Guidelines and recommendations developed and/or endorsed by the American

A function-based targeting system effectively and efficiently identifies older people at risk of functional decline and death. Self-reported diagnoses and conditions, when added to the system, do not enhance predictive ability. The function-based targeting system relies on self-report and is easily transported across care settings.

Care for vulnerable elders falls short of acceptable levels for a wide variety of conditions. Care for geriatric conditions is much less optimal than care for general medical conditions.

Although good evidence suggests that many agents are effective in preventing osteoporotic fractures, the data are insufficient to determine the relative efficacy or safety of these agents.

Hearing loss is the third most prevalent chronic condition in older Americans, after hypertension and arthritis 1 ; between 25% and 40% of the population aged 65 years or older is hearing impaired. 1-4 The prevalence rises with age, ranging from 40% to 66% in patients older than 75 years 5-7 and more than 80% in patients older than 85 years. 3 Alternative definitions of hearing loss would raise estimates of prevalence even higher. 8 In addition, the impact of hearing loss on society will increase not only because the population is aging, but also because the prevalence of age-adjusted hearing loss has increased significantly since the 1960s. 9,10 The diminished ability to hear and to communicate is frustrating in and of itself, but the strong association of hearing loss with depression and functional decline adds further to the burden on individuals who are hearing impaired. 11-16 Hearing loss in older patients strongly correlates with depression. For example, in a study of 253 patients aged 70 years or older, a strong statistical association was reported between the threshold of a low-frequency pure tone greater than 35 dB and depression. 17 In addition, a crosssectional study of 1191 communitydwelling older persons aged 70 to 75 years found that hearing impairment was significantly associated with depression as assessed by the Beck De

TUDIES SHOW THAT TISSUE LEVels of arachadonic acid-and eicosopentaenoic acid (EPA)derived eicosanoids influence many physiological processes, including calcium transport across cell membranes, angiogenesis, apoptosis, cell proliferation, and immune cell function. [1][2][3][4] These processes are integral to the immune system and hence the pathogenesis of autoimmune diseases such as arthritis, systemic lupus erythematosus, and asthma, as well as cancer. Epidemiological studies have suggested that groups of people who consume diets high in omega-3 fatty acids may experience a lower prevalence of some types of cancer, 5-8 and many small trials have attempted to assess the effects of omega-3 fatty acids on cancer treatment by adding omega-3 fatty acid to the diet either as omega-3 fatty acid-rich foods or as dietary supplements. [9][10][11][12][13][14][15][16][17][18][19][20][21][22] In addition, dietary omega-3 fatty acids have been found to modulate mammary tumor formation and proliferation in rodents. 23 In response to this evidence, a number of omega-3 fatty acid-containing dietary supplements have appeared on the market claiming to protect against the development of a variety of conditions including cancer. To assess the va-Author Affiliations are listed at the end of this article.

Level III, diagnostic study.

Background: Patient global ratings of care are commonly used to assess health care. However, the extent to which these assessments of care are related to the technical quality of care received is not well understood.