Geriatric conditions may be associated with adverse surgical outcomes. A comprehensive evaluation of treatment goals and communication of realistic risk estimates are essential to guide individualized decision making.

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This article revisits the question of voter turnout in American presidential elections from the perspective of political generations. We extend previous analyses by examining the entire period between 1952 and 1996 by further specifying the turnout model and, most important, by incorporating a generational component. We hypothesize that the direct effect of membership in the cohort born prior to 1932 is to increase voter turnout and the indirect effect of membership in this cohort is to increase the impact of party-related variables in accounting for turnout. Finally, we hypothesize that the indirect effect of membership in the cohort born after 1932 is to increase the impact of socioeconomic, media-related, and candidate-related variables. Our findings strongly suggest that generational effects account for a significant component of the decrease in turnout among American citizens. The impact of generations is most pronounced in the first half of the voting life cycle.In Democracy in America, Alexis de Tocqueville alluded to the difference between a subject and a citizen. The former passively allows the government to initiate and carry out public policy; the latter actively participates in the rituals of democracy. In many ways the legitimacy of a democratic polity can be cast as a function of the ratio of citizens to subjects. It would seem that a relatively obvious sine qua non of citizenship is voting. Applying this admittedly minimalist view of citizenship to American presidential elections, the citizen0 subject ratio is now in the neighborhood of unity. While the polity may not be in danger, it may well be in need of some introspection. Why are more and more of us not voting?Americans have long voted at a relatively low level. This level declined over the last half of the twentieth century, reaching 49% of those eligible in the 1996 presidential election. This decline has been difficult to explain in the context of an electorate seemingly better prepared to participate. Brody's (1978) prescient observation that the decline in voter turnout had occurred in the face of increased education generated a voluminous amount of scholarship by those attempting to solve the "puzzle of participation" (see Abramson and Aldrich 1982;

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In the United States and around the world, effective, efficient, and reliable strategies to provide emergency care to aging adults is challenging crowded emergency departments (EDs) and strained healthcare systems. In response, geriatric emergency medicine clinicians, educators, and researchers collaborated with the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine to develop guidelines intended to improve ED geriatric care by enhancing expertise, educational, and quality improvement expectations, equipment, policies, and protocols. These Geriatric Emergency Department Guidelines represent the first formal society-led attempt to characterize the essential attributes of the geriatric ED and received formal approval from the boards of directors of each of the four societies in 2013 and 2014. This article is intended to introduce emergency medicine and geriatric healthcare providers to the guidelines while providing recommendations for continued refinement of these proposals through educational dissemination, formal effectiveness evaluations, cost-effectiveness studies, and eventually institutional credentialing.