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Pathy's Principles and Practice of Geriatric Medicine


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The word gerocomy, attributed to Galen, was used for the medical care of the elderly and was adapted to geroncology for their sociological aspects. In 1903, Metchnikoff invented the word gerontology for the biological study of the ageing process. Nascher is generally credited with coining the word geriatrics.32 ‘The term was derived from the Greek, geron, old man and iatrikos, medical treatment. The etymological construction is faulty but euphony and mnemonic expediency were considered of more importance than correct grammatical construction’. Howell pointed out at least one author who had confused gerontology (the science of old age) and geriatrics (the care of the aged). The word gerontology has been attacked as a barbarous misspelling, and the word geratology, the study of old age, has been suggested instead. The founders of the Medical Society for the Care of the Elderly did not use the word geriatrics since it was, in the 1940s, almost unknown. Many UK hospital geriatric units, aware of the public’s perception of geriatrics as being apparently synonymous with senility, now call themselves ‘Department for the Medical Care of the Elderly’ or ‘Care of the Elderly Department’.

      Key points

       In spite of interest in old age, enlightened medical treatment of the elderly sick patient did not start until the twentieth century.

       Classification of patients and better treatment methods showed that the majority of those admitted to elderly care wards could be discharged.

       Community studies found unreported minor illness in older people, which could have a major impact on the quality of life if left untreated.

       University authorities were slow to implement the education of medical students about the medical and social aspects of illness in the older person.

       Powerful charitable foundations supported research into the causes of ageing.

      1 1. Abel‐Smith B. The Hospitals 1800–1948. Heinemann; 1964.

      2 2. Anonymous. The Lancet Sanitary Commission. Lancet; 1869.

      3 3. Webster C. Caring for Health: History and Diversity. Open University, Milton Keynes, 1993.

      4 4. Warren MW. Care of chronic sick. Br Med J 1943;ii:822–3.

      5 5. Jones AT, Nixon JA, Picken RMF. Welsh Board of Health: Hospital Surveys – the Hospital Services of South Wales and Monmouthshire. HMSO; 1945.

      6 6. Bevers EC, Gask GE, Parry RH. Ministry of Health: Hospital Survey – the Hospital Services of Berkshire, Buckinghamshire, and Oxfordshire. HMSO; 1945.

      7 7. Gray AMH, Topping A. Ministry of Health: Hospital Survey – the Hospital Services of London and the Surrounding Area. HMSO; 1945.

      8 8. Amulree L, Sturdee EL. Care of the chronic sick and of the aged. Br Med J 1946;i:617–8.

      9 9. Boucher CA. Survey of Services Available to the Chronic Sick and Elderly 1954–1955. Reports on Public Health and Medical Subjects No. 98. Ministry of Health; 1957.

      10 10. Godber G. Geriatrics as a Speciality. The British Library, National Sound Archive; 1991.

      11 11. British Medical Association. Report of the Committee on the Care and Treatment of the Elderly and Infirm. Br Med J Suppl 1947;i:133–40.

      12 12. British Medical Association. The right patient in the right bed. Br Med J Suppl 1948;ii:71–2.

      13 13. British Medical Association. Appendix IX: Report of the Geriatrics Joint Subcommittee of the British Medical Association. Br Med J (Suppl) 1955;i:181–90.

      14 14. Webster C. The Health Services Since the War. Volume 1. Problems of Health Care. The National Health Service Before 1957. HMSO; 1988.

      15 15. Webster C. The elderly and the early National Health Service. In: Pelling M, Smith RM, eds. Life, Death and the Elderly. Routledge; 1991:165–93.

      16 16. Thane P. Geriatrics. In: Bynum WF, Porter R, eds. Companion Encyclopaedia of the History of Medicine. Routledge; 1993:1092–118.

      17 17. Thane P. Inventing geriatric medicine. Old Age in English History. Oxford University Press; 2000:436–57.

      18 18. Warren MW. Care of the chronic aged sick. Lancet 1946;i:841–3.

      19 19. Cosin L. Geriatrics as a Speciality. The British Library, National Sound Archive; 1991.

      20 20. Cosin L. A new approach to the problems of geriatric care. Kaiser Found Med Bull 1956; 4:321–8.

      21 21. Amulree L. Adding Life to Years. National Council of Social Service; 1951.

      22 22. Gale J, Livesley B. Attitudes towards geriatrics: a report of the King’s survey. Age Ageing 1974; 3:49–53.

      23 23. Parkhouse J, McLaughlin C. Career preferences of doctors graduating in 1974. Br Med J 1976;ii:620–32.

      24 24. Lambert T, Goldacre M, Parkhouse J. Career preferences and their variation by medical school among newly qualified doctors. Health Trends 1996; 28:135–44.

      25 25. Royal College of Physicians of London. Report of the Royal College of Physicians of London on Geriatric Medicine. 1972.

      26 26. Royal College of Physicians of London. Medical care of the elderly: report of the Working Party of the Royal College of Physicians of London. Lancet 1977;i:1092–5.

      27 27. Department of Health and Social Security. On the State of the Public Health: the Annual Report of the Chief Medical Officer of the Department of Health and Social Security for the Year 1979. HMSO; 1980.

      28 28. Batchelor I. Policies for a Crisis. Nuffield Provincial Hospital Trust; 1984.

      29 29. Martin JP. Hospitals in Trouble. Blackwell; 1984.

      30 30. Ministry of Health. Care of the Aged Suffering from Mental Infirmity, R.H.B. (50) 26, H.M.C. (50) 25. National Health Service; 1950.

      31 31. Department of Health and Social Security. Services for Mental Illness Related to Old Age. HMSO; 1972.

      32 32. Nascher IL. Geriatrics. Kegan Paul, French, Truber; 1916.

PART 1 Ageing: Biological, Social, and Community Perspectives

       Florent Guerville1,2 and Maël Lemoine2

      1 Clinical Gerontology Department, Bordeaux University Hospital, Bordeaux, France

      2 ImmunoConcept Lab, CNRS UMR5164, University of Bordeaux, Bordeaux, France

      Ageing is not a technical word introduced recently into biology to refer to a well‐circumscribed, specific phenomenon. It comes from common language. In the last century, biologists tried to give the word a precise biological translation. Yet it still has a vague biological meaning, despite all the progress accomplished in discovering the mechanisms of ageing. Indeed, so‐called ‘mechanisms of ageing’ are generally mechanisms involved in the average acceleration or retardation of death in a population or the manifestation of signs usually attached to ageing. This is the best proxy we have, but the results should always be viewed with care. On the one hand, manipulating certain mechanisms (e.g. of metabolism) may advance or retard the average age of death without those mechanisms being necessarily involved in ‘ageing’ in the first place. On the other hand, some syndromes or diseases, like progeria, may mimic ageing without much of a link between the pathological process at hand and physiological, normal ageing. Such are the consequences of having to use a vague word in biology. However, the importance of this process to the understanding of human health is such that this concept