Update in Geriatrics

In 1900, only about 1 million Americans (4 % of the population) were older than 65 years of age. Currently, about 14 % of Americans are older than 65 years of age; by 2050, that figure will have in-creased to more than 20%. This demographic shift has no parallel in history. We have already seen the impact of the increased numbers of older persons on the practice of medicine, and the future of in-ternal medicine will be inextricably linked to this demographic change. Life expectancy after age 65 years continues to improve. Although the explanation for this finding is unclear, it is probably partly due to the improve-ment in the management of chronic illness. The improvements continue, as shown by the advances reported in 1996. In reviewing the major clinical advances in geriatrics, I turned mostly to clinical journals that are generally available to practicing internists. Included studies must have reported in-formation that is clinically important to a general internist's practice, and the findings, for the most part, had to be evidence based. In general, every study described in this Update offers observations or strategies that can be put into practice immediately. Ambula tory Medicine The past year provided insights into the unique presentation of thyroid disease in the elderly, ad-vances in relieving the pain associated with herpes zoster, a more rational choice in the medical treat-ment of benign prostatic hyperplasia, and new in-formation on the potential risks of oral hypoglyce-mic agents