From Vital and Health Statwtlcs of the National Center for Health Statlstlcs Number 110 � August 21, 1985 

Office-Based Ambulatory Care for Patients 75 Years Old 

and Oven National Ambulatory Medical Care Survey, \ 1980 and 1981 

by Hugo Koch, Division of Health Care Statistics, and Mickey C. Smith, University of Mississippi 

@ 

@ 

Introduction 

This report offers a statistical description of the care provided in the physician’s ot%ce to patients 75 years old and 

er. This segment of the population, comparatively small in 

past, is projected to increase dramatically over the next few 

ecades. For the health community this increase means the 

emergence of problems not encountered before. To anticipate 

these problems and to furnish the resources necessary to solve 

them, the Nation’s health planners need information about the 

health needs of the advanced aging and the treatment settings 

where these needs are met. 

Although it is important to examine the care provided to the 

advanced aging in the Nation’s hospitals and nursing homes, it 

is shortsighted to accept inpatient care as the model by which 

the health problems and treatment of all aging patients are 

judged. It is also necessary to examine outpatient settings, especiz?llythe doctor’s ofiice, where most of the advanced aging 

still seek their health care. 

To establish normative patterns for the office-based care 

of the advanced agin~ the authors combined the 1980 and 

1981 findings of the National Anbulatoxy Medical Care”Survey, 

an annual sample survey of office-based physicians conducted 

from 1973 through 1981 by the National Center for Health 

Statistics. The patient universe examined was the age group 75 

years old and over, which was divided, where detailed analysis 

was indicated and possible, into 5-year subgroups. The statistical bases for the report are shown in table 1. 

The following aspects of the office visit will be successively 

xamined: 

Sex of patient. 

Physician’s diagnoses. 

� Patient’s symptoms< 

Table 1. Number and percent distribution of or%!icevisits by age 

and sex of patient: United States, 1980 and 1981 

Office visits 

Number in Percent 

Patient age and sex thousands distribution 

All office patients . . . . . . . . . . . . . . . . . . . . 1,160,922 100.0 

All patients 

Under 75 years old . . . . . . . . . . . . . . . . . . . 1,078,468 92.9 

75years old And over . . . . . . . . . . . . . . . . . 82,454 7.1 

75-79 yaars old . . . . . . . . . . . . . . . . . . . 43,309 3.7 

80-84 years old . . . . . . . . . . . . . . . . . . . 24,713 2.1 

85years old And over . . . . . . . . . . . . . . . 14,431 1.3 

Female 

Under 75 years old . . . . . . . . . . . . . . . . . . . 646,220 55.7 

75years old And over . . . . . . . . . . . . . . . . . 53,498 4.6 

75-79 years old . . . . . . . . . . . . . . . . . . . 27,497 2.4 

80-84 years old . . . . . . . . . . . . . . . . . . . 16,430 1.4 

85years old And over . . . . . . . . . . . . . . . 9,571 0.8 

Male 

Under 75 years old . . . . . . . . . . . . . . . . . . . 432,248 37.2 

75years old And over . . . . . . . . . . . . . . . . . 28,956 2.5 

75-79 years old . . . . . . . . . . . . . . . . . . . 15,813 1.4 

80-84 years old . . . . . . . . . . . . . . . . . . . 8,284 0.7 

85years old And over . . . . . . . . . . . . . . . 4,860 0.4 

NOTE Figures may not add to totals due to rounding. 

. Medications ordered or provided. 

. Nonmedication therapy. 

. Former visit status and referrals. 

. Disposition and duration. 

� Physician’s specialty. 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service 
2 

The data presented are estimates, based on a sample of 

otlice visits rather than on the actual number, and, thus, are 

subject to sampling variability. The smaller an estimate, or any 

percent or ratio based on that estimate, the more imprecise it is 

likely to be; this applies particularly to the 5-year, sex-age sub 

groups. An asterisk preceding any estimate indicates that it 

exceeds 30 percent relative standard error. Guidelines for judging the precision of estimates are provided in the Technical 

notes at the end of this report, along with a brief description of 

the survey design. 

For greater ease of reference, the textual discussion will 

sometimes use the following designators: 

. AG group: patients 75 years old or over. 

. Younger group patients under 75 years of age. 

Data Highlights 

General 

Over the 2-year period from January 1980 through December 1981, patients in the AG group made an estimated 

82,454,000 visits to the offices of non-Federal physicians practicing in the coterminous United States. This amounted to an 

average of five visits per year for each person in the subpopulation over 74 years of age. (For the younger subpopulation, 

the average was about three visits per year.) Slightly over onehalf (53 percent) of these 82,454,000 visits were made by 

patients 75–79 years old, another 30 percent by patients 80– 

84 years old, and the remaining 17 percent by patients in the 

open-ended subgroup over 84 years of age (table 1). Similar to 

the pattern found for most age subgroups, visits by AG females 

substantially outnumbered visits by AG males, by a margin 

that increased to almost two to one in the older two subgroups. 

In large part, this gender difference among the very old is a 

function of relative longevity, reflecting an average life expectancy that in 1981 was 77.9 years for women versus 70.4 years 

for men. 

Diagnoses 

For the majority of AG visits (52 percent), multiple diagnoses were the rule (table 2). The National Ambulatory Medical Care Survey (NAMCS) allows for the processing of up to 

three of these diagnoses per visit. Of these, the first-listed is 

designated as the principal diagnosis, for the reason that it is 

the one most closely associated with the patient’s chief presenting symptom and thus usually commands the physician’s 

immediate attention. For patient groups among which a single 

diagnosis is the rule, an analysis by principal problem is probably adequate to describe the diagnostic mix typical of the group. 

At the AG visit, however, where coexisting problems are the 

rule, a broader perspective seems indicated, one that accounts 

for the overall impact of a disease entity, whether first listed or 

coexistent. 

Thus the approach used in tables 3–5 is to cumulate mentions of a diagnosis as a first-, second-, or third-listed problem 

to produce an all-listed diagnosis. For example, essential hypertension was a first-listed diagnosis at 10 percent of AG visits 

but an all-listed problem at 17 percen~ the circulatory diseases 

Table 2. Percent of office visits with multiple diagnoses by age 

and sex of patient United States, 1980 and 1981 

visits with — 

multiple 

Patient age and sex diagnoses 

All patients 

Under 75 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

75years old And over . . . . . . . . . . . . . . . . . . . . . . . . . . 

75-79 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

80-84 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

85years old And over . . . . . . . . . . . . . . . . . . . . . . . . 

Female 

Under 75years odd. . . . . . . . . . . . . . . . . . . ... . . . . . . . . 

75yeara old and over . . . . . . . . . . . . . . . . . . . . . . . . . . 

75-79 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

80-84 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

85years old And over . . . . . . . . . . . . . . . . . . . . . . . . 

Mala 

Under 75 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

75years old And over . . . . . . . . . . . . . . . . . . . . . . . . . . 

75-79 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

80-84 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

85years old And over . ., . . . . . . . . . . . . . . . . . . . . . 

31.1 

52.4 

50.0 

54.6 

56.5 

30.6 

52.1 

48.3 

54.8 

58.4 

31.7 

53.2 

53.0 

54.2 

52.8 

as a group accounted for 28 percent of all principal diagnoses 

but appeared as coexisting problems at yet another 27 perce 

producing an all-listed proportion of 55 percent. * Table 3 ranks the 25 diagnoses most frequently present at 

AG visits. Clearly apparent is the dominant presence of certain 

chronic diseases and their sequellae. The major afflictions of 

the ambulatory aging (essential hypertension, ischemic heart 

disease, diabetes, osteoarthrosis, and cataract) are ranked high 

on the list for both AG males and females. One notable difference between the sexes is the presence of two male-specific 

conditions, hyperplasia and malignant neoplasm of the prostate. Ranked among the 10 problems most frequently encountered among AG males, these diseases are especially evident among male patients in the subgroup 75–79 years. Among 

the other problems listed in table 3, the most substantial differences between male and female rankings were apparent for 

the following 

. Hypertensive heart disease (ranked 8th among AG females, 26th among males). 

