A brief history of geriatric medicine

This was written for a book introduction which was never published… enjoy!

Marjory Warren was a pioneering founder of Geriatric medicine. She showed that by providing care to long term older patients in the old workhouse wards, it was possible to rehabilitate many and to place them in appropriate settings that suited their needs within the community. She published her findings in the 1940s, in the British Medical Journal and the Lancet. Many of her ideas remain integral to the practice of geriatric medicine today. 

In 1965, Bernard Isaacs famously described the "Geriatric Giants:” instability (falls), immobility, intellectual impairment (cognition), and incontinence. These are often subspecialty disciplines within geriatric medicine and are integral in the Comprehensive Geriatric Assessment ( a whole person assessment). 

In 1977, a Royal College of Physicians London working group called for the integration of general medicine and geriatric facilities, inclusion in both undergraduate and postgraduate training and a multi-disciplinary approach to older adults.

Geriatric medicine is a whole person focused specialty. Older patients have accumulated a lifetime of health conditions and in combination with ageing, will often have an associated decline in function. This results in the need for care either within the home or within a care setting, such as a nursing home. Some patients are living on a precipice and it only takes a small “push,” such as a decline in health or a "social crises” to tip the balance requiring urgent medical or social assistance. It is impossible therefore, to realistically treat such patients without considering the whole picture, and often the extended picture includes their partner, family or some other social factor. Due to this web of health and social need, care requires a wider group of specialists and this is where the multi-disciplinary team comes in... a geriatrician’s best friend! 

Geriatric medicine is a fun, variable, developing and sometimes challenging specialty. However, with an increasing aged population, it is not possible for all older adults to be cared for by a geriatrician. Therefore, even if your career takes you in a different direction, I hope that whatever you take away from this chapter will equip you with the skills and knowledge to feel confident about looking after older adults in your care.