11 JAMA resources for internists to share with older-adult patients

Internists are often the captain of the health care team for older-adult patients, those 65 or older. These patients are frequently the most complex to care for, but there are tools available from the AMA to help internists give their senior patients evidence-based reliable information on the prevention, diagnosis and treatment of conditions that affect older adults.

The JAMA Network® has published Patient Pages since 1998 to distill high-quality evidence and make it more accessible for patient education and help guide patient decisions. Patient Pages provide a basic definition of the condition or issue, along with symptoms, consequences, diagnosis, treatment and prevention. These resources, illustrated by JAMA medical illustrators, are always freely accessible online.

As part of a series of news articles curating these outstanding resources, the AMA is highlighting free, recently published Patient Page resources of highest relevance to various physician specialties. This article highlights resources relevant to internal medicine, including treatment options for many common conditions.

AMA members can explore a range of peer-reviewed research and clinical information published by the JAMA Network, which brings JAMA^® together with JAMA Network Open and 11 specialty journals. Published continuously since 1883, JAMA is one of the most widely circulated, peer-reviewed, general medical journals in the world. If you are a member or interested in becoming one, learn how to access these educational materials and innovative tools. 

1. “What Is Osteoporosis?”

   1. This JAMA Patient Page describes osteoporosis risk factors, symptoms, screening, diagnosis and treatment. From the Patient Page: “Osteoporosis is a common disease among older adults that weakens bones and increases the likelihood of fractures.
   2. “Worldwide, one in three women and one in five men older than 50 years have a bone fracture due to osteoporosis during their lifetime. Fractures most commonly associated with osteoporosis involve the hip, spine, shoulder, forearm and pelvis. In 2019, 8 million women and 6 million men aged 50 years or older worldwide sustained a hip fracture—the most serious consequence of osteoporosis. About 24% of people with a hip fracture die within a year of their fracture.”

2. “Screening for Osteoporosis to Prevent Fractures”

   1. This JAMA Patient Page describes osteoporosis and the U.S. Preventive Services Task Force recommendations for screening for osteoporosis. From the Patient Page: “Osteoporosis is a disorder of decreased bone density that increases the risk of fractures, especially after a fall.”
   2. The JAMA Patient Page notes that “bones undergo a continual process of being broken down and rebuilt. With aging, the rate of bone breakdown starts to overtake the rate of bone building, which can lead to low bone mineral density and, eventually, osteoporosis and increased fracture risk. Hip fractures in particular are associated with disability, chronic pain, decreased quality of life and death.”

3. “Prevention of Falls in Older Adults”

   1. This JAMA Patient Page describes risk of falls in older adults and fall prevention recommendations from the U.S. Preventive Services Task Force. From the Patient Page: “Falls are the leading cause of injury in adults aged 65 years or older.
   2. “Falls are common among older adults. In a 2018 survey, more than one-fourth of U.S. older adults living in the community reported at least one fall in the past year. A serious fall in an older adult can result in injury (such as hip fracture) that causes decreased independence and decreased quality of life. The risk of falling increases with age for many reasons, including overall weakness and frailty; problems with balance, cognition and vision; certain medications; acute illness; and other environmental hazards. Those who have fallen in the past are at high risk of falling again.”

4. “Screening for Intimate Partner Violence and Caregiver Abuse of Older or Vulnerable Adults”

   1. This JAMA Patient Page describes intimate partner violence and caregiver abuse of older or vulnerable adults and summarizes recent U.S. Preventive Services Task Force recommendations on clinical screening for these conditions. From the Patient Page: “Intimate partner violence and caregiver abuse of vulnerable adults are common in the U.S.
   2. “The U.S. Preventive Services Task Force has issued a recommendation statement about screening for intimate partner violence among women of reproductive age, including those who are pregnant or postpartum. The statement also addresses caregiver abuse of older or vulnerable adults.”

5. “Social Isolation and Loneliness in Older Adults”

   1. This JAMA Patient Page discusses social isolation and loneliness as important public health concerns, especially among older adults. From the Patient Page: “The U.S. surgeon general has identified social isolation and loneliness as important public health concerns.
   2. “Social isolation is a condition in which individuals lack adequate connections to family, friends or a community. In contrast, loneliness is the subjective feeling of being alone. People prefer different amounts of time alone, and individuals can be alone without feeling lonely. Alternatively, an individual can be surrounded by people and still experience loneliness. In general, the risk of loneliness increases with social isolation. Social isolation and loneliness have been increasingly recognized as a health risk during and after the COVID-19 pandemic.”