� Neurotic disorders- (ranked 15th among females, 42d 

among males). 

. Chronic airway obstruction (ranked 8th among AG males, 

52d among females). 

It is interesting to observe that among these most frequent prob 

lems, there was no mention of a “senile” mental condition. In 

tables 4 and 5, the specific diagnoses are gathered into dia ­

nostic groups. 

At AG visits, the following diagnostic groups exceeded m — 

rate of mention the level found for the younger group 

�	 Diseases of the circulato~ sysiem—Present at a startling 

55 percent of AG visits, these conditions dramatically 
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

3 

Number of mentions per 1,000 office visits of patienta 75 years old and over by the 25 all-Iisted diagnoses most frequently mentioned 

d ranks of diagnoses by sex United States, 1980 end 1981 

Rank order bv 

a Numbar of sex of patient 

n mentions par 

k Most frequent all-listedi diagnoses and ICD-9-CM code2 7,000 visits Females Males 

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401 174 1 1 

Chronic ischemic heart disease.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...414 95 2 2 

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 67 4 3 

Osteoarthrosis and allied disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...715 60 3 7 

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366 51 5 5 

Heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...428 44 7 4 

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . ...427 36 9 6 

Arthropathies, other and unspecified. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...716 36 6 14 

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...365 28 10 13 

Hypertensive heart disease, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . ...402 26 8 *26 

Angina pectoris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...413 23 12 11 

Other disorders ox eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...379 23 11 15 

Heart disease; ill-defined descriptions and complications. , . . . . . . . . . . . . . . . . . . . . . ..429 20 14 17 

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440 20 13 19 

Chronic air.vay obstruction NEC3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...496 17 *52 8 

Other disorders ofurethra and urinary tract. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...599 17 16 16 

Cerebrovascular disease, other and ill-defined , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...437 16 26 12 

Other and unspecified anemias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...285 15 17 21 

Neurotic disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300 15 15 *42 

Other malignant neoplasm of skin.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...173 14 27 18 

Acute upper respirator infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...465 14 18 *29 

Malignant neoplasm of prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...185 13 . . . 9 

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...780 13 23 *22 

Hyperplasia of prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...600 12 . . . 10 

Other retinal disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...362 12 19 “38 

e-listed diagnosix Cumulates mentions as 1 st-, 2d-, or 3d-lis ted diagnosis. 

ed on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). 

t elsewhere classified. 

dominated the arena of office-based AG care. In relative 

proportions, they were about equally evident among AG 

females and males. Their rate of mention, largely due to 

the growing presence of heart failure, hypertensive heart 

disease, and cardiac dysrhythmias, continued to increase 

for both sexes beyond the 84th year. 

�	 Diseases of the rnusculoskeletal system—Ahhough both 

sexes showed a marked increase, it was among the AG 

females that these conditions were more frequently encountered, underscoring a need for early use of postmenopausal treatment with hormones and calcium replacement. Mention rate did not increase for either sex beyond 

the 84th year. 

Eye disorders—Three times as frequent at AG visits, both 

AG males and females were affected, and the mention rate 

continued to increase beyond the 84th year. 

Diseases of the endocrine glands (chiefly diabetes)— 

Nearly twice as frequent at AG visits, both AG males and 

females were affected about equally, For neither sex was 

there an increase in mention rate beyond the 84th year. 

Neoplasnzs-Increased rates of mention, though evident 

—	 for both sexes, were more substantial among AG males, 

chiefly owing to an estimated 1,000,000 mentions of malignant neoplasm of the prostate. For neither sex was there 

an increasing rate of mention beyond the 84th year. 

�	 Diseases of the blood and blood-forming organs (chiefly 

unspecified anemias)—One of the less frequently mentioned diagnostic groups, these conditions increased in 

mention rate for both AG females and AG males. The 

relatively small number of mentions precluded further analysis among the AG subgroups. 

�	 Digestive disorders—Mention rate increased for AG females while remaining about the same for AG males. 

.	 Diseases of thegenitoun”nan’ system—Mention rate more 

than doubled for AG males while decreasing by one-half 

among AG females. Chiefly responsible was the substantial presence among male patients of prostatic hyperplasia. 

For neither sex was there evidence of increasing rate of 

mention beyond the 84th year. 

For the following diagnostic groups, the AG mention rate 

either fell below or roughly equaled the rate found among 

younger office patients: 

�	 Infectious and parasitic diseases—Mention rate was about 

one-third the rate observed among younger patients. 

�	 Mentai disorders (dominantly nonpsychotic)-With this 

group, though minor in rate of mention, the rate among 

AG females was ahnost double that found among AG 

males. 

�	 Diseases of the respiratory system—Rather than the acute, 

self-limiting problems typical of younger patient groups, 

among AG patients it is the presence of the chronic respiratory problems, for example, chronic airway obstruction, 

that chiefly accounted for the relatively large rates of mention of this diagnostic catego~. This presence was most 

evident among AG males in the subgroup 80-84 years. 
4 advancedata 

Table 4. Number of mentions per 1,000 office visits of patients by age, sex, and selected diagnostic groups composed of all-listed diagnoses: 

United States, 1980 and 1981 

All patients Females Males 

Ail-listed diagnosesl (unselected diagnostic groups) Under 75 75 years Under 75 75 years Under 75 75 years 

and ICD-9-CM code2 

Infectious and parasitic diseases. . . . . . . . . . . . . . . . . . . . . . . ...001 -139 

Neoplasm.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239 

Endocrine, nutritional, and metabolic diseases and immunity 

disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...24&279 

Diseases of endocrine glands . . . . . . . . . . . . . . . . . . . . . . . . ...240-259 

Diseases of blood and blood-forming organs . . . . . . . . . . . . . ...280-289 

Mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-31 9 

Nonpsychotic disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300-31 6 

Disaases of newous system and sense organs. . . . . . . . . . . . ...320-389 

Diseases of central netvous system. . . . . . . . . . . . . . . . . . ..320-349 

Eye disorders . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . ...360-379 

Diseases ofcirculatow system . . . . . . . . . . . . . . . . . . . . . . . . . ...390-459 

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401 

Ischemic heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...410-414 

Other selected circulatory diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...428 

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...427 

Hypertensive heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...402 

Heart disease; ill-defined descriptions and complications . . . ...429 

Cerebrovascular disease; other and ill-defined. . . . . . . . . . . . . ...437 

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...440 

Angina pactoris. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...413 

Diseases ofrespk’atory system . . . . . . . . . . . . . . . . . . . . . . . . . ...460-51 9 

Diseases of digestive system . . . . . . . . . . . . . . . . . . . . . . . . . . ...520-579 

Diseases of genitourinary system. . . . . . . . . . . . . . . . . . . . . . . ...580-629 

Disaases of skin and subcutaneous tissue . . . . . . . . . . . . . . . ...680-709 

Diseases of musculoskeletal system . . . . . . . . . . . . . . . . . . . . . ..710-739 

Arthropathies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...711-71 6 

Symptoms, signs, and ill-defined conditions . . . . . . . . . . . . . ...780-799 

Injury and poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...800-999 

lA1l-listed diagnosis Cumulates mentions as 1 st-, 2d-, or 3d-listad diagnosis. 

