BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: :The aging of the US population poses one of the greatest future challenges for family practice residency graduates. At a time when our discipline should be strengthening geriatric education to address the needs of our aging population, the Group on Geriatric Education of the Society of Teachers of Family Medicine believes that recent guidelines from important family medicine organizations suggest that our discipline's interest in geriatric education may be waning. Barriers to improving geriatric education in family practice residencies include limited geriatric faculty, changes in geriatric fellowship training, competing curricular demands, and limited diversity of geriatric training sites. Improving geriatric education in family practice residencies will require greater emphasis on faculty development and integration of geriatric principles throughout family practice residency education. The Residency Review Committee for Family Practice should review the Program Requirements for Residency Education to ensure that geriatric training requirements are consistent with current educational needs. The leadership of family medicine organizations should collaboratively address the need for continued improvement in training our residents to care for older patients and the chronically ill.

背景与目标： ：美国人口的老龄化给家庭实习住院医师毕业生带来了未来最大的挑战之一。在我们的学科应加强老年医学以解决我们人口老龄化的需求的时候，家庭医学教师学会的老年医学小组认为，重要的家庭医学组织的最新指南表明，本学科对老年医学的兴趣可能正在减弱。在家庭执业居民中改善老年医学教育的障碍包括老年教师数量有限，老年研究金培训的变化，竞争性的课程需求以及老年医学培训场所的多样性。改善家庭执业居民的老年医学教育将需要在整个家庭执业住院医学中更加重视教师发展和老年医学原则的整合。家庭实践居住审查委员会应审查居住教育计划要求，以确保老年医学培训要求与当前的教育需求保持一致。家庭医学组织的领导者应共同解决持续改善培训居民以照顾老年患者和慢性病患者的需求。

BACKGROUND & AIMS: :Because of demographic trends, it is reasonable to expect that clinicians will care for an increasing number of elderly persons with challenging medical and psychosocial problems. These problems and issues, in turn, may lead to daunting ethical dilemmas. Therefore, clinicians should be familiar with ethical dilemmas commonly encountered when caring for elderly patients. We review some of these dilemmas, including ensuring informed consent and confidentiality, determining decision-making capacity, promoting advance care planning and the use of advance directives, surrogate decision making, withdrawing and withholding interventions, using cardiopulmonary resuscitation and do-not-resuscitate orders, responding to requests for interventions, allocating health care resources, and recommending nursing home care. Ethical dilemmas may arise because of poor patient-clinician communication; therefore, we provide practical tips for effective communication. Nevertheless, even in the best circumstances, ethical dilemmas occur. We describe a case-based approach to ethical dilemmas used by the Mayo Clinic Ethics Consultation Service, which begins with a review of the medical indications, patient preferences, quality of life, and contextual features of a given case. This approach enables clinicians to identify and analyze the relevant facts of a case, define the ethical problem, and suggest a solution.

背景与目标： ：由于人口趋势，可以合理地预期临床医生将照顾越来越多的具有挑战性的医学和社会心理问题的老年人。这些问题反过来可能导致令人生畏的道德困境。因此，临床医生应熟悉照顾老年患者时经常遇到的道德困境。我们审查了其中的一些难题，包括确保知情同意和保密，确定决策能力，促进预先护理计划和使用预先指示，替代决策，撤回和保留干预措施，使用心肺复苏术和不进行复苏的命令，响应干预请求，分配医疗资源并建议养老院护理。由于患者与临床医生之间的沟通不畅，可能导致道德困境。因此，我们提供了有效沟通的实用技巧。然而，即使在最好的情况下，也会出现道德困境。我们描述了一种基于案例的梅奥诊所伦理咨询服务所使用的道德困境方法，该方法首先是对给定病例的医学适应症，患者喜好，生活质量和背景特征进行审查。这种方法使临床医生能够识别和分析病例的相关事实，定义伦理问题并提出解决方案。

