A Brief History of Geriatrics

Embracing complexity of (brain) aging

Aging is a multifactorial process occurring in a pathophysiological continuum which leads to organ and system functional loss. While aging is not a disease, its pathophysiological continuum predisposes to illness and multimorbidity clusters which share common biomolecular mechanisms-the pillars of aging. Brain aging and neurodegeneration share many hallmarks with other age-related diseases. The central nervous system is often the weakest link susceptible to the aging process and its deterioration, resulting in cognitive impairment and other symptoms; the aging process is associated with proteostasis collapse, stem cell exhaustion, repair mechanisms, altered brain nutrient sensing, endothelial changes, inflammation, oxidative distress, and energy unbalance, as well as other disturbances. These mechanisms are highly interwoven, and considerable research is aimed at their disentanglement and detection of their clinically relevant impact, particularly in order to identify pharmacological and non-pharmacological preventive and therapeutic strategies.

Aging hallmarks, biomarkers, and clocks for personalized medicine: (re)positioning the limelight

The rapidly increasing aging prevalence, complexity, and heterogeneity pose the scientific and medical communities in front of challenges. These are delivered by gaps between basic and translational research, as well as between clinical practice guidelines to improve survival and absence of evidence on personalized strategies to improve functions, wellbeing and quality of life. The triumphs of aging science sheding more and more light on mechanisms of aging as well as those of medical and technological progress to prolong life expectancy are clear. Currently, and in the next two to three decades, all efforts must be put in a closer interdisciplinary dialogue between biogerontologists and geriatricians to enable real-life measures of aging phenotypes to be used to uncover the physiological - and therefore translational - relevance of newly discovered aging clocks, biomarkers, and hallmarks.

Changing trends in health orientation among older adults: A scoping review

Older people's health condition is not uniform, and the components of their health are interrelated. Concepts regarding the health of older people have emerged and changed over time. However, the transition of concepts and influencing factors are not well examined through research. We have conducted a scoping review of the changes over time in the concept of health for older people and the factors influencing these changes. The public websites of international organizations and academic societies related to older people's health and research paper database were searched, and the extracted data were summarized in a chronological table. Consequently, this study revealed changing trends in health orientation after health had been defined by WHO, namely, successful aging, productive aging, active aging, and healthy aging, and their components, not the concept of health. The emergence and changes of health orientation among older people may have accompanied proposals and measures of international organizations and academic societies developed in response to changes in the demographic structure, and changes in how society perceives and supports older people. With the changing eras that bring about advances in health technology, prolongation of life expectancy, and changes in lifestyles, the needs of older people, society's perceptions of aging and older people, and how to support them will also change. Our findings may provide a valuable basis for understanding aging and older people, reconsidering their health orientation based on the health issues of older people and their significance, and formulating policies for older people in the future. Geriatr Gerontol Int 2024; 24: 5-17.

The Landscape of Geriatric Fellow Scholarly Activity Participation: Findings From a National Survey of Program Directors

Introduction As the US population continues to age, there is a critical need for geriatricians to be trained and engaged in research to inform high-quality care for older adults. Our objective was to understand the extent, type, barriers, and facilitators of research training and the attitudes toward research training and scholarly activity among Accreditation Council for Graduate Medical Education (ACGME)-accredited US geriatric fellowship programs. Methods We conducted a cross-sectional survey of geriatric fellowship program directors from September to November 2022. Surveys assessing program characteristics, requirements for scholarly activity, director demographics, and director attitudes toward scholarly activity were distributed via email. We used descriptive statistics to assess fellowship scholarly activity requirements, facilitators, and perceived barriers. Results The survey response rate was 35.3% (41/116 programs). Most programs (82.9%) required participation in scholarly activity and provided protected time (73.2%). Definitions of scholarly activities greatly differed among programs. The most common scholarly activity requirements included participation in a scholarly project (70.7%) or local presentation (46.3%). The short duration of fellowship was the most common major barrier, reported by 70.7% of directors. Lastly, 34.1% of directors indicated satisfaction with the quality of research training provided, while 65.9% of directors reported satisfaction with the opportunities provided to participate in scholarly activities. Conclusions Overall, program requirements, facilitators, and perceived barriers to scholarly activity were heterogeneous among US geriatric program directors. Additionally, only about one-third of directors were satisfied with the research training provided. Our future work will compare the attitudes and reported barriers/facilitators of program director and fellow participants toward participation in scholarly activity.

