October 1996 Bulletin

Corrects life expectancy view

I read with interest Dr. Donald Reilly's Point of View article in the April 1996 Bulletin, "Weighing options for osteotomy, arthroplasty." In the article, Dr. Reilly describes the patient in question as "a 55-year-old man with symptomatic knee osteoarthritis." Further, he said, "Let us also assume that there is no medical contraindication to a surgical procedure for this patient and that he has a normal life expectancy approaching 20 years."

Dr. Reilly's discussion of surgical options for this patient is excellent, but I wish to bring to his attention and those of the readers of the Bulletin, the error in the assumption that a 55-year-old man, on average, dies before reaching age 75. Despite the fact that the commonly published life span of men in the U.S. is about 74 years, for the person who has reached 55, the accurate figure is closer to 80 years than 74.

The following illustrates an important point for orthopaedists and others who take care of elderly patients:

Life Expectancy, U.S., 1995

Females Males
At birth 80 74
At 65 83 79
At 75 88 85
At 85 94 92

Source: U.S. Bureau of the Census

Decisions made about care of the elderly patient must take into account the projection that the 75-year-old woman, on average, can be expected to live 13 years, not five years. If she has reached age 85, she is not "living on borrowed time," but rather, can be expected to live nine more years.

The Academy's Council on Education, working with the American Geriatric Society, has attempted to bring these and other issues to the attention of our members, through a symposium, instructional course, and scientific exhibit at the 1996 Annual Meeting, the development of a curriculum for orthopaedic residents and through articles in the Bulletin (see October 1995 Bulletin articles accessible in the Library section of the AAOS On-Line Service). Other activities are planned. The intent of this letter is not to take Dr. Reilly to task, but instead to educate orthopaedists about the elderly patient. I appreciate this opportunity to comment on this one facet of the aging issue which over the years will have a significant impact on orthopaedic practice.

S. Terry Canale, MD
Germantown, Tenn.

Dr. Canale is chairman of the Academy's Task Force on Serving the Elderly Orthopaedic Patient.

The opinions expressed are those of the authors and do not imply official policy of the Academy. The Bulletin invites Letters to the Editor on relevant issues, Academy events, or Bulletin articles.

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