BACKGROUND & AIMS: OBJECTIVE:To explore physicians' responses to the needs for education in geriatrics identified by a community needs survey. DESIGN:Interviews conducted during a cross-sectional survey. SETTING:Private family practices in Calgary. PARTICIPANTS:Randomly selected family physicians in Calgary who had previously recruited patients for a community needs survey. Thirty of 60 volunteer physicians randomly selected for phase 1 of the study were interviewed. One physician recruited patients for phase 1 but declined to be interviewed. MAIN OUTCOME MEASURES:Demographic variables, practice characteristics, and opinions on urgency of potential topics for continuing medical education. RESULTS:Physicians agreed with community informants that they need more education about medication for the elderly, medical management, and mental health issues. Physicians did not perceive pressing needs for education in communication skills with patients, in compassion, or in health promotion for patients. Physicians identified many barriers to meeting needs identified by the community. Among the most notable obstacles were inadequate time, inadequate remuneration, and lack of accessible community resources. CONCLUSIONS:Continuing medical education should help physicians recognize the community's needs and design programs that will address them.

背景与目标： 目的：探讨医生对社区需求调查确定的老年医学教育需求的反应。
设计：在横断面调查期间进行的访谈。
地点：卡尔加里的私人家庭实践。
参与者：卡尔加里随机选择的家庭医生，以前曾招募患者进行社区需求调查。随机选择了研究的第一阶段的60名志愿医生中的30名。一位医师招募了患者进入第一阶段，但拒绝接受采访。
主要观察指标：人口统计学变量，实践特征和对继续医学教育潜在主题的紧迫性的看法。
结果：医师同意社区信息提供者的意见，他们需要对老年人用药，医疗管理和精神健康问题进行更多的教育。医生没有意识到与患者沟通技巧，同情心或促进患者健康方面教育的紧迫需求。医生确定了满足社区确定的需求的许多障碍。最明显的障碍是时间不足，薪酬不足以及缺乏可利用的社区资源。
结论：继续医学教育应有助于医生认识到社区的需求并设计解决方案。

BACKGROUND & AIMS: BACKGROUND:Several studies have identified moderate reliability and validity for the Mini-Mental State Examination (MMSE). Some researchers showed the superiority of other dementia screening tests over the MMSE considering the test quality criteria. The aim of this study was the evaluation of MMSE, especially in the area of geriatrics. PATIENTS AND METHODS:MMSE and DemTect were carried out with 154 geriatric patients: 71 persons without cognitive impairment and 83 persons without delirium showed cognitive impairments as revealed by the DemTect. In addition, we also applied the Clock-Drawing-Test (CDT), Reisberg-Scale, Geriatric Depression-Scale (GDS, 15-item version) and the Confusion-Assessment-Method (CAM). RESULTS:According to the multitrait-multimethod approach, MMSE's convergent and divergent validity is similar to that of the DemTect. Both tests correlate only moderately with Spearman (r = 0.609) and revealed similar results for dementia in 57.1 % of the patients. MMSE showed low reliability and moderate reliability (Cronbach's α = 0.82) when ten items with low discriminatory power were excluded from the total test score. Difficulty of all items is only moderate (p = 0.86) and only eight items of the MMSE showed good test difficulty. CONCLUSION:All in all, DemTect and MMSE are not interchangeable. The MMSE estimates the average cognitive impairment of patients as considerably less pronounced than the DemTect. MMSE is, thus, not an instrument that would be recommended for the identification of mild cognitive impairment. In this case, tests with higher reliability and validity should be used.

背景与目标： 背景：多项研究已确定中度精神状态检查（MMSE）的中等信度和效度。考虑到测试质量标准，一些研究人员证明了其他痴呆筛查测试优于MMSE。这项研究的目的是评估MMSE，尤其是在老年医学领域。
患者和方法：对154名老年患者进行了MMSE和DemTect：DemTect揭示了71名无认知障碍的人和83名无83妄的人表现出认知障碍。此外，我们还应用了时钟绘图测试（CDT），Reisberg量表，老年抑郁量表（GDS，15个项目）和混淆评估方法（CAM）。
结果：根据多特征-多方法方法，MMSE的收敛效度和发散效度与DemTect相似。两项测试与Spearman的相关性均只有中等程度的相关性（r = 090.609），并且在57.1 patients％的患者中显示出痴呆症的相似结果。当从总测试成绩中排除十项具有较低辨别力的项目时，MMSE表现出较低的可靠性和中等的可靠性（Cronbach'sα= 0.82）。所有项目的难度仅为中等（p = 0.86），只有MMSE的八个项目显示出良好的测试难度。
结论：总而言之，DemTect和MMSE不可互换。 MMSE估计患者的平均认知障碍程度不如DemTect明显。因此，MMSE不是推荐用于识别轻度认知障碍的工具。在这种情况下，应使用具有更高可靠性和有效性的测试。