Dementia, a Polypharmaceutical Phenomenon: The Intimate Combinations of Dementia Drugs in Brazil

It is commonplace to state that dementia is a complex condition. Such complexity involves the limits between pathological and normal aging, diagnosis with no simple organic causation, and the use of psychiatric medication that does not cure but generates hope to alleviate symptoms such as forgetfulness and delirium. Based on an ethnography of one year and a half (2017-2018) in a Brazilian metropolis, within a Public Geriatric center and the households of three families, I argue that dementia, more than a complex condition, is a generator of drug complexity. Following Stefan Ecks' reflections on multimorbidity and polyiatrogenesis and Karen Barad's understanding of intra-action, I discuss the polypharmacy present in most cases of dementia that I have known. Considering the complicated relations of medications with themselves and with time and places, I conclude that dementia should be seen a polypharmaceutical phenomenon.

[Role of private geriatricians in the health care system (1/2): quantitative descriptive analysis by questionnaire]

Private practice geriatrics is a little known practice modality. We conducted a questionnaire survey to try to describe the role of private geriatricians in the health care system. Although few in number, private geriatricians report very different practices, including their conception of their role. This is the first monograph on the activity of private geriatricians, and the results have motivated us to propose a comprehensive analysis of this role.

Introduction: Historical Development and Progression of Clinical Research on Ageing

Research on ageing has developed since Greek times. It had a very slow advance during the Middle Ages and a big increase in the Renaissance. Darwin contributed somehow to the understanding of the ageing process and initiated a cumulus of ageing explications under the name of Evolutionary Theories. Subsequently, science discovered a great number of genes, molecules, and cell processes that intervened in ageing. This led to the beginning of trials in animals to retard or avoid the ageing process. Alongside this, improvements, geriatric clinical investigations (with the evidence-based medicine tools) started to consolidate as a discipline and commenced to show the challenges and deficiencies of actual clinical trials in ageing; the COVID-19 outbreak revealed some of them. The history of clinical research in ageing has already begun and is essential to affront the challenges that the world will face with the increasing ageing population.

Healthcare for older adults in North America: challenges, successes and opportunities

Older adults in North America face similar challenges to successful ageing as other adults around the world, including an increased risk of geriatric syndromes and functional decline, limited access to healthcare professionals specialising in geriatrics and constraints on healthcare spending for Long-Term Services and Supports. Geriatrics as a specialty has long been established, along with the creation of a variety of screening tools for early identification of geriatric syndromes. Despite this, workforce shortages in all older adult care service areas have led to significant gaps in care, particularly in community settings. To address these gaps, innovative programs that expand the reach of geriatric specialists and services have been developed. Opportunities exist for further dissemination of these programs and services, as well as for expansion of an ageing capable workforce.

Urology and Geriatrics in Korea: Present Status and Future Directions

Globally, the population aged 65 years and over is growing faster than all other age groups. South Korea, in particular, is one of the most rapidly aging societies worldwide. With the increase in the older population, the incidence of urologic diseases has increased significantly along with that of chronic diseases. Urologic diseases are an important component of the health problems faced by an aging society. Among those, urinary incontinence and voiding dysfunction cause significant health and quality of life problems in older adults. To properly manage these diseases, especially in the field of urology, it is necessary to propose appropriate policies for the health care of older people. Accordingly, the significance of geriatrics, particularly geriatric urology, has increased. Although geriatric urology in South Korea began relatively recently, the founding of the Korean Society of Geriatric Urological Care represents a significant step in the development of geriatric urology as a subspecialty. The goal of this review is to elaborate on the concept of geriatrics and to provide an overview of geriatric urology with a focus on its current status in South Korea. Furthermore, future challenges in the face of rapid demographic changes are reviewed.

