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COMMENTARY |
International Longevity Center-USA, New York.
Address correspondence to Robert N. Butler, MD, President and CEO, International Longevity Center-USA, 60 East 86th St., New York, NY 10028-1009. E-mail: robertb{at}ilcusa.org
In response to the article on the history of geriatrics (1), I have the following comments regarding developments in the field (2,3).
Pediatrics in the United States was opposed by organized medicine. Children were thought of as "miniature adults." It was not until 1930 that pediatrics became established as a medical specialty. Rosemary Stevens has argued that its development resulted from the "clean milk movement." I had always hoped that geriatrics would ride on the back of a "clean up the nursing home" movement. But it was not until the founding of the National Institute on Aging that geriatrics received the necessary intellectual and economic stimulus to begin to make some progress in the United States (2).
The Research on Aging Act of 1974, which created the National Institute on Aging, did not provide legislative authority or funds to grow academic geriatrics comparable to the authorization and funding available to the National Heart, Lung and Blood Institute to build the field of academic cardiology. We were able, however, to establish the Geriatric Medicine Academic Award. Many of the present leaders in the field successfully competed. Among them: William Hazzard, Patricia Barry, John W. Rowe, Fred Sherman, and other outstanding contributors.
At the same time, we contracted with the Institute of Medicine to create a task force to determine how (not whether) to incorporate geriatrics within medical education. Paul Beeson, one of America's most revered physicians but not a geriatrician, did an outstanding job. The resulting Beeson Report became very influential.
The Brookdale National Fellowship Program was later followed by a program named after Beeson, which provided prestigious awards for young physicians and scientists to develop the field. The John A. Hartford Foundation, the Commonwealth Fund, the Alliance for Aging Research, and the American Federation for Aging Research helped support the Beeson program and much more.
The growth of the National Institute on Aging provided research funding for a variety of age-related conditions, including Alzheimer's disease, as well as studies to understand the basic biology of aging at the molecular and cellular level. This gave further credibility to the fields of gerontology and geriatrics.
The Donald W. Reynolds Foundation inspired the creation of two departments of geriatrics, one at the University of Arkansas and the other at the University of Oklahoma. There are also departments at Hawaii and Florida State in addition to the first one established at Mount Sinai.
The lesson from all of this, I believe, is that the field requires the support of both the governmental and private sectors. For example, efforts by the American Geriatrics Society and the International Longevity Center have increased funding for the Geriatric Academic Career Awards administered by the Health Resources and Services Administration. The goal is to build a core of academic geriatricians within each of the 144 allopathic and osteopathic schools of medicine. This is a financially modest program costing approximately $22 million per year. But it would mean that, by 2022, when the massive baby boomer generation begins to reach its maximum, there would be teachers and programs in place so that no one could graduate from medical school or from any residency program, whatever the specialty, without understanding the basic physiology and pathophysiology of aging, age-related conditions, and the broad psychosocial, cultural, and community knowledge required of the expert geriatrician.
The imperatives to establish geriatrics remain robust: the growing numbers and proportions of older persons, the disease burden, heavy costs, and ageism or prejudice with respect to age, which remains pervasive. The growth of the science base will prove the ultimate attraction to both private and public support because the more we know, the more we can do to improve the quality of care of older persons.
The advances of the neurosciences, regenerative medicine, and immunology by the century's end will result in an increasingly vibrant, healthy, and extended life. Even so, there will likely remain conditions due to disease, unintended injuries, poor lifestyle, and environmental factors that will leave a considerable body of humanity adversely affected during the final chapter of their lives. Therein will be the enormous role of geriatrics to endeavor, where possible, to prevent, treat, rehabilitate, and always offer humane support. Perhaps ultimately that is the message of geriatrics: that to be old is not to be abandoned, but to receive the finest of human care available.
References
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