraska Medical Center
Omaha, NE
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C. Seth Landefeld, MD, Consultant to Emergency Medicine
Professor of Medicine and Epidemiology and Biostatistics
Chief, Division of Geriatrics
University of California San Francisco
Associate Chief of Staff
Geriatrics and Extended Care
San Francisco Veterans Affairs Medical Center
San Francisco, CA
Douglas K. Miller, MD, Consultant to Thoracic Surgery
Richard M. Fairbanks Chair in Aging Research
Associate Director, Indiana University Center for Aging Research
Scientist, Regenstrief Institute, Inc
Indiana University School of Medicine
Indianapolis, IN
Myron Miller, MD, Consultant to Physical Medicine and Rehabilitation
Professor, Department of Medicine
Johns Hopkins University School of Medicine
Academic Director, Division of Geriatric Medicine
Department of Medicine
Sinai Hospital of Baltimore
Baltimore, MD
Joseph G. Ouslander, MD, Consultant to Urology
Professor of Medicine and Nursing
Director, Division of Geriatric Medicine and Gerontology
Chief Medical Officer, Wesley Woods Center of Emory University
Director, Emory Center for Health in Aging
Research Scientist, Birmingham/Atlanta Veterans Affairs GRECC
Atlanta, GA
David H. Solomon, MD, MACP, Consultant to Otolaryngology and Editor
Project Director 1997-2003
Professor Emeritus of Medicine/Geriatrics
David Geffen School of Medicine at UCLA
Los Angeles, CA

Gynecology
Karen L. Miller, MD, Content Expert
Assistant Professor, Department of Obstetrics and Gynecology
University of Utah Health Sciences Center
Salt Lake City, UT
Morton A. Stenchever, MD, Senior Writer
Professor and Chairman Emeritus
Department of Obstetrics and Gynecology
University of Washington School of Medicine
Seattle, WA
xii
William C. Andrews, MD, FACOG, FRCOG, At-large Leader
Professor Emeritus of Obstetrics and Gynecology
Eastern Virginia Medical School
Norfolk, VA
Holly E. Richter, PhD, MD, At-large Leader
Associate Professor
Medical Surgical Gynecology
University of Alabama at Birmingham
Birmingham, AL

Ophthalmology
Anne Louise Coleman, MD, PhD, Content Expert and Senior Writer
Professor of Ophthalmology
Jules Stein Eye Institute
University of California
Los Angeles, CA
Andrew G. Lee, MD, Content Expert and Senior Writer
Associate Professor of Ophthalmology, Neurology, and Neurosurgery
University of Iowa Hospitals and Clinics
Iowa City, IA
Richard Alan Lewis, MD, MS, At-large Leader
Professor, Departments of Ophthalmology, Medicine, Pediatrics, and Molecular and
Human Genetics
Faculty Associate, Huffington Center on Aging
Houston, TX
Gwen K. Sterns, MD, At-large Leader
Clinical Professor, Department of Ophthalmology
University of Rochester School of Medicine and Dentistry
Chief, Department of Ophthalmology
Rochester General Hospital
Medical Director
Association for the Blind and Visually Impaired—Goodwill
Rochester, NY

Orthopedic Surgery
Susan Day, MD, Content Expert
Clinical Instructor, Michigan State University
Grand Rapids Orthopaedic Residency Program
Grand Rapids, MI

xiii
Robert Karpman, MD, MBA, Senior Writer
Phoenix, AZ
E. Dennis Lyne, MD, At-large Leader
Pediatric Orthopaedics
Program Director
Orthopaedic Surgery
Professor, Surgery and Pediatrics
Chief, Division of Orthopaedics
Michigan State University Department of Surgery
MSU-Kalamazoo Center for Medical Studies
Kalamazoo, MI
Charles Weiss, MD, At-large Leader
Chairman Emeritus
Department of Orthopaedics and Rehabilitation
Mount Sinai Medical Center
Miami Beach, FL
Clinical Professor of Orthopaedics
University of Miami School of Medicine
Coral Gables, FL