The 5Ms of Geriatrics in Gastroenterology: The Path to Creating Age-Friendly Care for Older Adults With Inflammatory Bowel Diseases and Cirrhosis

The number of Americans 65 years or older in 2060 will be more than double what it was in 2014. Approximately 40% of patients seen in gastroenterology (GI) and hepatology practices in the United States are 60 years or older. Adapting care delivery models, curating data on shifting risk-benefit decisions with geriatric syndromes, understanding appropriate assessments, and focusing on tailored implementation strategies are challenges that are actively confronting us as we provide care for a burgeoning population of older adults. Limited availability of geriatric specialists results in an onus of specialists caring for older adults, such as gastroenterologists, to innovate and develop tailored, comprehensive, and evidence-based care for adults in later life stages. In this article, we present the 5M framework from geriatrics to achieve age-friendly healthcare. The 5Ms are medications, mind, mobility, multicomplexity, and what matters most. We apply the 5M framework to 2 chronic conditions commonly encountered in clinical GI practice: inflammatory bowel diseases and cirrhosis. We highlight knowledge gaps and outline future directions to expand evidence-based care and advance the creation of age-friendly GI care.

HEARTS, minds and souls-it is time for geriatricians to bring more to continence management

Urinary incontinence (UI), the involuntary loss of urine, is a common health condition that may decrease the quality of life and which increases in incidence and prevalence with age. Recent epidemiologic data suggest an overall prevalence of 38% in women older than 60 years, increasing to 77% in older women living in nursing homes. Despite this high prevalence, incontinence remains underdiagnosed and undertreated in this age group. In a representative population of 7,000 participants drawn from the Irish Longitudinal Study of Ageing, 750 had UI of whom 285 (38%) had not sought the help of a health care professional. The reasons that older people do not seek help for incontinence are complex and multiplex. Stigma surrounding diagnosis, a sense of futility coupled to a notion that incontinence is a part of normal ageing and the fact that incontinence simply gets 'lost' in the midst of multimorbidity and frailty have all been shown to play a role. Active case finding has therefore been highlighted as a cornerstone of effective care in serial international guidelines.

Research into ageing and frailty

Research into ageing covers opportunities and challenges posed by an older population, and research to understand the ageing processes across the lifespan. The evidence base for Comprehensive Geriatric Assessment (CGA) is well established and efforts should now shift to understanding how to implement its principles across different healthcare contexts. Research around syndromes common in older people has progressed with variable success; while effective therapies for falls and cognitive impairment have been identified, older people with advanced frailty have commonly been excluded from Parkinson's disease and continence research. Research to understand the mechanisms of ageing has potential to mitigate against or treat emerging sarcopenia and cognitive impairment, and thus modify frailty trajectories. Pharmacogenetics could individualise therapeutics to reduce polypharmacy. These issues can only be addressed with development of infrastructure, capacity and expertise in ageing research. Commonly used research methodologies must be adapted to take account of frailty, cognitive impairment and functional dependency.

Determination of Biological Age: Geriatric Assessment vs Biological Biomarkers

Purpose of Review

Biological age is the concept of using biophysiological measures to more accurately determine an individual’s age-related risk of adverse outcomes. Grading of the degree of frailty and measuring biomarkers are distinct methods of measuring biological age. This review compares these strategies for estimating biological age for clinical purposes.

Recent Findings

The degree of frailty predicts susceptibility to adverse outcomes independently of chronological age. The utility of this approach has been demonstrated across a range of clinical contexts. Biomarkers from various levels of the biological aging process are improving in accuracy, with the potential to identify aberrant aging trajectories before the onset of clinically manifest frailty.