years and over years and over years and over 

44 

33 

70 

39 

9 

66 

57 

123 

10 

57 

143 

69 

26 

27 

5 

6 

6 

3 

1 

1 

5 

175 

60 

82 

75 

97 

29 

54 

107 

Number of mentions per 1,000 visits 

15 43 15 45 

76 34 54 31 

104 80 103 56 

81 43 80 32 

26 11 27 7 

38. 67 46 63 

33 59 40 55 

206 112 217 140 

16 10 17 10 

155 54 164 60 

540 128 540 166 

174 69 201 69 

131 17 120 40 

186 24 181 34 

44 4 41 6 

36 6 33 8 

26 6 33 6 

20 2 21 4 

17 1 11 1 

20 1 21 2 

23 4 21 7 

110 154 94 206 

81 55 89 69 

70 109 52 41 

57 71 56 81 

167 94 192 100 

103 33 121 23 

60 54 58 54 

62 81 68 146 

16 

116 

106 

82 

24 

24 

20 

187 

*14 

139 

541 

124 

153 

195 

48 

43 

*I3 

20 

26 

18 

27 

138 

63 

51 

‘Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). 

. Diseases of the skin and subcutaneous tissue–Although 

skin diseases were generally more of a problem in the 

younger patient group than they were at AG visits, they 

showed their highest single rate of mention among AG 

females over 84 years old. 

�	 Symptoms, signs, and ill-defined conditions—Recourse 

by physicians to this vaguest of diagnostic categories was 

no more common among AG ofl=ice patients than it was 

among their younger counterparts. 

�	 Znjwy and poisoning (chiefly accidents)—Though relatively less frequent among the less active AG group, for 

example, the rate for AG males decreased by two-thirds, 

the consequences of injury were much more serious for the 

advanced aging. 

Symptoms 

Formal diagnoses represent the objective bases on which 

the successful management of AG care principally depends. 

But also clinically relevant are the more subjective aspects of 

AG care, as represented by the complaints and symptoms that 

AG patients present. Indeed, a significant part of AG treatment may be almost wholly symptomatiq for example, the 

treatment of degenerative joint disease. As with the diagnoses, 

the National Ambulatory Medical Care Survey processes up 

to three of the patient’s self-expressed symptoms per visit, the 

first-listed entry being the most important from the patient’s 

point of view. Continuing the approach applied in forming the 

all-listed diagnoses, the findings in tables 6 and 7 cumulate 

mention as a first-, second-, or third-listed symptom to produce 

an all-listeds ymptom. 

Listed in table 6 are the 25 symptoms most frequently 

presented at AG visits. At about one-half of all AG visits, one 

or more of these symptoms appeared. For most of them there is 

a ready linkage to the 25 diagnoses in table 3. 

Gender differences in the ranking of these symptoms were 

uncommon. When they did occur, they generally showed a 

close parallel to the male-female differences found among the 

provenant diagnoses. For example, anxiety and nervousness, 

symptoms three times as tkequent among AG females, are chiefly 

associated with a diagnosis of neurotic disorder, which is also 

found in a three to one ratio favoring AG females. (It dese 

comment, however, that the overall findings testify to the re* tively high degree of emotional health enjoyed by AG patients, 

whether male or female. This is further attested to by the finding 

that a symptom of depression was presented at fewer than 1 

percent of AG visits.) 
5


Number of mentions per 1,000 office visits of patients by age and selected diagnostic groups composed of all-listed diagnoses: 

United States, 1980 and 1981 

All patients Females Males 

All-1isted diagnosesl (in selected 75-79 80-84 85 years 75-79 80–84 85 years 75-79 80-84 85 years 

diagnostic groups ] and ICD-9-CM code2 

Neoplasm . . . . . . . . . . . . . . . . . . . . . ...140-239 

Endocrine, nutritional, and metabolic diseases 

and immunity disorders. . . . . . . . . . ...240-279 

Diseases of endocrine glands. . . . ...240-259 

Mental disorders . . . . . . . . . . . . . . . . ...290-319 

Nonpsychotic disorders. . . . . . . . . ...300-316 

Diseases of nervous system and sense 

organs . . . . . . . . . . . . . . . . . . . . . . . . ...320-389 

Eye disorders . . . . . . . . . . . . . . . . . . .. 360-379 

Diseases of circulatory system . . . . . ...390-459 

Essential hypertension . . . . . . . . . . . . . . ...401 

Ischemic heart disease . . . . . . . . . ...410-414 

Other selected circulato~ diseases3 . . . . . . . . . 

Diseases of respirato~ system . . . . . ...460-519 

Diseases of digestive system . . . . . . ...520-579 

Diseases of genitourinary system. , . ...580-629 

Diseases of skin and subcutaneous 

tissue . . . . . . . . . . . . . . . . . . . . . . . . ...680-709 

Diseases of musculoskeletal system . ..710-739 

Arthropathies . . . . . . . . . . . . . . . . . ...711-716 

Symptoms, signs, and ill-defined 

conditions . . . . . . . . . . . . . . . . . . . . . ...780-799 

injury and poisoning . . . . . . . . . . . . . ...800-999 

years 

87 

110 

86 

42 

37 

199 

151 

498 

172 

122 

161 

110 

81 

69 

55 

171 

100 

53 

67 

years and over years years and over years 

Number of mentions per 1,000 visits 

62 65 62 42 50 130 

103 89 117 93 81 98 

84 59 93 74 55 74 

33 34 49 44 *38 31 

27 ’30 44 37 *34 *25 

203 235 218 205 234 166 

149 177 170 146 176 118 

567 623 480 581 641 522 

178 171 192 202 219 137 

141 142 109 134 127 146 

199 242 158 189 240 64 

122 86 97 101 74 34 

83 75 88 99 75 69 

71 71 45 60 61 11 

53 69 51 46 86 63 

162 164 195 185 195 130 

100 117 118 116 140 69 

70 64 51 66 66 56 

59 50 73 66 54 58 

years and over 

102 95 

123 105 

104 *69 

*11 *24 

‘8 *2 I 

198 237 

153 181 

539 586 

125 *76 

155 172 

221 247 

164 110 

*51 *75 

93 “89 

68 *36 

115 102 

66 *73 

78 *59 

*44 *4 I 

‘All-listed diagnosis: Cumulstes mentions as 1st-, 2d-, or 3d-listed diagnosis. 

ased on the International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM). 

a 

@ 

eludes heart failure [ICD 428); cardiac dysrhythmias (ICD 427); hypertensive hearl disease (ICD 402); heart disease, ill-defined descriptions and complication 

CD 429); cerebrovascular disease, other and [lI-defined (ICD 437); atherosclerosis (ICD 440); and angina pectoris ([CD 41 3). 

It is noteworthy that the topranked symptom, dizziness, 

does not permit as easy a linkage to diagnosis as the linkage 

evident for most of the other symptoms on the list. Transient 

cerebral ischemias, for example, were associated with fewer 

than 5 percent of the dizziness visits. Worthy of exploration 

are the possible effects of the more intensive use of drugs in 

AG treatment. 

A complaint of pain was presented at roughly 21 percent 

of the 82,454,000 AG visits, a proportion only slightly greater 

than the comparable proportion (20 percent) found among patients under 75 years old. Of these 17,123,000 pain-associated 

AG visits, five diagnostic categories accounted for a clearly 

dominant proportion (76 percent). 