Otolaryngology
Hinrich Staecker, MD, PhD, Content Expert
Associate Professor of Otolaryngology, Head and Neck Surgery
University of Maryland School of Medicine
Baltimore, MD
Steven M. Parnes, MD, Senior Writer
Chairman of Otolaryngology–Head and Neck Surgery
Albany Medical College
Albany, NY
Ara A. Chalian, MD, FACS, At-large Leader
Associate Professor
Department of Otorhinolaryngology–Head and Neck Surgery
University of Pennsylvania
Philadelphia, PA

Physical Medicine and Rehabilitation


Helen Hoenig, MD, MPH, Content Expert
Associate Professor of Medicine
Division of Geriatrics, Department of Medicine
Center for the Study of Aging and Human Development
Duke University Medical Center
Chief, Physical Medicine and Rehabilitation Service
Durham Veterans Affairs Medical Center
Durham, NC
xiv
Hilary C. Siebens, MD, Senior Writer
Professor of Clinical Medicine
Professor of Clinical Physical Medicine and Rehabilitation
University of California, Irvine, College of Medicine
Irvine, CA
Arlene S. Bierman, MD, MS, Consultant
Senior Research Physician (2001)
Center for Outcomes and Effectiveness Research
Agency for Healthcare Research and Quality (AHRQ)
Rockville, MD
Ontario Women’s Health Council Chair (August 1, 2003)
Women’s Health University of Toronto
Inner City Health Research Unit
St. Michaels Hospital
Toronto, ON, Canada
Gary S. Clark, MD, CPE, At-large Leader
Professor and Chair
Department of Physical Medicine and Rehabilitation
Case Western Reserve University School of Medicine
MetroHealth Medical Center
Cleveland, OH
Gerald Felsenthal, MD, At-large Leader
Chairman Emeritus Department of Rehabilitation Medicine
Sinai Hospital of Baltimore
Clinical Professor Department of Epidemiology and Preventive Medicine
University of Maryland School of Medicine
Baltimore, MD

Thoracic Surgery
Nicola Francalancia, MD, Content Expert
Associate Professor of Surgery
Department of Surgery
Division of Cardiothoracic Surgery
University of Massachusetts Medical School
Worcester, MA
John Yee, MD, Content Expert
Assistant Professor of Surgery
University of Michigan Medical Center
Section of Thoracic Surgery
Ann Arbor, MI

xv
Joseph LoCicero III, MD, FACS, Senior Writer and Associate Editor
The Point Clear Charities Professor
Chair of Surgery
Director, Center for Clinical Oncology
Director, Center for Interventional Technologies
The University of South Alabama
Mobile, AL
John R. Benfield, MD, FACS, At-large Leader
Professor of Surgery Emeritus
David Geffen School of Medicine at UCLA
University of California, Davis
Los Angeles, CA
T. Bruce Ferguson, Jr., MD, At-large Leader
Professor
Departments of Surgery and Physiology
LSU HSC Cardiovascular Outcomes Research Group
New Orleans, LA
David A. Fullerton, MD, At-large Leader
Professor of Surgery
Chief, Cardiothoracic Surgery
University of Colorado Health Sciences Center
Denver, CO
Nicholas T. Kouchoukos, MD, At-large Leader
Division of Cardiovascular and Thoracic Surgery
Missouri Baptist Medical Center, BJC Healthcare
St. Louis, MO

Urology
Tomas L. Griebling, MD, Content Expert
Assistant Professor of Urology
Assistant Scientist, Center on Aging
The University of Kansas
Kansas City, KS
George W. Drach, MD, Senior Writer
Professor of Urology
University of Pennsylvania
Philadelphia, PA
M. Craig Hall, MD, At-large Leader
Associate Professor and Director of Urologic Oncology
Department of Urology and Comprehensive Cancer Center
Wake Forest University Medical Center
Winston-Salem, NC

xvi
Pat Duane O’Donnell, MD, At-large Leader
Director of Oklahoma Incontinence Center
Urologic Specialists of Oklahoma
Tulsa, OK