Summary

Grading of frailty is a demonstrably, clinically, and research-relevant proxy estimate of biological age. Emerging biomarkers can supplement this approach by identifying accelerated aging before it is clinically apparent. Some biomarkers may even offer a means by which interventions to reduce the rate of aging can be developed.

Opportunities for Adding Undernutrition and Frailty Screening Measures in US National Surveys

Both undernutrition and frailty adversely affect the health and functional outcomes of the older adult population. Timely and accurate national data are necessary to assess those at risk of these debilitating but often preventable conditions, to correct them and support healthy aging. The objective was to identify relevant measures in undernutrition and frailty screening tools and determine if these measures are collected in recent protocols for US national surveys sampling older adults and which measures could be added to be able to better assess risk of undernutrition and frailty. Commonly used undernutrition and frailty screening tools were evaluated to identify measures that were unique or common to both. US national surveys were examined to determine whether they included older adults in their survey sample, collected health measures from participants, in what form, and whether they were functional indexes or survey questions. A comparative analysis of survey protocols was performed to determine which surveys collected data related to the measures of undernutrition and frailty. Of the 8 national surveys, only 3 provided ≥1 physical measurement (i.e., height/weight, grip strength, balance). Most surveys included self-reported data on height/weight, physical functioning/mobility, disability, and psychological components. Whereas 6 included questions on food security/food program participation, only 1 collected data on dietary intake. Currently national surveys include only limited health measures that can be used to identify undernutrition and frailty risk in older adults. Adding a few simple screening measures already included in popular screening tools, such as grip strength, unintentional weight loss, and loss of appetite, to national surveys which monitor older Americans would facilitate estimation of the prevalence of undernutrition and frailty risk, better estimate those at risk, provide an opportunity to set national goals to reduce their risk, and help implement strategies for improved health outcomes.

Kampo Medicine for Various Aging-Related Symptoms: A Review of Geriatric Syndrome

With the continued growth of the aging population in Japan, geriatric syndrome (GS), which is associated with aging-related symptoms, has become a social problem. GS is caused by physiological and pathological aging and may manifest various symptoms. Physicians use multidisciplinary approaches to provide treatment for individual GS symptoms. Kampo medicine, a Japanese traditional medicine that uses multiple pharmacologically active substances, is useful for many syndromes, conditions, disorders, and diseases associated with GS. Evidence of the effectiveness of Kampo medicine for GS has accumulated in recent years. The effects of Kampo treatment for symptoms related to functional decline of the cardiovascular, respiratory, and digestive systems, cognitive impairment and related disorders, pain and other sensory issues, among others, support the use of Kampo medicine for the management of GS. The role of Kampo medicine for GS is summarized in this review.

What can we learn from the past about the future of gerontology: Using natural language processing to examine the field of gerontology

OBJECTIVES

We thematically classified all titles of eight top psychological and social gerontology journals over a period of six decades, between 1961 and February, 2020. This was done in order to provide a broad overview of the main topics that interest the scientific community over time and place.

METHODS

We used natural language processing in order to analyze the data. In order to capture the diverse thematic clusters covered by the journals, a cluster analysis, based on "topic detection" was conducted.

RESULTS

A total of 15,566 titles were classified into 38 thematic clusters. These clusters were then compared over time and geographic location. The majority of titles fell into a relatively small number of thematic clusters and a large number of thematic clusters was hardly addressed. The most frequently addressed thematic clusters were: a) Cognitive functioning, b) Long term care and formal care, c) Emotional and personality functioning, d) health and e) Family and informal care. The least frequently addressed thematic clusters were: a) Volunteering, b) Sleep, c) Addictions, d) Suicide, and e) Nutrition. There was limited variability over time and place with regard to the most frequently addressed themes.

