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1 Department of Geriatrics, Geneva University Hospitals, Switzerland
2 Ludwig Boltzmann Institut für Interdisziplinare Rehabilitation in der Geriatrie, Vienna, Austria
3 Klinikum Nürnberg Nord, Nuremberg, Germany
Geriatrics is the youngest of the big clinical disciplines. Less than one century after the creation of the word "geriatrics" by the American-Austrian born Ignatus Nascher (1) and around 50 years after the British nomination as a distinct clinical discipline (2), "geriatrics thus faces a crossroads" (3). Nothing seems more natural and challenging.
The world was never as old as today, and it seems only one intermediate step of an incredible victory of hygiene, mother-and-child health, and adult medicine. Care to older persons does and will continue to contribute to this increase in life expectancy. At present, it is important to highlight similarities but also differences between the developed and developing world, as well as the United States of America and other developed countries, mainly within Europe with their individual health systems. In this respect, the somewhat pessimistic view of Professor Kane is not entirely shared on the other side of the Atlantic ocean. Nevertheless, difficulties also exist in Europe to position geriatrics positively amongst established medical disciplines and, in particular, internal medicine (4).
Geriatrics not only deals with well-defined diseases, but even more often with complex syndromes such as falls. Therefore, a broader knowledge of different medical specialties is needed, in which a holistic approach to geriatric patients is essential. However, geriatrics should not be limited to chronic care, even if geriatrics is "the epitome of good chronic care" (3).
In order to become the merited central part within the armamentarium of the different medical specialties, geriatrics has to become even more attractive and recognized in the following sectors: First, health promotion, disease, and disability prevention in aging persons must be initiated by geriatricians with the goal of not only extending healthy life expectancy, but maintaining functional independence, thus enhancing quality of life. This also includes community care for aging people (5)(6). Second, antiaging medicine should be supported by a high-quality level of both biological research and well-planned randomized control trials. The demand of the population at stake for this rapidly involving field should foster geriatricians' involvement in this field. Third, to date, each medical discipline has to cope with compromised older patients and therefore geriatric know-how is asked for in nearly every health care setting. For these reasons, geriatricians need to actively contribute to the development of psychogeriatrics, gerontopharmacology, gerodontology, oncogeriatrics, and the like. The best way to cope with the requests of specialists is to develop with all clinical partners specific and adapted care programs, as pediatricians did decades ago. Fourth, rehabilitation, especially for elderly people, should be performed by a multidisciplinary team, headed by a geriatrician. Using comprehensive geriatric assessment, leading problems can be identified and individual "treatment/intervention/evaluation cocktails" can be mixed. Finally, end-of-life care is a centerstone of geriatrics as more than 80% of all deaths occur beyond the age of 65 in developed countries. Geriatricians must also enhance their ethical concerns in a way that promotes "dignity-conserving" care (7).
These developments must be paralleled by high-end biological research performed by young and promising faculty members. These developments are crucial to allow new drug developments both in antiaging and geriatric medicine (angiogenic factors, Alzheimer's disease vaccine, embryonic stem cells for the treatment of Parkinson's disease, heart failure, and sarcopenia). Moreover, high-level "pre-, post-, and post-post graduate courses" in geriatrics to "train the future teachers in geriatrics" (such as the European Academy for Medicine of Ageing) should be mandatory (8)(9).
It was not the aim of this commentary to encompass all the field of geriatrics, but rather to add some "European thoughts" when we are choosing the appropriate way at the crossroads. Recent advances in both clinical and scientific knowledge in geriatrics and gerontology will certainly lead to a better recognition of the newest and probably most important "supraspecialty" of the 21st century—let us just put on the green lights!
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  J. E. Morley, J. H. Flaherty, and D. R. Thomas Editorial: Geriatricians, Continuous Quality Improvement, and Improved Care for Older Persons J. Gerontol. A Biol. Sci. Med. Sci., September 1, 2003; 58(9): M809 - 812. [Full Text] [PDF]
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J. E. Morley Editorial: Hot Topics in Geriatrics J. Gerontol. A Biol. Sci. Med. Sci., January 1, 2003; 58(1): M30 - 36. [Full Text] [PDF]
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D. R. Thomas Letters to the Editor: The Future History of Geriatrics: Consulting the Experts J. Gerontol. A Biol. Sci. Med. Sci., January 1, 2003; 58(1): M92 - 92. [Full Text] [PDF]
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