BACKGROUND & AIMS: :Medication management is an important component of medical education, particularly in the field of geriatrics. The Association of American Medical Colleges has put forth 26 minimum geriatrics competencies under eight domains for graduating medical students; medication management is one of these domains. The Portal of Geriatric Online education (www.POGOe.org) is an online public repository of geriatrics educational materials and modules developed by geriatrics educators and academicians in the United States, freely available for use by educators and learners in the field. The three POGOe materials presented in this review showcase pearls of medication management for medical and other professional students in novel learning formats that can be administered without major prior preparation. The review compares and contrasts the three materials in descriptive and tabular formats to enable its appropriate use by educators in promoting self-learning or group learning among their learners.

背景与目标： ：药物管理是医学教育的重要组成部分，尤其是在老年医学领域。美国医学院联合会在八个领域提出了26种最低的老年医学能力，以供应届医学生毕业。药物管理是这些领域之一。老年医学在线教育门户网站（www.POGOe.org）是由老年医学教育者和美国院士开发的老年医学教育材料和模块的在线公共存储库，可供该领域的教育者和学习者免费使用。本评论中介绍的三种POGOe材料以新颖的学习形式展示了医学和其他专业学生药物管理的明珠，无需事先进行大量准备即可进行管理。该评论以描述性和表格形式对三种材料进行了比较和对比，以使教育工作者能够适当地使用它们来促进学习者之间的自我学习或小组学习。

BACKGROUND & AIMS: :In autumn 2005, the Geriatric and Gerontological Scientific Societies together with the Organisation of Geriatric Departments developed a quality seal in a discussion process over about 18 months. The needs to be addressed were corporate development, allocation through an independent and external institution for quality management, consideration of the heterogeneous German structure of geriatric medicine, independence of specific conditions and the consideration of 20 years of geriatric medicine practise in Germany. The seal is specific for geriatric medicine and assumes successful certification in general quality management. It describes the needs in the area of structure, process and outcome quality. Since introduction, 12 geriatric departments (as of March 2007) have been successfully certified.

背景与目标： ：2005年秋天，老年医学和老年医学科学学会与老年医学部门组织在长达18个月的讨论过程中共同建立了质量保证书。需要解决的需求是公司发展，通过独立的外部机构进行质量管理，考虑德国老年医学的异质结构，特定条件的独立性以及考虑德国20年的老年医学实践。该印章专用于老年医学，并在常规质量管理中获得成功的认证。它描述了结构，过程和结果质量方面的需求。自推出以来，已有12个老年科（截至2007年3月）获得了成功认证。

BACKGROUND & AIMS: INTRODUCTION:Diabetes mellitus is approaching epidemic proportions in most countries and has captured the attention of physicians at local, national and global levels. The elderly population remains at a higher risk for diabetes mellitus (1), and the disease poses unique concerns for geriatricians, primary care physicians, nurses and specialised pharmacists who provide care to the elderly. Glycaemic control, geriatric-related syndromes and cardiovascular risk factors considerably affect the elderly patient's functional status and life expectancy (2). Geriatric syndromes may include polypharmacy, chronic pain, injurious falls, cognitive impairment, urinary incontinence and depression. Higher rates of premature death; functional disability; and chronic illnesses, such as hypertension, cerebrovascular accidents, dementia and coronary artery disease, often affect elderly diabetic patients. DISCUSSION:Collaborative efforts are continually needed to allocate and maximise utilisation of resources to help empower older adults with diabetes to overcome barriers to disease management. Healthcare providers are increasingly challenged by the complexity of problems that face old patients, and must therefore be prepared to assess and treat diabetes mellitus within the milieu of many geriatric-related chronic illnesses. Healthcare providers must tailor individualised treatment methods, with the ultimate goal of not only achieving laboratory norms but also improving the quality of life for this vulnerable population. CONCLUSION:There is a need for extra care and overcoming barriers to diabetes control in old patients as a dynamic and a continuous task that needs coordination of healthcare systems and professionals at all levels of care.