Geriatrics and humanism: Dementia and fallacies of care

Based on fieldwork in a specialized geriatric outpatient clinic in Brazil, this article shows how a humanistic discourse that 'means well' can do good, but can also produce a regime of care that ultimately results in care that is contrary to stated values. These values - such as holistic care, multidisciplinarity, and empathy - that have been at the heart of geriatrics since its more official founding in the 1940s and 1950s, cannot be conceived as only local. The Brazilian data mirrors international geriatric values and norms, which, however, are being applied here in a specific context, in a country perceived as 'young' and with limited resources for elder care. Fallacies of care in this context result preliminary from a translation of more structural factors as individualized (self-)care and from the abstraction and generalization of aging individuals as 'older people'.

The evolution of geriatric neurology

The founders of neurology in the late 19th century and early 20th century laid the foundation for modern geriatric neurology by detailed observations, in their patients, of the clinical expressions of aging of the nervous system. Further advances in clinical manifestations of aging and more detailed examination of disease states in the elderly accelerated in the last quarter of the 20th century. Basic, translational, and clinical research support of geriatric neurology studies expanded and advanced during this period and into the 21st century. The size and sophistication of this movement was stimulated by a number of factors: the successful development of geriatrics as a specialty in primary care, internal medicine, and psychiatry; the projected growth of the geriatric population; and the projections of the number of people with Alzheimer's disease. However, there were and continue to be inadequate numbers of trained geriatric neurologists available to care for the "silver tsunami" of elderly patients with age-related diseases that will present in the next 3 decades. The combination of massive investment in dementia/Alzheimer's research in the past decade, widespread awareness among researchers and trainees of the opportunities to do research in age-related diseases, and the need for further knowledge of neurodegenerative diseases led to a broad expansion of research efforts. Longitudinal clinical studies of the elderly and the advent of sophisticated neuroimaging, genetics, and laboratory techniques are advancing the field. The initiation of therapeutic interventions has led to cautious optimism about the ability to ameliorate suffering in these patients and diminish the burdens of central nervous system aging.

Validation and Adaptation of the Multidimensional Prognostic Index in an Older Australian Cohort

BACKGROUND AND AIMS

The Multidimensional Prognostic Index (MPI), an objective and quantifiable tool based on the Comprehensive Geriatric Assessment, has been shown to predict adverse outcomes in European cohorts. We conducted a validation study of the original MPI, and of adapted versions that accounted for the use of specific drugs and cultural diversity in the assessment of cognition, in older Australians.

METHODS

The capacity of the MPI to predict 12-month mortality was assessed in 697 patients (median age: 80 years; interquartile range: 72-86) admitted to a metropolitan teaching hospital between September 2015 and February 2017.

RESULTS

In simple logistic regression analysis, the MPI was associated with 12-month mortality (Low risk: OR reference group; moderate risk: OR 2.50, 95% CI: 1.67-3.75; high risk: OR 4.24, 95% CI: 2.28-7.88). The area under the receiver operating characteristic curve (AUC) for the unadjusted MPI was 0.61 (0.57-0.65) and 0.64 (95% CI: 0.59-0.68) with age and sex adjusted. The adapted versions of the MPI did not significantly change the AUC of the original MPI.

CONCLUSION

The original and adapted MPI were strongly associated with 12-month mortality in an Australian cohort. However, the discriminatory performance was lower than that reported in European studies.

Arti Hurria and the progress in integrating the geriatric assessment into oncology: Young International Society of Geriatric Oncology review paper

Until recently, the progress in the diagnosis and management of cancer has not been matched by similar progress in the assessment of the increasing numbers of older and more complex patients with cancer. Dr. Arti Hurria identified this gap at the outset of her career, which she dedicated toward studying the geriatric assessment (GA) as an improvement over traditional methods used in oncology to assess vulnerability in older patients with cancer. This review documents the progress of the GA and its integration into oncology. First, we detail the GA's origins in the field of geriatrics. Next, we chronicle the early rise of geriatric oncology, highlighting the calls of early thought-leaders to meet the demands of the rapidly aging cancer population. We describe Dr. Hurria's early efforts toward meeting these calls though the implementation of the GA in oncology research. We then summarize some of the seminal studies constituting the evidence base supporting GA's implementation. Finally, we lay out the evolution of cancer-focused guidelines recommending the GA, concluding with future needs to advance the next steps toward more widespread implementation in routine cancer care. Throughout, we describe Dr. Hurria's vision and its execution in driving progress of the GA in oncology, from her fellowship training to her co-authored guidelines recommending GA for all older adults with cancer-published in the year of her untimely death.

