Should geriatric medicine remain a specialty? No

Gray Transformation of Internal Medicine

Aim To study the profile of patients hospitalized in an internal medicine facility of a public hospital and explore if there is a shift in the age distribution of hospitalized patients toward an older age group. Methods The study was conducted at a tertiary care hospital in Delhi where the department of medicine has six units and a particular unit is in charge of the emergency room one day a week and every sixth Sunday. A total of 716 patients hospitalized in the medicine ward through the emergency services each Wednesday and every sixth Sunday (i.e, admission days of a particular unit) during a period for six months (November 2017 to April 2018) were retrospectively identified and their name, age, sex, comorbidities, final diagnosis, duration of hospital stay, and the outcome were noted. This was compared with similar data collected from a previous study conducted in the same setting in the years 2010-2011. The data were analyzed using Stata version 13 software (StataCorp, College Station, Texas). Findings were compared using the chi-squared test or t-test, wherever applicable. Results The mean age of patients hospitalized in 2010-2011 was 43.9 years, and this had increased to 48 years in 2018-2019 suggesting that the average patient being hospitalized in general medicine wards of a public hospital was now approximately five years older. Thirty-nine percent (39%) of the individuals admitted were more than 60 years of age in 2018-2019 as compared to 28.0% in 2010-2011. There was a significant rise in the cases of cardiovascular and gastrointestinal diseases and a decline in poisoning and infectious diseases from the year 2010-2011 to 2018-2019. A significantly higher prevalence of cardiovascular diseases, diabetes, and respiratory diseases was found in the current study among older adults. Conclusion There has been a significant shift in the distribution of hospitalized patients in the internal medicine in-patient wards toward the older age group during the last decade. Also, there is a significant difference between the disease profiles of older and young patients. A comprehensive approach to geriatric medicine should be introduced and followed.

The emergence and utilisation of frailty in the United Kingdom: a contemporary biopolitical practice

Frailty has recently emerged as a dominant concept against a backdrop of media and governmental narratives that frame the growing ageing population as an economic threat to the current configuration of health care in the United Kingdom (UK). Despite frailty's popularity amongst geriatricians and policy makers, the concept faces resistance from other health-care professionals and older people themselves. This paper draws on the Foucauldian idea of biopower; by suggesting that the contemporary emergence and utilisation of frailty represents a biopolitical practice a number or critical observations are made. First, despite biomedical experts acknowledging ambiguities in the definition of frailty, the concept is presented as a truth discourse. This is driven by the ability of frailty measurements to predict risk of costly adverse outcomes; the capability of frailty scores to enumerate complex needs; and the scientific legitimacy frailty affords to geriatric medicine. Consequently, frailty has become pervasive, knowable and measurable. Second, the routine delineation between frail and robust objectifies older people, and can be said to benefit those making the diagnosis over those being labelled frail, with the latter becoming disempowered. Last, studies show that frailty is associated with increasing wealth inequalities in the UK; however, experts’ suggested management of frailty shifts the focus of responsibility away from ideologically driven structural inequalities towards the frail older person, attempting to encourage individuals to modify lifestyle choices. This neglects the association between lifestyle opportunities and socio-economic deprivation, and the impact of long-term poverty on health. These observations, set against the contemporary political climate of economic austerity, cuts to public services and rationalisation of health resources, bring the urgency of a critical consideration of frailty to the fore.

Teaching and learning geriatric medicine

Populations throughout the world are ageing, with the oldest old the most rapidly growing segment of society. Caring for this ageing population, some of whom have multiple chronic and disabling diseases, will be challenging to healthcare systems. Current training programmes are generating relatively low numbers of geriatricians, largely because students and residents lack interest in a career in geriatric medicine. Therefore, specialists in geriatric medicine cannot directly provide care for all older people. There is a responsibility to ensure that successful practices and essential skills are shared.

Here we explore negative attitudes towards geriatric medicine and contrast these with factors motivating change. Educational theories are discussed to investigate how processes of learning and the personal development of students can be optimized. An understanding of geriatric medicine is important for undergraduates, postgraduate trainees in geriatric medicine, general practitioners and allied health professionals. The different challenges presented by each group are reviewed, accompanied by recommendations to enhance learning and examples of effective teaching practices.

Attitudes to aging: a comparison of obituaries in Canada and the U.K

BACKGROUND

Populations worldwide are aging and the overall prevalence of dementia at death is now 30%. Since the contemporary social impact of a disease is indicated by the frequency of its newspaper coverage and since obituary notices illuminate conceptions of death, we hypothesized that obituary notices placed by families would reflect societal attitudes to aging and dementia.

METHODS

We undertook critical discourse analysis of obituaries in representative national and local newspapers in Canada and the U.K.

RESULTS

In the 799 obituaries studied, chronological age, suggested donations in memory of the deceased, and donations to dementia charities were each included in significantly more obituaries in Canadian newspapers than in U.K. ones. Military service was explicit for significantly more men aged > or = 80 years in Canada compared to the U.K. (41% versus 4%; p < 0.05). Of the donations to medical charities, nearly half (n = 117) were to cancer charities and one-fifth (54) to heart and stroke foundations. In the U.K., obituaries for those aged > or = 70 years were more likely to recommend donations to children's charities (n = 12) or the Royal National Lifeboat Institution than dementia charities.

CONCLUSIONS

Donations to dementia charities were significantly more common in obituaries in Canada than in the U.K. In both countries, donations to medical charities did not reflect disease prevalence or impact to the individual. Societal attitudes in the U.K. may be impacted by the fragmentation of aging research and antipathy to geriatric medicine in the national medical press.