背景与目标： 简介：在大多数国家，糖尿病已接近流行病的程度，并引起了地方，国家和全球各级医生的关注。老年人口患糖尿病的风险较高（1），该疾病引起了为老年人提供护理的老年医生，初级保健医生，护士和专业药剂师的独特关注。血糖控制，老年性综合症和心血管危险因素会严重影响老年患者的功能状态和预期寿命（2）。老年综合症可能包括综合制药，慢性疼痛，跌倒，认知障碍，尿失禁和抑郁症。较高的过早死亡率；功能障碍；慢性疾病，例如高血压，脑血管意外，痴呆和冠状动脉疾病，通常会影响老年糖尿病患者。
讨论：持续需要协作努力来分配和最大程度地利用资源，以帮助增强糖尿病的成年人克服疾病管理的障碍。老年患者面临的问题的复杂性日益使医疗保健提供者面临挑战，因此，医疗保健提供者必须做好准备以评估和治疗许多与老年病有关的慢性病范围内的糖尿病。医疗保健提供者必须量身定制个性化的治疗方法，其最终目标不仅要达到实验室规范，而且要改善这一弱势群体的生活质量。
结论：作为一项动态且持续的任务，需要对老年患者进行额外的护理和克服糖尿病控制障碍，这需要医疗保健系统和各个护理级别的专业人员进行协调。

BACKGROUND & AIMS: OBJECTIVE:To describe the development, implementation, and assessment of a geriatric pharmacotherapy elective course emphasizing a patient-centered approach and active, self-directed learning strategies. DESIGN:The course content included fundamental concepts in aging, geriatric syndromes, activities involving assessment of medically complex older adults, presentation of controversies in clinical geriatrics, book and film clubs, an Adopt-a-Patient project, and scientific and reflective writing. Students participated in site visits to interview and interact with older adults. ASSESSMENT:Student evaluation of the course was assessed with the teaching evaluation tool, an end-of-semester survey, a follow-up P4 survey, and reflective writings. Students strongly agreed that course goals were achieved. Learning how to communicate with older adults and assess complex medication regimens were the areas of highest importance to students. P4 students strongly agreed that skills learned in the course were important to their success in advanced pharmacy practice experiences (APPEs). CONCLUSION:A pharmacotherapy course emphasizing active and self-directed learning in geriatrics through innovative teaching was adaptable to doctor of pharmacy (PharmD) students at various stages of their training and improved students' perceptions of aging.

背景与目标： 目的：描述老年药物疗法选修课程的开发，实施和评估，该课程强调以患者为中心的方法和主动的，自我指导的学习策略。
设计：课程内容包括衰老，老年综合症，涉及评估医学上复杂的成年人的活动，临床老年病争议，书籍和电影俱乐部，收养患者项目以及科学和反思性写作等基本概念。学生参加了现场访问，以采访老年人并与之互动。
评估：使用教学评估工具，学期末调查，后续P4调查和反思性写作对课程的学生评估进行了评估。学生们强烈同意达到课程目标。学习如何与老年人沟通并评估复杂的药物治疗方案对学生而言是最重要的领域。 P4学生强烈同意，该课程中学习的技能对于他们在高级药学实践经验（APPE）中的成功至关重要。
结论：通过创新教学强调老年医学中主动和自主学习的药物疗法课程适合药学（PharmD）学生在其培训的各个阶段，并改善了学生对衰老的认识。

