, Volume 26, Issue 5, p 459
Date: 26 Mar 2011

From the Editor’s Desk: The Clustering of America, and the Conundrum of Caring for the Complex Adult

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In his book “The Clustered World,” Michael J. Weiss describes how socio-demographically, the American population can be seen as 62 clusters, defined by specific characteristics across geographic regions. Weiss notes increasing fragmentation at all levels of society, as our insular communities live separate, non-overlapping lives. Whether Blue Blood Estates, Gray Power, Young Influentials, Hard Scrabble, or Mines and Mills, our lives intersect regularly only in public venues or in health care.

This issue of JGIM highlights the health challenges faced by these insular, vulnerable clusters of American society—and the need for more evidence to guide their care. One of our most vulnerable clusters is the poor elderly, whose complex medical disorders are heightened by lack of physiologic and financial reserve. Zulman and colleagues examine the lack of evidence to guide appropriate medical care in the elderly. In their systematic review, they examine all randomized therapeutic trials published ...