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We conclude that abbreviated scales such as the LSNS-6 should be considered for inclusion in practice protocols of gerontological practitioners. Screening older persons based on the LSNS-6 provides quantitative information on their family and friendship ties, and identifies persons at increased risk for social isolation who might benefit from in-depth assessment and targeted interventions.

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ABSTRACT

Preventive home visitation programs appear to be effective, provided the interventions are based on multidimensional geriatric assessment and include multiple follow-up home visits and target persons at lower risk for death. Benefits on survival were seen in young-old rather than old-old populations.

Nonvertebral fracture prevention with vitamin D is dose dependent, and a higher dose should reduce fractures by at least 20% for individuals aged 65 years or older.

The association between corticosteroid therapy and subsequent infections was calculated by pooling data from 71 controlled clinical trials. The overall rate of infectious complications was 12.7010 in the 2,111 patients randomly allocated to systemic corticosteroids and 8.0070 in the 2,087 controls (relative risk [RR], 1.6; 95% confidence interval reI], 1.3-1.9; P < .001). The risk of infection was particularly high in patients with neurologic diseases (RR, 2.8; 95% CI, 1.9-4.3; P< .001) and less pronounced in patients with intestinal (RR, 1.4; 95% CI, 1.1-1.7; P = .02), hepatic (RR, 1.4; 95% CI, 0.9-2.3; P = .25), and renal (RR> 1; P = .03) diseases. The rate was not increased in patients given a daily dose of <10 mg or a cumulative dose of <700 mg of prednisone. With increasing doses the rate of occurrence of infectious complications increased in patients given corticosteroids as well as in patients given placebo, a finding suggesting that not only the corticosteroid but also the underlying disease state account for the steroid-associated infectious complications observed in clinical practice.Corticosteroids in pharmacologic doses are commonly used to inhibit the immunologic network [1, 2]. As a consequence one might expect that the resistance to a wide variety of bacterial, viral, protozoal, and fungal agents is depressed, as was clearly demonstrated by numerous investigations in animals [3][4][5]. The effect of corticosteroids on the rate of infection was shown to depend upon many variables, including the dosage of the steroid and the resistance of the animal. These observations in animals were in accordance with the clinical impression of an increased rate of infections in patients treated with glucocorticoids.Toxicologic studies in animals allow in many but not all instances for the prediction of potential adverse effects of a drug in humans and for the establishment of the underlying mechanism for such unwanted effects. However, such studies cannot provide a quantitative estimate of the rate of occurrence of a given adverse effect in humans. This might also be true for corticosteroids. For instance, a large number of the investigations dealing with the enhance-

A program of in-home comprehensive geriatric assessments can delay the development of disability and reduce permanent nursing home stays among elderly people living at home.