Establishing the First Geriatric Medicine Fellowship Program in Ghana

As life expectancy in Ghana improves, a large and growing population of older adults require healthcare. Despite governmental support for the care of older adults, there have been no geriatricians and no in-country educational path for those desiring to become specialists in this field. In fact, 23 of 54 countries in sub-Saharan Africa (SSA) lack even a single geriatrician. We describe a novel and collaborative approach used to develop the first geriatric training fellowship in Ghana. Faculty from the Ghana College of Physicians and Surgeons and the University of Michigan worked together to develop a rigorous and evidence-based geriatrics curriculum, based on US standards but adapted to be appropriate for the cultural, economic, educational, and social norms in Ghana. This approach led to a strong training model for care of older adults while also strengthening the ongoing collaboration between the two partner universities in Ghana and the United States. The fellowship has been inaugurated in Ghana and can serve as a concrete educational model for other countries in SSA. J Am Geriatr Soc 67:1718-1723, 2019.

Different Cognitive Frailty Models and Health- and Cognitive-related Outcomes in Older Age: From Epidemiology to Prevention

Frailty, a critical intermediate status of the aging process that is at increased risk for negative health-related events, includes physical, cognitive, and psychosocial domains or phenotypes. Cognitive frailty is a condition recently defined by operationalized criteria describing coexisting physical frailty and mild cognitive impairment (MCI), with two proposed subtypes: potentially reversible cognitive frailty (physical frailty/MCI) and reversible cognitive frailty (physical frailty/pre-MCI subjective cognitive decline). In the present article, we reviewed the framework for the definition, different models, and the current epidemiology of cognitive frailty, also describing neurobiological mechanisms, and exploring the possible prevention of the cognitive frailty progression. Several studies suggested a relevant heterogeneity with prevalence estimates ranging 1.0–22.0% (10.7–22.0% in clinical-based settings and 1.0–4.4% in population-based settings). Cross-sectional and longitudinal population-based studies showed that different cognitive frailty models may be associated with increased risk of functional disability, worsened quality of life, hospitalization, mortality, incidence of dementia, vascular dementia, and neurocognitive disorders. The operationalization of clinical constructs based on cognitive impairment related to physical causes (physical frailty, motor function decline, or other physical factors) appears to be interesting for dementia secondary prevention given the increased risk for progression to dementia of these clinical entities. Multidomain interventions have the potential to be effective in preventing cognitive frailty. In the near future, we need to establish more reliable clinical and research criteria, using different operational definitions for frailty and cognitive impairment, and useful clinical, biological, and imaging markers to implement intervention programs targeted to improve frailty, so preventing also late-life cognitive disorders.

50 Years of the Korean Geriatrics Society

The Korean Geriatrics Society was founded on October 3, 1968. Over the 50 years since then, the Society has incessantly strived to stay attuned to the aging society and to achieve an increasingly greater research impact in the field of gerontology and geriatric medicine. The Society has passed through periods of preparation for a leap forward, followed by rapid growth, expansion, and maturity. As a result, the Society has gained a firm foothold at home and abroad as a leading research society for both qualitative and quantitative achievements in geriatric medicine. At this juncture, with an ultra-aging society being just around the corner, we are celebrating its 50th anniversary and anticipating our second half-century with great enthusiasm about our mission and role as a leading geriatric research organization.

Status of Geriatrics in 22 Countries

OBJECTIVES

The aim of this article is to describe the current status of geriatrics and position of geriatricians in 22 countries of three continents, and to portray their attitudes towards and resources allocated to geriatrics.

METHODS

An electronic survey was delivered to a convenience sample of 22 geriatricians in leading positions of their countries.

