Geriatric medicine, or geriatrics, is a sub-specialty of internal medicine that focuses on the care and well-being of older people. A geriatrician is a physician who practices geriatric medicine, specializing in the care of older people. There is no set age at which patients may be under the care of a geriatrician. Rather, this decision is determined by the individual patient’s needs. For example, a 50 year-old patient suffering from Alzheimer’s disease can be under the care of geriatricians.
Geriatric medicine differs from standard adult medicine because it targets on the unique complex needs of the older people. There are distinct differences between the younger adults and the older people in terms of physiological reserve, ability to cope with and recover from illnesses. In addition, older people often have multiple comorbidities and their illnesses tend to present atypically. They are also more susceptible to complications of invasive investigations as well as drug side effects. Cognitive impairment, feeding issues, mobility, self-care and social problems are common and are best managed by a geriatrician-led multidisciplinary team. Geriatric medicine and geriatricians exist to help prevent and treat diseases in the older people, and to preserve and prolong quality of life during one’s senior years. Geriatricians are expert in providing holistic care to complex older patients. Through performing comprehensive assessment and coordinating a multi-disciplinary team, they provide professional management of different geriatric giants of older patients.
In Hong Kong, Geriatricians are serving a variety of roles within the healthcare system, including hospital care, long-term care, home care, and terminal care. They often work closely with other specialists, nurses, pharmacists, therapists, and social workers.
Besides working in both acute and extended care hospitals, geriatricians have important role in running Geriatric Day Hospitals (GDH) and providing community medical services to the older people, including the Community Geriatric Assessment Team (CGAT) services as well as the Integrated Care and Discharge Support (ICDS) services. Moreover, geriatricians work closely with different specialties in hospitals to implement services and programs for older patients. They also collaborate with various organizations in the society, including many NGOs, to promote geriatric knowledge in the public and to provide services to the older people.
A short history of geriatric medicine
It is generally agreed that geriatric medicine originated in the United Kingdom 80 years ago out of a reaction to neglect and apathy of older patients thought not to be amenable to medical treatment and thus obliged to spend their last years in chronic infirmaries. Dr Marjorie Winsome Warren CBE, MB (1897-1960) was regarded as the mother of British geriatrics medicine. The specialty of geriatric medicine also developed in North America, Europe as well as in Canada. In Asia, geriatric medicine was first started in Hong Kong in 1975, and now geriatric specialty has developed in a number of Asian countries. In 1998, ten Asian countries formed the Geriatric Medicine in Asia Working Group, with the objective to promote the development of geriatric medicine in Asia. This has further evolved to the Asia-Pacific Network in Geriatric Medicine in 2006 with regular conferences held since then. Geriatric Medicine has continued to grow and an impressive knowledge base has been accumulated. This combined with increasing expertise in the multidisciplinary treatment and assessment of older patients and in ensuring that health and social services work in a coordinated fashion, has improved the care of ill older people.