Percent of all 

pain-associate d 

Catego~ visits 

Diseases of the musculoskeletal 

system . . . . . . . . . . . . . . . . . . . . . . . . 34.0 

Diseases of the circulatory system. . . . . 18.5 

Diseases of the digestive system . . . . . . 9.2 

Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.1 

Diseases of the newou.s system and 

sense organs . . . . . . . . . . . . . . . . . . . . 6.2 

The findings in table 7 express the sex-age dispersions of 

the pain-associated AG visits. They reveal that pain was more 

apparent among the AG females than among the males, reaching its highest proportion (23.4 percent) among females in the 

subgroup 80–84 years. Beyond the 84th year, the proportion 

of pain-associated visits declined among female patients while 

remaining roughly the same among the male subgroup. 

Medication Therapy 

Figure I illustrates the prominent role played by drugs in 

the oftice-based care of the advanced aging. Seven of every ten 

AG visits were drug visits; that is, they involved the utilization 

of one or more medications. For four of these seven drug visits, 

drug therapy was the only form of treatment applied. 

To assess the volume and nature of the drug therapy ap 

plied by oflice-based practitioners, survey procedure required 

that the physician respondents list up to eight of the medications 

that they ordered or provided in the course of the visit. Nonprescription as well as prescription drugs were recorded and, 

along with any new drugs, continuing drugs were listed, if the 

patient was specifically instructed during the visit to continue 

the medication. The resulting drug mentions were distributed 

according to the age and sex patterns shown in table 8. 

It is clearly evident that the average rate of drug mentions 

for the AG group well exceeded the rate of use found for the 

younger group. Two major indicators support this more intensive use of drug therapy: 

.	 An estimated 70 percent of AG visits were drug visits, an 

increase of 9-10 percent over the proportion found for 

drug visits by the younger group. 
1

2

3

4

5

6

7

8

9

10

11

12

13

14

�

6 advancedata 

Table 6. Number of mentions per 1,000 office visits of patients 

75 yeara old and over by the 25 all-listed symptoms most frequently 

presented and rank of symptoms 

and 1981 

R 

a 

n 

k 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

Most frequent all-listed~ 

symptoms 

Dizziness . . . . . . . . . . . . . . 

Vision dysfunctions. . . . 

8ack pain . . . . . . . . . . . . . . 

Leg pain . . . . . . . . . . . . . . . 

Cough . . . . . . . . . . . . . . . . . 

Chest pain . . . . . . . . . . . . . 

Shortness of breath, . . . . . 

General weakness. . . . . . 

Knee pain . . . . . . . . . . . . . 

Skin lesion . . . . . . . . . . . . . 

Abdominal pain. . . . . . . . 

Headache . . . . . . . . . . . . . . 

Foot and toe pain . . . . . . . 

Tiredness and 

exhaustion . . . . . . . . . . . . 

Hip pain . . . . . . . . . . . . . . . 

Abnormal sensations 

of the eye . . . . . . . . . . . . . 

Head cold . . . . . . . . . . . . . 

Shoulder pain . . . . . . . . . . 

Anxiety and 

nervousness. . . . . . . . . 

Abnormal pulsations and 

palpitations . . . . . . . . . . . 

Nausea . . . . . . . . . . . . . . . . 

Frequency and urgency 

of urination . . . . . . . . . . . 

Generalized pain, site 

unspecified . . . . . . . . . . . 

Symptoms of fluid 

abnormalities. . . . . . 

Skin irritations. . . . . . . . . 

by sex: United States, 1980 

Rank order by 

Number of sex of patient 

mentions per 

1<000 visits Females Males 

38 1 3 

34 2 7 

32 4 2 

31 3 6 

28 6 4 

27 5 8 

26 9 1 

26 8 5 

20 7 *25 

20 11 9 

19 13 10 

18 10 *I8 

17 14 11 

15 16 *13 

15 15 *I6 

14 12 *4O 

12 20 *I4 

12 18 *22 

12 17 *5 I 

11 19 *23 

10 27 *I9 

10 32 *I5 

10 22 *3O 

10 21 *34 

9 24 *32 

lA1l-listed symptom: Cumulstes mentions as 1 st-, 2d-, or 3d-listed symptom. 

�	 Roughly 44 percent of AG visits involved the provision of 

multiple drugs, an increase of about one-third over the 

multiple-use proportion found at visits by younger patients 

Within the AG group, there were significant gender differences 

in these two measures of drug intensity 

�	 The proportion of drug visits was higher among the AG 

females than among the males. (For both sexes, however, 

the proportion did not show an increase beyond the 84th 

year.) 

� The relative exposure to multiple drugs was substantially 

greater among AG females, especially in the older two 

subgroups but, again, for both sexes it did not appear to 

increase beyond the 84th year. 

Table 9 offers a ranked listing of the 25 drugs most frequently ordered or provided at AG visits. Two agents, hydrochlorothiazide (a diuretic) and digoxin (a cardiac drug) head 

the list by a considerable margin. Most of the other listed agents 

also link rather closely to the most frequent diagnoses listed in 

table 3 and the most frequent symptoms listed in table 6. 

Table 7. Percent of office visita with symptomatic pain by sex 

and age of patient United States, 1980 and 1981 

Percent o 

visits with 

symptomatic 

Patient sex and age pain~ 

Female 

Under 75 years old . . . . . . . . . . . . . . . . . . . . . . . . . . 19.3 

75years old And over . . . . . . . . . . . . . . . . . . . . . . . . 22.4 

75-79 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.5 

80-84 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . 23.4 

85years old And over . . . . . . . . . . . . . . . . . . . . . . 20.2 

Male 

Under 75 years old . . . . . . . . . . . . . . . . . . . . . . . . . . 20.0 

75years old And over . . . . . . . . . . . . . . . . . . . . . . . . 17.8 

75-79 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . 19..3 

80-84 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.4 

85years old And over . . . . . . . . . . . . . . . . . . . . . . 15.6 

1Cumulates visits where aymptomstic pain was a 1 st-, 2d-t or 3d-listed reason 

for visiting the doctor. 

Because the more frequent use of multiple medications at 

the AG visits may increase the threat of adverse interactions, 

the concomitant use of drugs needs detailed exploration not 

possible in this brief report. It maybe instructive, however, to 

cite the 10 agents that most commonly appeared in conjunctio~ 

B 

�

������ 

~ Drug therapy

m 

Altarnatives to drug therapy B

Figure 1. Percent distribution of office visits of persons 75 years 

and over by treatment modality: United Statea, 1980 and 1981 
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

1

2

3

4

5

6

7

ammedab7 

Number and percant distribution of drug mentions, percent of office visits with at least 1 drug mention, and percent of office visits 

with multiple drug mentions, by aga and sex of patient United Statas, 1980 and 1981 

Patient age and sex 

All office patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

All patients 

Under 75 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

75years old Andover........,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

75-79 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

80-84 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

85years old And over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Under 75 years old. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

75years old and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

75-79 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

80-84 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

85years old And over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Male 

Under 75 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

75years old And over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

75-79 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

80-84 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

85years old And over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

At least Multiple 

7 drug drug 

Drug mentions mention mentions 

Number in Percent


thousands distribution Percent of visits


1,330,746 100.0 61.8 30.9 

1,195,419 89.8 

135,327 10.2 

68,652 5.2 

41,914 3.7 

24.761 1.9 

712,725 53.6 

91,301 6.8 

44,783 3.4 

29,402 2.2 

17,117 1.3 

482,695 37.2 

44,026 3.3 

23,869 1.8 

12,512 0.9 

7,644 0.6 

61.2 29.9 

69.5 44.0 

68.8 42.5 

70.4 45.8 

70.1 45.1 

60.9 29.6 

70.8 45.4 

69.5 43.4 

72.1 47.4 

72.2 47.6 

61.7 30.3 

67.2 41.3 

67.6 40.9 

67.1 42.5 

66.0 40.4 

Table 9. Number of mentions per 1.000 office visits of the 25 drugs moat frequently ordered or provided for patients 75 years old and over and 

rank by sex: United States, 1980 and 1981 

R 

a 

n 

k 

@ 2 

23 

24 

25 

Name of drug (generic) 