BACKGROUND & AIMS: OBJECTIVE:The objectives of this work were to determine the prevalence of self-reported subclinical status for functional limitation and disability at baseline and assess their independent effects on the onset of functional limitation and disability 1-2 years later. METHODS:Nine hundred ninety-eight African American men and women 49-65 years old in St. Louis, MO, received comprehensive in-home evaluations at baseline and two annual telephone follow-ups. Outcome measures included walking a half-mile, climbing steps, stooping-crouching-kneeling, lifting or carrying 10 lbs., and doing heavy housework. RESULT:The baseline prevalence of subclinical status was 26.4% for walking a half-mile, 26.8% for climbing steps, 39.0% for stooping-crouching-kneeling, 29.1% for lifting or carrying 10 lbs., and 22.7% for doing heavy housework. The adjusted odds ratios for the task-specific subclinical status measure at baseline on developing difficulty 1-2 years later were 1.68 (p < .05) for walking a half-mile, 4.46 (p < .001) for climbing steps, 2.48 (p < .001) for stooping-crouching-kneeling, 2.51 (p < .001) for lifting or carrying 10 lbs., and 2.22 (p < .001) for doing heavy housework. Performance tests (tandem stand, chair stands, and preferred gait speed) did not have consistent independent effects on the onset of functional limitation or disability. CONCLUSION:The subclinical status measures were the main predictors of the onset of difficulty in all tasks and functions 1-2 years later. Interventions to reduce frailty should focus on self-reported subclinical status as an early warning system.

背景与目标： 目的：这项工作的目的是确定基线时自我报告的功能受限和残障亚临床状态的普遍性，并评估其在1-2年后对功能受限和残障发作的独立影响。
方法：密苏里州圣路易斯的988名49-65岁的非洲裔美国人，在基线时接受了全面的室内评估，并接受了两次年度电话随访。结果措施包括步行半英里，爬上台阶，弯腰蹲下跪，举起或抬起10磅体重以及做繁重的家务劳动。
结果：亚临床状态的基线患病率是半英里步行26.4％，爬山台阶26.8％，弯腰屈膝跪姿39.0％，举重或举重10磅29.1％，繁重的家务劳动22.7％ 。在1-2年后因发展困难而在基线时针对特定任务的亚临床状态测量值的调整后优势比为：半英里步行时为1.68（p <.05），攀登步骤为4.46（p <.001），为2.48（p跪着蹲下时p <.001），举起或搬运10磅重时为2.51（p <.001），而做繁重的家务则为2.22（p <.001）。性能测试（纵排站立，椅子站立和优选的步态速度）对功能受限或残疾的发作没有一致的独立影响。
结论：亚临床状态测量是1-2年后所有任务和功能出现困难的主要预测指标。减少体弱的干预措施应着重于自我报告的亚临床状态，作为预警系统。

BACKGROUND & AIMS: :Clinically significant non-major depression has been underinvestigated, despite its high prevalence and public health impact. Although there is increasing recognition of the importance of subsyndromal forms of depression, their nosologic boundaries and neurobiologic mechanisms remain largely unknown. This review discusses the literature pertaining to the current concepts, phenomenology, neurobiology, and treatment approaches for geriatric non-major clinically significant depression. The authors examine the similarities and differences between various subtypes of depressive disorders, and compare non-major clinically significant depression in the elderly with non-geriatric adult populations. The authors draw conclusions from the published literature and present clinical criteria for the diagnosis of clinically significant non-major depression in the elderly.

背景与目标： ：尽管临床流行率很高且对公共卫生有影响，但尚未对临床上显着的非重大抑郁症进行调查。尽管人们越来越认识到亚综合征形式的抑郁症的重要性，但它们的病理学界限和神经生物学机制仍是未知之数。这篇综述讨论了有关老年非重大临床意义抑郁症的最新概念，现象学，神经生物学和治疗方法的文献。作者检查了各种抑郁症亚型之间的异同，并比较了非老年成人人群中非重大临床意义的抑郁症。作者从已发表的文献中得出结论，并提出了诊断老年人临床上重要的非重大抑郁症的临床标准。