6. “Driving Impairment Among Older Adults”

   1. This JAMA Patient Page describes risk factors for driving impairment among older adults, such as medical conditions and medications, and ways to mitigate driving impairment. From the Patient Page: “Older drivers may have age-related and medical conditions that affect their driving performance.
   2. “More than 90% of car crashes are caused by human error. In older adults, age-related changes of decreased vision, cognitive decline, slowed reaction time and decreased grip strength increase the risk of common driving errors, including straying from driving lanes, failing to observe speed limits and overlooking traffic signs.”

7. “What Is Age-Related Macular Degeneration?”

   1. This JAMA Patient Page describes age-related macular degeneration development and progression; symptoms and risk factors; and diagnosis, monitoring, and treatment. From the Patient Page: "Age-related macular degeneration (AMD) causes severe vision impairment in older adults.
   2. “Age-related macular degeneration affects approximately 20 million individuals in the U.S. and 196 million people worldwide. Although AMD does not typically cause complete vision loss, it accounts for 6% to 9% of legal blindness globally. Patients with late-stage AMD may lose their ability to drive, read and recognize faces.”

8. “Geriatric Assessments in Older Adults With Cancer”

   1. This JAMA Oncology Patient Page describes the geriatric assessment used by clinicians to evaluate the health of older adults with cancer. From the Patient Page: “The health and well-being of older adults after a cancer diagnosis differs greatly from one person to another and should be carefully reviewed prior to treatment. Research has shown that management guided by the geriatric assessment (GA) can benefit patients and decrease adverse effects from chemotherapy.
   2. “The GA is a set of tools clinicians use to evaluate the health of older adults. It gathers information about health status, well-being and social support not routinely collected during the workup of a patient with cancer. The GA can facilitate treatment discussions and decisions between the patient and the care team, identify other health conditions and prevent or delay complications.”

9. “I Am Worried About Memory Loss—What Should I Know?”

   1. This JAMA Internal Medicine Patient Page describes memory loss and dementia and how they may be treated. From the Patient Page: “Memory loss is a common worry when people get older, but it can happen for different reasons.
   2. The JAMA Internal Medicine Patient Page also explains what happens to memory and thinking skills in older age: “Some thinking skills, like knowledge and wisdom, improve with age. Changes in memory, thinking and reasoning are common with aging. Having trouble remembering someone’s name or misplacing items can be a normal part of getting older.”

10. “RSV Infection in Older Adults”

    1. This JAMA Patient Page describes respiratory syncytial virus and its symptoms, risk factors and preventive measures. From the Patient Page: “Respiratory syncytial virus (RSV) causes respiratory infections in humans.”
    2. The JAMA Patient Page also summarizes the symptoms of RSV infection, which, in most people, “causes mild cold-like symptoms of cough, runny nose, sore throat, headache, decreased appetite and fever that typically last less than five days. However, in older adults, RSV can cause more severe disease such as pneumonia, or can worsen respiratory diseases, including asthma or chronic obstructive pulmonary disease."

11. “Polypharmacy and Deprescribing”

    1. This JAMA Patient Page describes the problem of polypharmacy and its consequences, and how deprescribing can reduce polypharmacy. From the Patient Page: "Polypharmacy is the excessive or unnecessary use of medications.”
    2. The JAMA Patient Page explains that deprescribing is “the medically supervised process of decreasing or stopping medications that are no longer needed or may be causing harm. The benefits and risks of medications can change as people get older, so medications that have been taken for many years may need to be adjusted or even stopped. Sometimes an alternative medication that is safer or a nonmedication lifestyle change may be recommended to manage a health condition.”

In addition to the Patient Page feature, here are other ways physicians can leverage resources from the JAMA Network to help them in their clinical practice:

• Take CME courses and earn AMA PRA Category 1 Credit™.
• Fulfill maintenance of licensure (MOL) and CME requirements on JN Learning™, the home for all JAMA Network CME.
• Read concise summaries of clinical guidelines and recommendations in a format designed for today’s busy physicians.

The subscription cost of JAMA is included with your AMA membership, plus unlimited digital access to all JAMA Network journals, including JAMA Internal Medicine and these other journals: JAMA Cardiology, JAMA Dermatology, JAMA Psychiatry, JAMA Network Open, JAMA Neurology, JAMA Oncology, JAMA Ophthalmology, JAMA Otolaryngology–Head and Neck Surgery, JAMA Pediatrics and JAMA Surgery.

The journals include many helpful features for students, residents and fellows, including full-text PDFs, clinical challenges, archived editions, audio and video author interviews where authors give their perspectives on a study’s objectives, findings and implications.