ago, in March 2010, there were 7029 board certified geriatrics and 1705 board‐certified psychiatrists in the US. In 2008–2009, there were 470 geriatric medicine fellowship slots, of which only 62% were filled. Over two‐thirds of the slots were filled by international medical graduates. At the time of the last edition of the textbook (2012), there was one geriatrician for every 2699 persons age 75 or older in the US. At the present rate of recruitment into geriatrics, this will decrease to one for every 5549 older Americans by 2030. Physicians working in nursing homes can be certified separately by becoming a Certified Medical Director, which is offered by the American Medical Directors Association.
Over the last 30 years, the US has taken an important lead in developing the scientific base of modern geriatrics. Unfortunately, the lack of sustained interest by young physicians in geriatrics is likely to erode this over the next decade.
Geriatrics in the rest of the world
The first geriatrics society in France was formed in 1939 under the leadership of A. Baudouin. In the modern era, Professor Bruno Vellas, whose father developed the University of the Third Age, has revolutionised the approach to geriatrics in France. He founded the Journal of Nutrition Health & Aging as an important ageing journal in Europe. He also developed the Mini Nutritional Assessment tool. His centre at the University of Toulouse has become a leader in modern research in nutrition, Alzheimer’s disease, and nursing homes.
In Italy, ‘Recover’ (old people’s homes) was established by the Catholic Church in the mediaeval period. At the start of the twentieth century, hospital departments for the care of older persons and the disabled were formed. By the middle of the twentieth century, there were long‐stay hospital units (lungodegenza), rehabilitation units (infermeria), and rest homes (casa di riposo). The Geriatric Society in Italy was formed in 1949. M. Ascoli was the first chair. Italy has two longitudinal studies on ageing, namely the Italian Longitudinal Study on Aging (ILSA) and the In CHIANTI (Invecchiare in Chianti).
In Sweden, the first chairs of geriatrics were established in Uppsala University and Göteborg (Gothenburg) University. Under the leadership of Alvar Svanborg and Bertel Steen, the longitudinal population study of persons over 70 years of age was established in Gothenburg in 1970–1971. The work of Torben Gill at the Old People’s Town in Copenhagen from 1936 led to Denmark establishing a specialty of long‐term care. In 1972, the Danish Society of Geriatric Medicine was founded.
The Spanish Society of Geriatry and Gerontology was started in 1948. A. Baudouin was the first chairperson. Geriatrics has been a recognised medical specialty since 1978, with a four‐year training program. Switzerland played a major role in the development of geriatric psychiatry under the leadership of Professor J.‐.P Junod, who became the first Professor of Geriatrics in 1962. The University of Geneva has developed a Department of Geriatrics. Jean‐Pierre Michel, along with other European colleagues, developed the European Academy for Medicine of Ageing (EAMA) in Sion, a centre for training young geriatric faculty.
The leader in geriatrics in Japan is the Tokyo Metropolitan Institute of Gerontology, which was founded in 1972. It was associated with a 700‐bed geriatric hospital. The National Institute of Longevity Science was established in 1995.
The first International Congress of Gerontology was held in Liège, Belgium, in 1950. In 1952, the second congress held in St Louis led to the formation of the International Association of Gerontology. This has recently been renamed the International Association of Gerontology and Geriatrics (IAGG). In conjunction with the World Health Organization (WHO) and under the recent leadership of Professor Vellas, the society has become more active and developed the GARN research network. As an example of IAGG’s outputs, they have recently published guidelines, developed by a task force chaired by John Morley and Yves Rolland, to enhance care in nursing homes (Table 2).
Table 2 The IAGG Task Force recommends the following.
| No. | Recommendation |
|---|---|
| Recommendation 1 | Effective leadership structures are established, that where possible, include an expert physician (medical director), and an expert registered nurse (nursing director) and skilled administrator |
| Recommendation 2 | An international alliance is formed to develop nursing home leadership capacity and capabilities |
| Recommendation 3 | To showcase international exemplars of excellence in nursing home practice to raise awareness of the demonstrable benefits for older people and high standards achieved through expert practice |
| Recommendation 4 | To create positive working conditions for nursing home practitioners with attractive career development opportunities, recognition and similar rewards enjoyed by health care workers in comparable roles within the acute care services |
| Recommendation 5 | That nursing home quality indicators are developed that are sensitive to clinical and care needs and the right of older people to care that is dignified and respectful |
| Recommendation 6 | The use of physical and chemical restraints should be reduced to those that are absolutely indispensable |
| Recommendations 7 | That ‘meaningful activities’ be offered to residents to provide physical and mental exercise and opportunities to participate within the nursing home and in community life, enhancing personal autonomy, social relationships (including intergenerational relationships), and social support |
| Recommendation 8 | That evidence‐informed pain assessment and management programmes are introduced into all nursing homes |
| Recommendation 9 | That evidence‐informed end of life and palliative care programmes are introduced into all nursing homes |
| Recommendation 10 | National drug approval agencies consider requiring drug trials that are age appropriate and inclusive of nursing home residents before they are approved |
| Recommendation 11 | IAGG develop international certification courses for nursing (care) home health professionals |
| Recommendation 12 | Pilot the use of ‘Community of Practice Models’ as a practice improvement method for nursing homes, utilizing both face‐to‐face interdisciplinary training and virtual team support |
| Recommendation 13 | A universal ethical approach to obtaining informed consent and monitoring the appropriateness of research is developed |
| Recommendation 14 | Develop nursing home research capacity in developing nations |
| Recommendation 15 |
An investment is made in research priorities that address major public health problems and inequalities that affect older people receiving long‐term care. Research priorities for which a high need is recognised include:A worldwide survey of different models of care, nursing home structure and issues in improving quality of care is undertakenA worldwide survey of older persons and their families is undertaken to determine their preferences for long‐term careA cross‐national, prospective epidemiological study measuring function and quality of life in nursing homesDevelopment of culturally appropriate standardised assessment instruments including those involving social participatory methodsA function‐focused approach to the prevalence of geriatric
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