Hydrochlorothiazide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Digoxin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Furosemide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 

Triamterene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Propanolol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Methyldopa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Potassium replacement solutiona. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Vitamin B-1 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Nitroglycerin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Lsosorbide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Reserpine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Multivitamins, general . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Acetaminophen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Chlorthalidone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Dihydroergotamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Ibuprofen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Meclizine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Theophylline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Iron preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Phenobarbital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Chlorpropamide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Papaverine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Spironolactone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Tetracycline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Number of Comparable rank 

mentions per 

Therapeutic effect 7,000 visits q Females Males 

Diuretic 

Cardiac drug 

Diuretic 

Diuretic 

Analgesic, and so forth 

Cardiac drug 

Antihypertensive agent 

Replacement solution 

Vitamin 

Vasodilating agent 

Vasodilating agent 

Antihypertensive agent 

Vitamin 

Analgesic and antipyretic 

Diuratic 

Treatment of migraine 

Analgesic, anti-inflammatory 

Antinauseant 

Spasmolytic agent 

Anti-anemia agent 

Sedative 

Antidiabetic, agent 

Spasmolytic agent 

Diuretic 

Antibiotic 

126 2 

109 1 

69 3 

46 4 

43 6 

42 5 

36 13 

35 9 9 

32 10 12 

32 11 10 

29 14 8 

27 12 17 

25 13 21 

23 16 14 

23 15 16 

20 19 15 

20 17 *31 

19 18 28 

18 38 11 

17 20 27 

17 23 22 

17 25 23 

16 21 *37 

15 26 “35 

15 32 24 

1Includes mantions of an sgent as a single-ingredient drug and its mentions as an ingredient of a combination drug. 
8 dmcdata 

with the ranking dreg, hydrochlorothiazide. In rank order of For the following drug classes the AG mention rate showed 

frequency of co-occurrence these were as follows: an increase over the average level found for younger offlc 

patients: o Rank Drug 

� Analgesics. l . . . . . . . . . . . . . . . . . . . Triamterene � Antineoplastic agents and estrogens. (When the estrogens 2., . . . . . . . . . . . . . . . . . Digoxin 

3 . . . . . . . . . . . . . . . . . . . Methyldopa used in the treatment of prostatic carcinomas are added to 

4 Spironolactone the formal class of antineoplastic agents, there is a predict5::::::::::::::::::: Reserpine able increase for AG males in the overall rate of antineo6 . . . . . . . . . . . . . . . . . . . Propanolol 

7 . . . . . . . . . . . . . . . . . . . Hydralazine plastic mentions.) 

8 . . . . . . . . . . . . . . . . . . . Potassium replacement solutions � Cardiovascular-renal agents (including the spasmolytic 

9 . . . . . . . . . . . . . . . . . . . Aspirin agents used to relieve symptoms of the urinary tract). 10.	 . . . . . . . . . . . . . . . . . Furosemide 

� Gastrointestinal drugs (including the spasmolytic agents 

In tables 10 and 11 the individual agents are grouped into used in the symptomatic treatment of gastrointestinal hypertherapeutic classes. Generally, there was a predictable relation- motility). 

ship between the mention rate of a given drug class and that of � Hematologics. 

its associated diagnosis or symptom. � Insulins and antidiabetic agents. 

Table 10. Number of mentions per 1,000 office visits of drugs ordered or provided for patients under 75 yeara old and over 74 yeara old by 

selected drug categories: United States, 1980 and 1981 

All patients Females Ma/es 

Under 75 75 years Under 75 75 years Under 75 75 years 

Selected drug categories years and over yaars and over years and over 

Number of mentions per 1,000 visits 

All drug mentions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,108 1,641 1,103 1,707 1,117 1,520 

Antihistamine drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 28 73 34 88 1 

Anti-infective agents [systemic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 94 176 85 204 109e 

Antineoplastic agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 9 10 9 5 *9 

Autonomic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 48 41 52 43 40 

Blood formation and coagulation.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 31 15 29 9 36 

Cardiovascular drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 367 81 385 117 333 

Cardiac drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 175 31 177 51 172 

Antihypertensive agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 97 35 115 37 65 

Vasodilating agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 92 15 89 27 96 

Central. nervous syatem drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 261 187 290 168 209 

Analgesics andantipyretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 159 94 173 99 132 

Antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 20 20 24 13 *13 

Major tranquilizers (for example: thorazine) . . . . . . . . . . . . . . . . . . . . . . . 8 10 8 12 8 *7 

Minor tranquilizers (for example: diazepam), sedatives, and 

hypnotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 57 44 66 35 38 

Respiratory and cerebra l stimulants.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 10 15 12 6 *6 

Replacement solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 36 12 39 11 31 

“Diuretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 215 68 226 61 194 

Expectorants and cough preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 16 30 13 37 21 

Ophthalmic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 74 28 72 34 76 

Agents used to treat glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 28 4 29 6 26 

Mydriatica andcycloplegics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 10 3 *7 3 *I4 

Anti-infective and anti-inflammatory agents. . . . . . . . . . . . . . . . . . . . . 19 26 17 24 21 30 

Gastrointestinal drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 76 38 85 40 59 

Antacids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 11 6 11 6 *1 1 

Laxatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 18 6 20 5 *I3 

Emetics and anti-emetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 19 7 22 5 *I5 

Miscellaneous (chiefly agenta used to treat duodenal ulcer). . . . . . . . . . 9 12 8 14 11 ‘9 

Hormones andsynthetic substances. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 125 112 127 64 121 

Adrenals (systemic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 38 33 40 34 34 

Estrogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 16 17 13 *1 21 

Insulins andantidiabetic agents.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 46 16 43 18 51 

Thyroid and antithyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 15 13 18 3 “9 

Serums, toxoids, and vaccines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 18 34 22 51 *1 

Skin preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 70 90 66 93 7 

Spasmolytic agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 46 13 40 23 5 m 

Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 68 49 75 18 56 

Vitamin B complex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 38 12 41 7 33 

1Drug categories are adapted from 2 sources: The therapeutic categories of the American Hospital Formulery Service, reproduced with permiaaion of the American 

Society of Hospital Pharmacist, and the drug classes used in the Nationa/ Drug Code Directmy, 1982 edition. 
9


Table 11. Number of mentions per 1,000 office visits of drugs ordered or provided for patients 75 years old and over by age, sex, and selected 

drug categories United States, 1980 and 1981 

All padents Females Males 

75-79 80-84 85 years 75-79 80-84 85 years 75-79 80–84 85 years 

Selected drug categories! years years and over years years and over years years and over 

Number of mentions per 1,000 visits 

All drug mentions . . . . . . . . . . . . . . . . . . . . . . . . . . 1,585 1,696 1,716 1,629 1,790 1,786 1,509 1,510 1,573 

Anti-infective agents (systemic) . . . . . . . . . . . . . . . 

Autonomic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Blood formation and coagulation . . . . . . . . . . . . . . 

Cardiovascular drugs . . . . . . . . . . . . . . . . . . . . . . . . 

Cardiac drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Antihypertensive agents . . . . . . . . . . . . . . . . . . . 