RESULTS

The time required in post graduation specialist training to become a geriatrician varied from one year (subspecialty in the USA) to six years (independent specialty in Belgium). The number in the population aged 80+ per geriatrician varied from 450 (Austria) to 25,000 (Turkey). Of respondents, 55% reported that geriatrics is not a popular specialty in their country. Acute geriatric wards, rehabilitation and outpatient clinics were the most common working places for geriatricians. Nearly half of the respondents had an opinion that older patients who were acutely ill, were receiving subacute rehabilitation or had dementia should be cared for by geriatricians whereas half of the respondents would place geriatricians also in charge of nursing home and orthogeriatric patients. The biggest problems affecting older people's clinical care in their countries were: lack of geriatric knowledge, lack of geriatricians, and attitudes towards older people. Half of respondents thought that older people's health promotion and comprehensive geriatric assessment were not well implemented in their countries, although a majority felt that they could promote good geriatric care in their present position as a geriatrician.

CONCLUSION

The position of geriatric, geriatricians' training and contents of work has wide international variety.

Establishing in-hospital geriatrics services in Africa: Insights from the University of Benin Teaching Hospital geriatrics project

Background:

Unawareness of the peculiar healthcare needs of the elderly and resource constraints may be some reasons why until recently, Nigerian hospitals have not been equipped with the human and infrastructural resources required to meet older adults’ special healthcare needs. There is paucity of specialized health services for the elderly in Africa. Nigeria, with a population of over 170 million, did not have any healthcare facility with dedicated services for the elderly until 2012. The University of Benin Teaching Hospital (UBTH) in Nigeria was established in 1973 and created its geriatrics unit in October 2013. A prepared environment and trained interdisciplinary teams are pivotal in providing effective healthcare services for the elderly. The ongoing UBTH geriatrics project aims to provide specialized interdisciplinary health services to older adults and to provide training and continuing professional development in geriatrics for healthcare staff. In developing our inpatient services, we adopted the acute care for elders (ACE) model and worked in tandem with the “ABCs” of implementing ACE units.

Results:

In the face of limited resources, it was possible to establish a functional geriatrics unit with a trained interdisciplinary team. Family participation is central in our practice. Since October 2013, residents and house officers in internal medicine have been undertaking 4- and 12-weekly rotations, respectively. There is also a robust academic program, which includes once-weekly geriatric pharmacotherapy seminars, once-weekly interdisciplinary seminars, and 2-weekly journal club meetings alternating with seminars on geriatric assessment tools.

Conclusions:

It is possible to establish geriatric services and achieve best practices in resource-limited settings by investing on improving available human resources and infrastructure. We also make recommendations for setting up similar services in other parts of Africa.

[Geriatrics - an interdisciplinary challenge]

The care of elderly patients will continue to challenge the healthcare system over the next decades. As a rule geriatric patients suffer from multimorbidities with complex disease patterns, and the ability to cope with everyday life is severely reduced. Treatment is provided by a multiprofessional geriatric team, and the primary goal is improvement of functional status, quality of life in the social environment and autonomy by employing a holistic approach. In Germany geriatric care is provided by physicians from various medical specialties (e.g. general practitioners, internists, neurologists and psychiatrists). In the training for the subspecialty clinical geriatrics, these specialties enjoy equal rights. Recent efforts to establish a qualification as physician for internal medicine and geriatrics have initiated a discussion to make the suitability for qualification as a geriatrician dependent on the medical specialty. Geriatric patients benefit from multidisciplinary cooperation. Neurologists possess great expertise in the treatment of patients with dementia, depression, delirium, consequences of degenerative spinal cord diseases and vertebral bone fractures, stroke, Parkinson's syndrome, epileptic seizures, vertigo and dizziness, neuropathies, lesions of peripheral nerves and in the multimodal therapy of pain. To function in a position of responsibility in a geriatric department, neurologists need skills in general internal medicine. These are acquired either on a geriatric ward or during specialization as a neurologist by full time secondment to large neurological or interdisciplinary intensive care units.

