Elderly people with multiple health problems have better outcomes when treated by teams led by geriatricians -- but too often, the specialty of geriatrics, like its patients, is disrespected and ignored. The issues are discussed in the lead Editorial in this week's edition of The Lancet.
The American Geriatrics Society has warned that the ageing US population faces a critical shortage of geriatricians. Despite geriatrics being rated the most satisfying specialty, the perceptions of poor pay and lack of glamour in a youth-obsessed culture are blamed for dwindling numbers of recruits to the existing 7000 US geriatricians. This is despite ongoing large increases to the elderly population in the US and elsewhere -- the number of over 65-year-olds in the USA is expected to hit 70 million in 2030, with around 1.6 million being added each year until then. A century ago, one person in 20 worldwide was aged over 65 years; today it is one in six; and by 2051, it is predicted to be one in four.
The Editorial highlights the lack of preparedness for this increase in older people -- eg, in the UK in 2006, 25% of health trusts did not have a multidisciplinary falls service -- a hallmark of integrated elderly care. This is despite the fact falls affect 30% of over 60-year-olds and 40% of over 70-year-olds every year, and are a major cause of injury and death. Old age is often accompanied by frailty and a number of other diseases, some age-specific, and some that present atypically as a result of age -- and thus geriatrics is a speciality that requires both problem-based and diagnosis-based medicine.
The Editorial says: "Some of the blame for poor progress in services and, in the USA, for recruitment, must lie with geriatricians for not taking a strong role in leadership and giving an audible voice to their specialty." It adds that for geriatrics to thrive as a specialty and for older patients to truly benefit, the profession must take on promptly and decisively the opportunities of education, research, advocacy, and collaboration presented by an aging population. It also calls for academic leadership to embed elderly care within undergraduate and postgraduate training programmes.
The Editorial concludes: "That modern healthcare now faces the challenge of rapidly ageing populations is a celebration of the great strides made by public health and preventive medicine. Generations of practitioners and researchers have brought medicine to this pinnacle. But to enable continued progress, all health disciplines share a responsibility to cooperate with geriatrics to bring competent, compassionate care to old age."
PDF OF EDITORIAL: http://multimedia.thelancet.com/pdf/press/elderly.pdf
Journal
The Lancet