Vasodilating agents, . . . . . . . . . . . . . . . . . . . . . . 

Central nervous system drugs. . . . . . . . . . . . . . . . . 

Analgesics and antipyretics . . . . . . . . . . . . . . . . 

Major tranquilizers (for example: thorazine) 

and antidepressants . . . . . . . . . . . . . . . . . . . . . 

Minor tranquilizers (for example: diazepam), 

sedatives, and hypnotics. . . . . . . . . . . . . . . . . . 

Replacement solutions . . . . . . . . . . . . . . . . . . . . . . 

Diuretics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Ophthalmic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . 

Gastrointestinal drugs . . . . . . . . . . . . . . . . . . . . . . . 

Hormones and synthetic substitutes . . . . . . . . . . . 

Adrenals (systemic) . . . . . . . . . . . . . . . . . . . . . . . 

Insulins and antidiabetic agents. . . . . . . . . . . . . 

Skin preparations . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Spasmolytic agents . . . . . . . . . . . . . . . . . . . . . . . . . 

Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

92 103 

47 47 

26 34 

353 379 

162 167 

94 101 

93 91 

267 277 

160 166 

34 29 

57 66 

29 40 

195 227 

73 70 

69 73 

132 127 

38 41 

48 48 

65 69 

44 46 

59 71 

83 82 99 70 109 

52 54 50 53 36 

43 *22 *29 51 34 

369 370 406 392 323 

195 166 185 195 155 

101 109 126 116 69 

92 69 94 82 97 

217 292 318 234 224 

141 172 189 146 139 

20 41 35 *22 *23 

40 65 81 *45 42 

54 28 44 64 29 

254 200 241 276 187 

87 70 74 83 79 

99 72 94 106 65 

100 1*2 117 101 115 

35 40 44 *37 35 

36 51 35 *32 41 

68 56 66 97 80 

52 40 37 47 51 

91 70 74 91 40 

112 107 

*42 *49 

*44 “27 

324 381 

190 195 

*51 *72 

83 113 

195 183 

121 131 

*I8 *13 

*36 *31 

*32 *34 

197 210 

63 95 

“32 *86 

147 99 

*33 *32 

73 *48 

74 *69 

65 “61 

67 *9O 

oDrug categories are adapted from 2 source% The therapeutic categories of the American Hospital Formula!y Service, reproduced with permission of the American 

ociety of Hospital Pharmacists, and the drug classes used in the Nationa/ Drug Code Directmy, 1982edition. 

. Ophthalmic drugs. 

.	 Sedatives, hypnotics, and minor tranquilizers. (The increase is apparent only for AG femalex it seems at least 

partly linked to the increased presence of symptomatic 

pain.) 

� Vitamins. 

For the remaining drug classes, the AG mention rate either 

fell below or roughly equaled the rate for younger oflice patients. 

.	 In spite of the increased presence of inflammatory disorders 

among AG patients, it is noteworthy that the mention rate 

for the systemic, anti-inflammatory agents differed little 

between AG sufferers and the younger patients. In contrast, the use of the nonsteroidal anti-inflammatory agents 

(not treated as a separate class in tables IO and 11) nearly 

doubled for AG patients, increasing from 69 mentions per 

1,000 visits for the younger group to a rate of 124 mentions 

per 1,000 visits for the AG group. It is evident that the 

nonsteroidals were preferred for the routine maintenance 

therapy that is so much a part of AG care. 

.	 Parallel with the diagnostic findings in table 5, skin preparations, although their average use is more intensive among 

the younger patients, showed their highest single rate of 

mention among AG females over 84 years of age. @ .	 Finally, there was a noteworthy decrease between younger 

and older patients in the mention intensity of two sensitive 

drug categories, controlled drugs and combination drugs. 

For controlled drugs the mention proportion declined from 

8–9 percent for the younger group to about 6 percent for 

the AG patients. The controlled drugs most frequently 

mentioned in AG care were the minor tranquilizers or 

sedatives. For combination drugs the mention proportion 

decreased from 25 percent for the younger group to about 

20 percent among the AG patients, the decline being most 

apparent among the opioid-nonopioid combinations. 

Nonmedication therapy 

In sheer volume, the role of nonmedication therapy in AG 

care is by no means as imposing as that played by drug therapy. 

This is apparent from figure 1, which shows that nonmedication 

therapy was ordered or provided at fewer than one-half (43 

percent) of AG visits, at about two-thirds of which it occurred 

concomitantly with the use of one or more drugs. 

Of six nonmedication procedures ordered or provided in 

AG care (table 12), five either fell below or roughly equaled 

their proportionate use among patients under 75 years of age. 

These were physiotherapy, office surgery, psychotherapy, diet 

counseling, and family or social counseling. Three of these procedures warrant comment. 

.	 O@ce surge~—Although relatively less frequent among 

the AG group as a whole, surgical procedures showed their 

highest single intensity of use among AG females in the 

subgroup over 84 years of age. (This was chiefly due to 

surgical intervention in the treatment of the senile keratoses.) 
� 

10 adwlncedata 

Table 12. Number and percent of office visits of patients, by age and nonmedication therapy ordered or provided: United State% 1980 and 198k 

Nonmedication therapyl 

All office visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Nononmedication therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Physiotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Office aurgey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Psychotherapy or therapeutic listening. . . . . . . . . . . . . . . . . . . . . . . . . . . .


Diet counseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Femilyand social counsel ing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Medical counselingz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


1Selected procedures.


‘Probably also includes instruction on drugs provided.


NOTE: Figures may not add to totals due to rounding. 

.	 Psychotherapy or therapeutic listening—Along with the 

diagnostic and symptomatic evidence examined earlier, 

the infrequent resort to these procedures among AG patients offers further testimony to a relatively high degree of 

emotional health. 

�	 Family and social counseling—One reason for the minimal use of these procedures may derive from the fact that 

they were marginal to treating the kind of specific, physiologically rooted morbidity that dominates AG visits. (It is 

estimated that 94 percent of all AG visits were strongly 

illness oriented.) But the main reason is probably that AG 

patients simply did not need this kind of cwnseling to the 

extent required by aging patients in other treatment environments. The same survivor toughness that produced 

fewer emotional problems among the ambulatory aging 

All patients 

Under 75 75 years 75-79 80-84 85 years 

years and over years years and over 

Number of visits in thousands 

1,078,468 82,454 43,309 24,713 .14,431 

Percent of visits 

53.6 56.6 57.0 56.7 55.5 

4.9 4.1 4.2 4.1 3.8 

7.5 5.9 5.7 5.1 7.9 

5.1 3.0 3.1 2.9 *2.7 

8.1 8.1 8.1 8.3 7.6 

2.1 1.4 1.2 “1.6 *1.3 

22.8 26.4 26.1 26.3 27.5 

may have enabled them to cope independently with family 

and social problems. 

As the form of counseling most directly applicable to the 

practical, on-going management of chronic illness, it was predictable that medical counseling—to include instruction in the 

use of drugs-would be relatively more common among AG 

patients than among younger counterparts. 

Other visit characteristics 

As a group, AG patients seldom changed doctory about 

92 percent of their visits were made to the physician with whom 

they had an established relationship (table 13). Thus continuity 

of care is seen to be a hallmark in the management of the aging, 

ambulatory patient. Of their visits to other physicians (8 percent), about one-half were referred by the parent physician. 