BACKGROUND & AIMS: :In the recent past, most physician visits by older adults were with a primary care physician, with less than 40% of ambulatory visits to other specialists. Since 1991, that trend has reversed. In 2001, 53% of ambulatory visits by patients aged 65 years or older were to nonprimary care specialists. Demographic trends and an expanding geriatrics medicine knowledge base require that every physician develop skills specific to the care of older adults. There are concerns that physicians-in-training are not learning adequate specific geriatrics medicine content to prepare them for the rapidly expanding numbers of older adults who will be seeking medical care. Training standards to prepare residents and fellows for practicing medicine are established by experts in the various medical specialties serving on individual residency review committees (RRCs) of the Accreditation Council for Graduate Medical Education. In 2002 (with a follow-up in 2003), the Association of Directors of Geriatric Academic Programs' team at the University of Cincinnati School of Medicine's Institute for Health Policy and Health Services Research reviewed all 91 nonpediatric specialties' RRC program requirements to identify the specific curriculum requirements related to geriatrics medicine training. As of 2003, 27 of the 91 RRC-accredited specialties have specific geriatrics training requirements; the other 70% of these specialties did not specifically mention geriatrics training. Even among the specialties with specific geriatrics training requirements, curriculum expectations are modest. The geriatrics-specific descriptions within the program requirements of the 27 specialties are presented in this article. The authors encourage the RRCs for all nonpediatric specialties to update their program requirements to ensure that future physicians graduating from their graduate medical education programs are adequately prepared to care for older adults.

背景与目标： ：最近，大多数老年人的医师就诊都是由初级保健医师进行的，不到40％的其他专科就诊者就诊。自1991年以来，这种趋势已经逆转。在2001年，年龄在65岁或65岁以上的患者的非卧床就诊中有53％是非初级保健专家进行的。人口趋势和不断扩展的老年医学知识基础要求每位医师都应发展专门针对老年人的护理技能。令人担忧的是，接受培训的医生没有学习到足够的特定老年医学药物含量，无法为将要寻求医疗服务的迅速增长的老年人做准备。由研究生医学教育认可委员会的个人住院医师审查委员会（RRC）中服务的各个医学专业的专家制定了为居民和医学从业人员做准备的培训标准。 2002年（2003年进行了跟进），辛辛那提大学医学院健康政策与健康服务研究所的老年医学项目主管小组审查了所有91个非儿科专业的RRC计划要求，以确定与老年医学培训有关的具体课程要求。截至2003年，在91个获得RRC认可的专业中，有27个具有特定的老年医学培训要求。这些专业中的其他70％没有专门提及老年医学培训。即使在具有特定老年医学培训要求的专业中，对课程的期望也很低。本文介绍了27个专业的计划要求内的老年医学特定描述。作者鼓励所有非儿科专业的RRC更新其计划要求，以确保从其研究生医学教育计划毕业的未来医生有足够的准备来照顾老年人。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: OBJECTIVES:The European Working Group on Sarcopenia in Older People 2 (EWGSOP2) recently defined the new concept of probable sarcopenia to help improve screening and prevent future sarcopenia. We investigated the prevalence of probable sarcopenia, defined as weak grip strength, in community-dwelling older Colombian adults, and examined the long-term associated conditions. DESIGN:Cross-sectional study. SETTING:Urban and rural Colombian older adults from the "Estudio Nacional de Salud, Bienestar y Envejecimiento (SABE) study". PARTICIPANTS:5237 Colombian older adults aged ≥60 years. MEASUREMENTS:Probable sarcopenia was assessed following the cut-off points for weak grip strength recommended by EWGSOP2 guidelines. Odds ratios (ORs) of the relationship between long-term conditions and probable sarcopenia were determined using logistic regression. RESULTS:The prevalence of probable sarcopenia defined as weak grip strength was 46.5% [95% confidence interval (CI), 45.1-47.8]. Physical inactivity "proxy" (OR 1.35, 95% CI 1.14-1.59); diabetes (OR 1.32, 95% CI 1.11-1.56); and arthritis, osteoarthritis, and rheumatism (OR 1.44, 95% CI 1.25-1.67) were independently associated with probable sarcopenia. CONCLUSIONS AND IMPLICATIONS:We found that almost half of all the Colombian older adults in our sample had probable sarcopenia. Individuals with physical inactivity, diabetes, arthritis, or osteoarthritis and rheumatism had a higher prevalence of probable sarcopenia. Probable sarcopenia is clinically highly relevant, and several of the factors associated with this condition are potentially preventable, treatable, and reversible.