Cross-Cutting Issues Chapter


Marion Danis, MD, Contributor
Head, Section on Ethics and Health Policy
Department of Clinical Bioethics
National Institutes of Health
Bethesda, MD
Laura C. Hanson, MD, MPH, Contributor
Associate Professor of Medicine
Division of Geriatric Medicine
University of North Carolina at Chapel Hill
Chapel Hill, NC

National Institutes of Health, National Institute on Aging


Evan C. Hadley, MD, Conference Observer
Associate Director (Geriatrics and Clinical Gerontology)
National Institute on Aging, NIH
Bethesda, MD
Stanley L. Slater, MD, Conference Observer
Deputy Associate Director for Geriatrics and Clinical Gerontology
National Institute on Aging
Bethesda, MD

RAND Health, RAND Corporation


Paul G. Shekelle, MD, PhD, Advisor and Facilitator at Content Experts meeting,
February 2001
Senior Natural Scientist
Santa Monica, CA
Catherine H. MacLean, MD, PhD, Advisor and Facilitator at Content Experts meeting,
February 2001
Natural Scientist
Santa Monica, CA
Roberta Shanman, MLS, Literature Reviews Consultant
Senior Librarian
Santa Monica, CA

xvii
Amy Atchison, JD, MLIS, Literature Reviews Consultant
Senior Librarian
Santa Monica, CA
Patricia Smith, Meeting Planner, Technical Assistance
Administrative Assistant
Santa Monica, CA

Publications Consultants
Sue Radcliff, Research Consultant
Denver, CO
Barbara B. Reitt, PhD, ELS(D), Medical Editor
Reitt Editing Services
Northampton, MA
L. Pilar Wyman, Indexer
Wyman Indexing
Annapolis, MD

American Geriatrics Society


Janis Eisner, Project Manager, Geriatrics for Specialists
American Geriatrics Society
The Empire State Building
New York, NY
Nancy Lundebjerg, MPA, Associate Vice President for Professional Education and
Special Projects
American Geriatrics Society
The Empire State Building
New York, NY
Marina Shaykevich, MS, Health Coordinator
American Geriatrics Society
The Empire State Building
New York, NY
Amy Tam-Liao, Health Coordinator
American Geriatrics Society
The Empire State Building
New York, NY

xviii
AGENCY FOR HEALTHCARE RESEARCH
AND QUALITY (AHRQ)
We thank the Agency for Healthcare Research and Quality (AHRQ) for co-sponsoring the
conference on a research agenda in Potomac, Maryland, in November 2001. We especially
thank Dr. Arlene Bierman for making the local arrangements for the meeting.

AGS COUNCIL OF THE SECTION ON


SURGICAL AND RELATED MEDICAL SPECIALTIES
We thank the members of the Council (formerly the Interdisciplinary Leadership Group)
for their wise guidance of the overall Geriatrics for Specialists project. Members in 2001:
American Academy of Ophthalmology (AAO)
Andrew G. Lee, MD
Thomas J. Liesegang, MD
American Academy of Orthopaedic Surgeons (AAOS)
Kenneth J. Koval, MD
Charles Weiss, MD
American Academy of Otolaryngology-Head and Neck Surgery (AAO-H&NS)
Steven M. Parnes, MD
Allan M. Rubin, MD
American Academy of Physical Medicine and Rehabilitation (AAPM&R)
Hilary C. Siebens, MD
Dale C. Strasser, MD
American College of Emergency Physicians (ACEP)
Richard S. Slevinski, MD
American College of Obstetricians and Gynecologists (ACOG)
Gerald Holzman, MD
Luella Klein, MD
American Society of Anesthesiologists (ASA)
J.G. Reves, MD
Alan D. Sessler, MD
American Urological Association (AUA)
George W. Drach, MD
Martin I. Resnick, MD
Association of Program Directors in Surgery (APDS)
J. Patrick O’Leary, MD
Walter J. Pories, MD
Society of Thoracic Surgeons (STS)
Mark B. Orringer, MD
Joseph LoCicero III, MD, FACS
Society for Academic Emergency Medicine (SAEM)
Lowell W. Gerson, PhD
xix

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