Table 13. Percent distribution of office visits of patients by referral status and patient-problem status, according to age United Statea, 

1980 and 1981 

All patients 

Under 75 75 years 75-79 80-84 85 years 

Referral status and patient-problem status years and over years years and over 

Alloffice viaita . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,078,468 

Number of visits in thousands 

82,454 43,309 24,713 14,431 

Percent distribution 

100.0 100.0 100,0 100.0 -

3.9 3.9 3.0 5<3 

96.1 96.1 97.0 94.6 

8.3 8.4 7.2 9. 0 

91.8 91.7 92.8 90.4 

13.9 14.5 13.5 12.7 

77.9 77.2 79.3 77.7 

All office visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Referral status 

Referred by another physician . . . . . . . . . . . . . . . . . . . . . . . . ...”.... . . . 

Notre$erred . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Patient-problem status 

New patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Established patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

New problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Continuing problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

100.0


4.5 

95.5 

14.8 

85.1 

22.9 

62.2 

NOTE Figurea may not add to totala due to rounding. 
advancedata 11 

0’ 

@ 

@ 

Voluntary doctor selection probably occurred at fewer than 4 

ercent of AG visits. 

About 8 of every 10 AG visits was a return (progress) 

visi< usually for one or more of the chronic problems discussed 

earlier. The presentation of new problems by AG patients generally signaled the onset of one of the sequellae of the longstanding, chronic diseases, for example, diabetic retinopathy 

aggravated by hypertension. 

Although the average proportion of referrals did not differ 

significantly between the AG and the younger group, there was 

a noteworthy increase in referred visits among AG patients in 

the subgroup over 84 years of age (table 13). Earlier diagnostic 

evidence suggests that this increased need for specialized attention was chiefly the result of three intensifying conditions: 

circulatory problems, eye disorders, and skin diseases. 

In their followup instructions to AG patients, physicians 

were substantially more specific than they were with the younger 

group (table 14), because the conditions monitored were, in 

large pafi intensifying problems that offered little or no hope 

for complete remission. Thus the disposition instruction “return 

at specified time” was markedly more frequent at AG visits. 

“Telephone followup,” a monitoring procedure certainly less 

taxing to the aging, was, on the average, no more frequent 

among AG patients than among younger patients. 

Findings suggest that physicians spend more time in facetc-face contact with AG patients than they do with younger 

atients, but, on the average, tils increased encounter time 

only amounted to an additional 1 or 2 minutes (table 14). The 

longest average duration of contaq between 17 and 18 minutes, 

occurred with AG patients 80 years old and over. Probably 

much of this increased contact time was due to the need for 

relatively more medical counseling and instruction in the use of 

medications. 

Providers 

The final aspect of AG care to be explored is that of the 

doctors of medicine and osteopathy providing the care (table 

15). Four providers, general physicians, family physicians, 

internists, and ophthalmolo@sts, accounted for three-fourths of 

the AG visits. It is noteworthy that two of these providers—the 

general physician and the family physician-are generalists, in 

the breadth of their clinical scope and in the demographic fact 

that their patients range from one end of the age continuum to 

the other. Their combined visit proportion (36 percent) constitutes the largest single share of the 82,454,000 AG visits, exceeding the comparable proportion (33 percent) found for the 

group under 75 years old. 

Next in relative frequency are the visits to internists. Their 

proportion of AG visits (23 percent) was double the comparable 

proportion found for the younger group. Although internists 

qualifi as generalists in many of their practice characteristics, it . 

is probably their specialist skills in managing the circulatory 

diseases that account chiefly for their prominent position in 

AG care. 

The increased presence of eye disorders among AG patients (tables 4 and 5) is predictably paralleled by the increased 

frequency of their visits to the ophthalmologist. 

With diagnostic correlates that are obvious, it was expected that nearly two-thirds of the 3,197,000 referred visits 

Table 14. Percent distribution of office visits of patients by visit disposition and duration, according to age United States, 1980 and 1981 

All patients 

Under 75 75 years 75–79 80-84 

Disposition and duration years and over years years 

All office visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,078,468 

All office visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 

No followup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.9 

Return at specified time. ..,..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59.7 

Return if needed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23.2 

Telephone followup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4 

Admit to hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2 

Durationz 

0 minute3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.6 

l-l O minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43.4 

11-30 minutes . . . . . . . . . .. c.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47.9 

Iminutes or more . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1 

Mean visit duration4 in minutes.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.8 

Number of visits in thousands 

82,454 43,309 24,713 

Percent of visits 

100.0 100.0 100.0 

5.7 6.2 5.6 

72.8 72.3 72.8 

16.6 16.0 17.0 

3.5 3.3 3.2 

3.3 3.2 2.9 

1.8 1.8 2.0 

34.1 35.9 32.0 

58.5 57.1 60.8 

5.5 5.3 5.2 

16.7 16.4 17.1 

85 years 

and over 

14.431 

100.0 

4.4 

74.2 . 

16.0 

4.4 

4.2 

*1.7 

32.3 

59.4 

6.7 

17.4 

lSelected alternatives. Therefore, figures will not add to totals. 

‘Figures may not add to totala due to rounding. 

3N0 face-to-face encounter between physician and patient. 

41ncludes only face-to-face encounters between physician and patient. 
� 

� 

� 

� 

� 

� 

� 

� 

� 

� 

� 

� 

� 

� 

� 

12 achncedata


Table 15. Percent distribution of office visits of patients by specialty of the attending physician according to sex and age of patient 

United States, 1980 and 1981 

Physician specialty 

All office visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

All office visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

General and family practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Internal medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

General surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Obstetrics and gynecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Orthopedic surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Cardiovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Dermatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Urology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Psych iatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Neurology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Otola~ngology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Another specialties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

. NOTE: Figures may not add to totala due to rounding. 

made by AG patients would be to five specialists: 

Percent of 

Specialists referred visits 

Internist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.3 

General surgeon . . . . . . . . . . . . . . . . . . . . . 15.5 

Ophthalmologist . . . . . . . . . . . . . . . . . 14.6 

Orthopedic surgeon . . . . . . . . . . . . . . . . . . . “10.9 

Dermatologist . . . . . . . . . . . . . . . . . . . . . . . *7.9 

Summary 

Ofiice-based ambulatory care of the advanced aging may 

be generally characterized by the following features: 

All patients Females Males 

Under 75 75 years Under 75 75 years Under 75 75 years 

years and over years and over years and over 

Number of office visits in thousands 

1,078,468 82,454 646,220 53,498 432,248 28,956 

Percent distribution 

100.0 100.0 100.0 100.0 100.0 100.0 

32.6 36.4 32.4 37.8 33.0 33.8 

11.6 23.1 11.2 23.1 12.2 23.0 

5.2 5.5 4.9 5.5 5.8 5.3 

10.0 1.0 16.6 1.5 

4.9 3.2 3.7 3.8 6.7 1.9 

1.2 2.9 0.9 2.4 1.6 3.9 

4.5 3.4 4.5 3.7 4.4 3.0 

1.6 3.3 0.9 1.2 2.5 7.2 

2.9 “0.4 2.8 “0.4 3.1 “0.4 

0.6 “0.4 0.5 “0.4 0.6 “0.6 

4.8 12.6 4.6 13.2 5.2 11.6 

2.3 1.6 2.0 1.5 2.7 1.8 

17.7 6.2 15.0 5.5 22.2 7.5 

Female patients accounted for two-thirds of the care.


At most of the visits the physician had to cope with multiple


diagnoses.


Most of the morbidity encountered took the form of long-


term, physiologically rooted, chronic diseases or their se­


quellae.


The sharply reduced prospect for complete cure led to an


emphasis on routine maintenance care carefully monitored


by the physician.


The strong, illness-based focus led to a reduced use of


nonillness care, including measures that were considered


marginal to the direct management of the illness (for ex-


ample, family and social counseling).


