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April 9, 2018

Toenails as the “Hemoglobin A1c” of Functional Independence—Beyond the Polished Wingtips

Author Affiliations
  • 1New England GRECC (Geriatric Research, Education, and Clinical Center), Division of Geriatrics and Palliative Care, VA Boston HealthCare System, Boston, Massachusetts
  • 2Division of Aging, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 3Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Intern Med. Published online April 9, 2018. doi:10.1001/jamainternmed.2018.0099

It was a warm autumn morning when the man stepped through the doors to the clinic, alone. His brown wingtip Oxford shoes gleamed from a quick polish at the shoe shiner en route to his appointment. He had woken early to prepare for the occasion, beginning with a clean shave. The pressed collar of his white shirt peeked out from under his favorite blazer. A passerby would be forgiven for thinking that he was on his way to work and not the doctor’s office.

It was his first appointment since the death of his wife, his high school sweetheart, a few months earlier. His physician greeted him with a smile and asked about his drive. As she accompanied him down the hall to the examination room, she made a mental note that his usual brisk walk had slowed since she had last seen him. She glanced at his intake vital signs—his weight was unchanged, his blood pressure within range. Yes, he reported, he had kept up his routine of physical activity, frequenting the gym 3 mornings a week.

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