[Principles of social gerontology]

Social gerontology is seen as a science-based but application-oriented subdiscipline of gerontology. It focuses particularly on social relationships in old age, social participation of elderly and old people and the protection of their individual needs. Self-determination and autonomy are important value orientations. Central issues are the quality of life and life satisfaction from the perspective of personal resources and biographical influences and the conditions of individual aging in the sense of differential gerontology. Against this background, in the first part of this article Kirsten Aner discusses the social construction of aging and in part two Ines Himmelsbach describes the typical life events and developmental tasks in the process of aging. The article concludes with a theoretical basis in which Cornelia Kricheldorff outlines social aging theories and derives a brief description of approaches and interventions.

Height loss with advancing age in a hospitalized population of Polish men and women: magnitude, pattern and associations with mortality

The connection between the rate of height loss in older people and their general health status has been well documented in the medical literature. Our study was aimed at furthering the characterization of this interrelationship in the context of health indices and mortality in a hospitalized population of Polish adults. Data were collated from a literature review and from a longitudinal study of aging carried out in the Polish population which followed 142 physically healthy inmates, including 68 men and 74 women, for at least 25 years from the age of 45 onwards. Moreover, cross-sectional data were available from 225 inmates, including 113 men and 112 women. These subjects were confined at the same hospital. ANOVA, t-test, and regression analysis were employed. The results indicate that the onset of height loss emerges in the fourth and five decade of life and there is a gradual acceleration of reduction of height at later stages of ontogeny in both sexes. Postmenopausal women experience a more rapid loss of height compared with men. The individuals who had higher rate of loss of height (≥3 cm/decade) tend to be at greater risk of cardiovascular events and all-cause mortality. In conclusion, our findings suggest that a systematic assessment of the rate of loss of height can be useful for clinicians caring for elderly people because of its prognostic value in terms of morbidity and mortality.

Dehydration, Hypernatremia, and Hyponatremia

Disturbances of serum sodium are one of the most common findings in older persons. They are also a major cause of hospital admissions and delirium and are associated with frailty, falls, and hip fractures. Both hypernatremia and hyponatremia are potentially preventable. Treatment involves treating the underlying cause and restoring sodium and volume status to normal. The arginine vasopressin antagonists, vaptans, have increased the therapeutic armamentarium available to physicians.

The contribution of geriatric medicine to integrated care for older people

AIMS

to describe contribution of geriatric medicine to the development of integrated care for older people and to suggest future directions for the further development of integrated care for older people.

METHODS

literature review and case studies.

RESULTS

geriatricians have made a significant contribution to the development of integrated care for older people. The feasibility of this approach has been shown in demonstration projects. Although there is only limited evidence from randomised controlled trials, integrated care seems likely to be beneficial. There is an opportunity to develop new approaches to integrated care for older people in prevention and provision of community alternatives to hospital care.

CONCLUSION

the principles and practice of geriatric medicine have been shown to underpin the successful development of integrated care for older people and should continue to do so as new challenges emerge.

Frail bodies: geriatric medicine and the constitution of the fourth age

Clinical discourses of frailty are central both to the construction of the social category of the fourth age and to the role and identity of hospital geriatric medicine. However, the influence of such clinical discourses is not just from science to the social sphere and nor do these discourses have their source in a putative truth of the old body but emerge from an interplay between physiological facts, discourses of governmentality, productive processes associated with late modern capitalism and the professional ambitions of geriatric medicine. The article explores this interplay in the two key discourses of frailty that have emerged in the clinical literature during the past 15 years, that of the phenotype and the accumulation of deficits, respectively. Outlining the development of the discourse of senescence from its origins to the more recent emergence of a nosological category of frailty the article explores how these key discourses capture the older body according to particular sets of norms. These norms link physiological understanding with broader discourses of governmentality, including the professional project of geriatric medicine. In particular, metaphorical representations in the discourses of frailty convey key cultural and clinical assumptions concerning both older bodies and old age more generally.