Drug therapy was markedly more frequent than other treat­


ment mechanisms. It was relatively more intense with fe­


males than with males.


The increased use of multiple drugs created more potential


for adverse interactions.


Physicians gave evidence of an increased conservatism “
 J9

the use of controlled and combination drugs. 

There is a need for further study of the possible linkage 

between the increased intensity of drug use and such frequently occurring symptoms as dizziness and blurred vision. 

Mental and emotional illness, including what is loosely 

referred to as “senility,” was a relatively minor problem 

for both sexes. 

An increase in the female use of sedatives, hypnotics, and 

minor tranquilizers may be due less to the existence of 

emotional illness than to the increasing presence of symptomatic pain. 

A long-standing relationship between physician and patient 

is the rule. Referrals are relatively infrequent as is voluntary doctor shopping. 

Most of the care, general or specialized, occurred in the 

offices of three primary care physicians: the general physician, the family physician, and the internist. 

The average contact between physician and patient lasted 

about 17 minutes, only about 1 minute longer than the 

average contact with younger patients. 

These oldest of ofi=icepatients display a certain survivor 

toughness of mind and body that needs further exploration— 

especially among patients in the oldest, open-ended subgroup. 
.........................................

admncedata 13


aTechnical notes 

Source of data and sample design 

The estimates presented in this report are based on the 

findings of the National Ambulatory Medical Care Survey 

(NAMCS), a yearlong sample survey of office-based care conducted by the National Center for Health Statistics. Findings 

for two survey years, 1980 and 1981, were combined to produce the estimates. The target universe of NAMCS is composed of oflice visits made by ambulatory patients to nonFederal and noninstitutional physicians who are principally 

engaged in office-based patient care practice. Visits to physicians practicing in Alaska and Hawaii are excluded from the 

range of the survey, as are visits to anesthesiologists, pathol~ 

gists, and radiologists. 

Table 1. Approximate relative standard errors of estimated numbers 

of office visits and of drug mentions when the drug is listed by 

product name (for example, Valium), based on all physician 

specialties: National Ambulatory Madical Care Survey, 1980 

and 1981 

Relative 

standard 

Estimated number of office visits error in 

or specific drug mentions in thousands percent 

00 . *44.8 e	00 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *31 .7

450 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “30.0 

600 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26,0 

800 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.6 

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20,2 

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.5 

5.000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.5 

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1 

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.6 

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.4 

700,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.9 

2008000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6 

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5 

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4 

EXAMPLE OF USE OF TABLE: An aggregate estimate of 35,000,000 office 

wslts has a relative standard error of 5.0 percent or a standard error of 1,750,000 

visits (5.0 percent of 35,000,000 visits). 

Table Il. Approximate standard arrora of percents of estimated numbers 

Medical Care Survey, 1980 

Base of percent 

NAMCS uses a multistage probability sample design that 

involves a stepwise sampling of primary sampling units, physicians’ practices within primagr sampling units, and patient 

visits within physicians’ practices. The physician sample (5,805 

for the 2-year period) was selected from master files maintained 

by the American Medical Association and the American Osteopathic Association. Those members of the sample who were 

in scope and available participated at a rate of 77.3 percent. 

Responding physicians completed visit records for a systematic 

random sample of their otlice visits during a randomly assigned 

7-day reporting period. During the combined years 1980 and 

1981, responding physicians completed 89,447 visit records, 

of which 6,384 were records of visits by patients 75 years old 

or over. Characteristics of the physician’s practice, such as 

primary specialty, were obtained or confhrned during an induction interview. The National Opinion Research Center, 

under contract to the National Center for Health Statistics, 

w’asresponsible for the field operations of the survey. 

Sampling errors and rounding 

The sampling error is a measure of the sampling variability 

that occurs by chance because only a sample, rather than the 

entire universe, is surveyed. The relative standard error of an 

estimate is obtained by dividing the standard error by the estimate itself and is expressed as a percent of the estimate. In this 

repo~ any estimate that exceeds a relative standard error of 

30 percent is marked with an asterisk. Table I should be used to 

obtain the relative standard error for aggregates of office visits. 

Standard errors for estimated percents of visits (or for rates per 

1,000 visits reduced to percents) are shown in table II. 

The determination of statistical inference is based on a 

one-sided t-test with a critical value of 1.645 (0.05 level of 

confidence). Terms relating to differences, such as “exceeded” 

or “fell below” indicate that the differences are statistically 

significant. Terms such as “similar” or “roughly equal” mean 

that no statistical significance exists between the estimates beof office viaits based on all physician specialties: National Ambulatory 

Estimated percent 

(number of office visits in thousands) 1 or 99 5 or 95 70 or90 20 or 80 30 or 70 50 

Standard error in percent 

500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7 5.9 8.1 10.8 12.4 13.5 

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.9 4.2 5.7 7.6 8.7 9.5 

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.3 2.9 4.0 5.4 6.2 6.7 

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.8 1.9 2.6 3.4 3.9 4.3 

0,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.6 1.3 1.8 2.4 2.8 3.0 

@ 0,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

0.4 

0.3 

0.9 

0.6 

1.3 

0.8 

1.7 

1.1 

2.0 

1.2 

2.1 

1.3 

100,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.4 0.6 0.8 0.9 1.0 

500,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.2 0.3 0,3 0.4 0.4 

EXAMPLE OF USE OF TABLE: An estimate of 30 percent based on an aggregate of 15,000,000 visits haa a standard error of 2.4 percent, or a relative standard error 

of B percent (2.4 percent divided by 30 percent). 
14 adwncedata 

ing compared. Estimates have been rounded to the nearest National Center for Health Statistics 

thousand. 3700 East West Highway 

Any questions regarding these findings or the survey pr~ Hyattsville, Md. 20782 0 

cedures that produced them may be addressed to— Phone 301–436-7 132 

Hugo Koch 

Ambulatory Care Statistics Branch 
---

15


Symbols 

Data not available 

. . . Category not applicable 

Quantity zero 

0.0 Quantity more than zero but less than 

0.05 

z	 Quantity more than zero but less than 

500 where numbers are rounded to 

thousands 

* Figure does not meet standard of 

reliability or precision (more than 30 

percent relative standard error) 

#	 Figure suppressed to comply with 

confidentiality requirements 
16 aduancdata


Recent 1ssues of A dvance Data From Vital and Health Statistics 

No. 109. Hospital Use by Childrerr United States, 1983 (Issued 

May 23, 1985) 

No. 108. Wanted and Unwanted Childbearing United States, 1973-

82 (Issued May 9, 1985) 

–-No:I07. Marriage and First Intercourse, Marriage Dissolution, and 

Remarriage: United States, 1982 (Issued Apr. 12, 1985) 

No. 106. Use of Topical Antimicrobial Drugs in Office-Based Pra e tice: United States, 1980-81 (Issued Apr. 10, 1985) 

No. 105. Diagnosis-Related Groups Using Data From the National 

Hospital Discharge Survey United States, 1982 (Issued Jan. 18, 1985) 

. 

Suggested Citation 

National Center for Health Statistics, H. Koch and 

M. C. Smith: Office-based. ambulato~ csre for 

patients 75 years old and over, National Ambulatory 

Medical Care Sutvey, 1980 and 1981. Advance 

Data From Vital and Health Statistics. No. 110. 

DHHS Pub. No. (PHS) 85-1250. Public Health 

Service, Hyattsville, Md., Aug. 21, 1985. 

U.S. DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Public Health Service 

National Center fpr Health Statistics


3700 East-West Highway


Hyattsville, Matyland 20782


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