Introduction - The Role of the Physician in Geriatric Medicine in the Ageing Society

Age and Ageing,  Nov, 1994  by M.J. Denham,  P.H. Millard

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Old age should be one of the best times of our lives, a time to explore, learn, relax, do things we have always wanted to do, and at the same time to be relieved of many everyday worries and responsibilities. The majority of elderly people are well, healthy and enjoy an active life, but some become unwell, have health needs and may require hospital care. It is their care which is the subject of this publication.

The demographic changes in this country are well known (see the Figure), but a few salient facts are worth reiterating:

1. Life expectancy--a woman of 65 years can expect to live for a further 18 years, whilst a man of the same age can expect a further 15 years.

2. Numbers of elderly people--because of improved living conditions, better nutrition and higher standards of medical care, there are now 6.3 million people in Britain aged over 70 years of age. By 2010 there will be over 7 million, with 80-plus-year-olds numbering 2.8 million. Currently Her Majesty the Queen sends a congratulatory telegram to more than 2700 new centenarians annually compared with less than a tenth of that number in 1950.

The specialty of geriatric medicine came into existence, as you will read, because of inappropriate hospital care of elderly people. The subsequent improvements in their medical care have been largely attributed by a former Chief Medical Officer, Sir George Godber, to geriatricians and their colleagues with their expertise in social care, as well as the technical medical components of health care.

Over the years, geriatric medicine has developed different styles of working practice producing a degree of healthy rivalry between the enthusiasts for the various methods. At present no one technique can be preferred, the best option is the one best fitted for the local situation and conditions. Research in this area could be very interesting and enlightening, leading to further potential developments.

In spite of the undeniable benefits which elderly patients can derive from the latest therapeutic advances, it remains both sad and reprehensible that negative attitudes towards treatment of older people excludes some patients from these treatments of proven value. Moreover, elderly people in hospital are often accused of `blocking beds' and thus preventing other younger people, who are by implication more worthy, from being admitted. Truly ours is not a culture which has great reverence for old age, unless the person is fit, able and a major figure-head.

Another major change seen in the last few years is the extensive withdrawal of National Health Service hospitals from the provision of long-stay care. In some parts of the country this seems to be almost total. Many geriatricians remain extremely apprehensive about the quality of care in non-NHS accommodation and fear the `rebirth' of conditions found by Marjory Warren in the 1930s. It is to be hoped that the regular visits by health authorities and social services will ensure that standards of care are maintained and that audit and outcome measures are undertaken to ensure enduring high quality of life.

Much research still remains to be carried out into the diseases of old age and considerable effort is now being directed towards conquering dementia. It may be that gene therapy will change the face of geriatric medicine in the next 20 years with a `squaring' of the survival curve. Research is still needed in areas of therapeutics, service delivery, rehabilitation, evaluation of screening procedures, with audit measures instituted to evaluate the many forms of care, especially outcome measures. Indeed the specialty is wide open to those interested in research.

In conclusion, this publication reviews the current state of geriatric medicine, considers current practice and looks to the future. The individual chapters should be of considerable value to all those involved in the medical care of the elderly.

COPYRIGHT 1994 Oxford University Press
COPYRIGHT 2004 Gale Group