Summary of Articles from the Journal of the American Geriatrics Society: November 2010, Volume 58

Reviewed, prepared, and submitted by Thomas T. Yoshikawa, MD, Editor-in-Chief, Journal of the American Geriatrics SocietyTitle: A Randomized Controlled Trial of the Effects of Vitamin D on Muscle Strength and Mobility in Older Women With Vitamin D InsufficiencyAuthors: Zhu K, Austin N, Devine A, et alSummary: It is well known that older persons are at greater risk for vitamin D insufficiency or deficiency because of inadequate sun exposure, diminished ability of the skin to synthesize vitamin D, and lower dietary intake of the vitamin. Low vitamin D status in older people appears to be associated with lower muscle strength and poorer physical performance. In this study, 302 community-living older adults (aged 70 to 90) with low serum 25-hydroxyvitamin D (vitamin D2) levels of less than 24 ng/mL were randomized to receive vitamin D2 (1000 IU/day) plus calcium citrate (1 g/day) or placebo plus calcium citrate for 1 year. Lower limb muscle strength and mobility (Timed Up and Go test; TUAG) were assessed at baseline and after 1 year. There was a significant improvement in strength for hip extensors and hip adductors (but not other muscles) and in the TUAG in the weakest and slowest participants. It was concluded that vitamin D should be prescribed to older people with vitamin D insufficiency or deficiency.Comments: There is current controversy regarding the health and clinical benefits of vitamin D, based on the recent report by the Institute of Medicine. The mixed and varying results of vitamin D clinical trials may in part be due to a number of factors, including different populations studied, what outcomes are being assessed, age of patients, serum concentrations of vitamin D of studied population, type of vitamin D preparation used as intervention (D2 vs D3), duration of intervention, use of calcium supplementation, etc. Until vitamin D supplementation can be shown to be detrimental to older patients, it would appear that daily supplement of this vitamin may be beneficial and worthwhile in those with below-normal levels of the vitamin.The opinions expressed are solely those of the reviewer and do not necessarily reflect those of the American Geriatrics Society or the Journal of the American Geriatrics Society. ______________________________________________________________________Title: A National Survey of Geriatric Medicine Fellowship Programs: Comparing Findings of 2006/7 and 2001/2 from the American Geriatrics Society and Association of Directors of Geriatric Academic Programs Geriatrics Workforce Policy Studies CenterAuthors: Bragg EJ, Warshaw GA, Meganathan K, et alSummary: A national cross-sectional survey was conducted in 2007 of all geriatric medicine fellowship training programs (with a 71% survey response) and compared with results of a similar study performed in 2002. The number of Accreditation Council for Graduate Medical Education–accredited fellowship programs has gradually increased from 120 to 139 in 2001/2 to 2007/8, respectively. The percent of filled first-year positions in 2001/2 was 69.4 compared to 56.4 in 2007/8. The number of advanced fellows (second year and beyond) decreased significantly from 79 (2001/2) to 28 (2007/8), largely due to reduced availability of advanced positions and lower demand for these slots following change in eligibility for board certification/added qualification in Geriatric Medicine from 2 years to 1 year. These data indicate that there is insufficient numbers of formally trained geriatricians to care for the expanding population of frail older patients, train other disciplines in the care of these complex patients, conduct research in aging, and develop leaders in geriatrics.Comments: Although recommendations to enhance the geriatric medicine workforce by the Institute of Medicine are appropriate (enhanced reimbursement for care of older patients; financial incentives to increase geriatric workforce; programs for loan forgiveness for those who become geriatric specialists), the immediate solution may be that geriatricians will have to be restricted to caring for the oldest and most frail patients (ie, those who are 80 years and older with multiple comorbidities and well-established frailty status). Older patients who do not fall under these criteria would be cared for by generalists and other primary care providers.The opinions expressed are solely those of the reviewer and do not necessarily reflect those of the American Geriatrics Society or the Journal of the American Geriatrics Society. ______________________________________________________________________Title: In Memoriam of Dr. Robert ButlerAuthor: Rowe JWSummary: Dr. Rowe provides an in-depth and insightful review of the life and career of Dr. Robert Butler, one of the truly “giants” and pioneer in the field of aging. Space limitations prohibit an appropriate summary of all of Dr. Butler’s outstanding achievements and contributions to geriatrics and gerontology. Some of the most notable accomplishments include him being selected as the founding Director of the National Institute on Aging. He was awarded the Pulitzer Prize for his nonfiction book, Why Survive? Being Old in America. Dr. Butler established the nation’s first Department of Geriatrics and Adult Development at the Mount Sinai School of Medicine and Medical Center. Dr. Butler was a leading investigator in the notable “Human Aging Study” at the National institute of Mental Health prior to his full-time commitment to the development of the field of geriatrics. Besides being an extraordinary public speaker, Dr. Butler wrote over 300 articles and 18 books on a wide variety of topics related to aging and health. Comments: We will all miss this magnificent human being, scholar, physician, leader, and advocate of older persons. As Dr. Rowe stated, “Bob Butler had a truly transformative effect on gerontology and geriatrics.”The opinions expressed are solely those of the reviewer and do not necessarily reflect those of the American Geriatrics Society or the Journal of the American Geriatrics Society.