背景与目标： 目的：欧洲老年人肌肉减少症工作组2（EWGSOP2）最近定义了可能的肌肉减少症的新概念，以帮助改善筛查和预防未来的肌肉减少症。我们调查了居住在社区中的哥伦比亚老年人中可能的肌肉减少症的患病率（定义为较弱的握力），并研究了长期相关的状况。
设计：横断面研究。
地点：来自“ Estudio Nacional de Salud，Bienestar y Envejecimiento（SABE）研究”的城市和哥伦比亚农村老年人。
参加人数：5237名年龄≥60岁的哥伦比亚老年人。
测量：根据EWGSOP2指南推荐的弱握力临界值，评估可能的肌肉减少症。使用logistic回归确定长期病情与可能的少肌症之间关系的几率（OR）。
结果：可能的肌肉减少症的患病率定义为较弱的握力，为46.5％[95％置信区间（CI），45.1-47.8]。缺乏体育活动的“代理人”（OR 1.35，95％CI 1.14-1.59）；糖尿病（OR 1.32，95％CI 1.11-1.56）;关节炎，骨关节炎和风湿病（OR 1.44，95％CI 1.25-1.67）分别与可能的肌肉减少症相关。
结论和意义：我们发现样本中几乎一半的哥伦比亚老年人都患有肌肉减少症。缺乏运动，糖尿病，关节炎或骨关节炎和风湿病的人患肌肉减少症的可能性较高。可能的肌肉减少症在临床上具有高度相关性，与这种情况相关的一些因素是潜在可预防，可治疗和可逆的。

BACKGROUND & AIMS: :Nursing homes typically have been a relatively isolated component of health care in the United States. Now, however, nursing homes are experiencing a change in the patients they serve. In recent years, nursing home patients have been admitted sicker and after a shorter hospital stay than in the past. Such changes are likely to continue to occur as the size of the population of frail elderly continues to increase and as insurers look for alternatives to high cost hospital care. An additional stimulus to change is that the public is asking for innovation in noninstitutionalized long-term care. This essay advocates that nursing homes are the ideal component of the health care system to lead innovative program development focused on the creation of a highly organized continuum of care for the frail elderly. Physicians must be a fundamental part of this process, providing the guidance and leadership necessary for nursing homes to evolve into comprehensive geriatrics centers. Strategies are provided for developing physician office practices in nursing homes, a fundamental first step in the process of change. Additionally, ideas are provided for developing day care centers and physician house call programs based in nursing homes. Also, tight and highly functional relationships among nursing homes and acute hospitals must be developed. The example of the Johns Hopkins Geriatrics Center is described briefly as one such program now in place.(ABSTRACT TRUNCATED AT 250 WORDS)

背景与目标： ：在美国，疗养院通常是相对孤立的医疗保健组成部分。但是，现在，疗养院的服务患者正在发生变化。近年来，与过去相比，疗养院患者的病情和住院时间短。随着脆弱的老年人口数量的不断增加以及保险公司寻求替代高成本医院护理的机会，这种变化很可能会继续发生。改变的另一个刺激因素是，公众要求在非机构化的长期护理中进行创新。本文主张，养老院是医疗保健系统的理想组成部分，可以引领创新计划的发展，重点是为脆弱的老年人提供高度组织化的连续护理。医师必须是该过程的基本组成部分，为疗养院发展成为综合的老年医学中心提供必要的指导和领导。提供了在疗养院中发展医师办公室实践的策略，这是变革过程中的基本第一步。此外，还为在养老院中建立日托中心和医师上门服务计划提供了思路。此外，必须在疗养院和急诊医院之间建立紧密和高度有效的关系。约翰霍普金斯老年医学中心的示例已被简要描述为一个这样的程序。（摘要以250字截断）