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The Evolution of American Geriatrics

Section of Geriatric Medicine, Yale University School of Medicine, Yale New Haven Hospital, Connecticut.

Address correspondence to John C. Beck, MD, Professor of Medicine, Emeritus, Address correspondence to Leo M. Cooney, Jr., MD, Chief, Section of Geriatric Medicine, Yale University School of Medicine, Tompkins 17, Yale New Haven Hospital, 20 York St., New Haven, CT 06504. E-mail: leo.cooney{at}ynhh.org

The advances in geriatrics in American medicine in the past three decades have been impressive indeed. Thirty years ago, there was little or no mention of the care of older persons in American medical schools curricula or residency programs. The vast majority of medical schools now have programs in geriatrics, and training in the care of older patients has become a standard component of medical student and residency training programs. There are many reasons for this transformation; none have been more important, in my judgment, than the establishment of the National Institute on Aging and the vision of the first two directors of this agency, Robert Butler and T. Franklin Williams.

These two leaders recognized that strong programs in geriatrics had to be established in as many medical schools as possible in order to bring care of elderly persons to the attention of students, residents, faculty, and deans. The initial Geriatric Medicine Academic Awards provided support for faculty members to develop these programs. These awards helped establish a number of vibrant and successful geriatric programs.

The National Institute on Aging has had many partners in the development of American geriatrics. The American Geriatrics Society and The Gerontological Society of America gave academic and clinical homes to those interested in the care of elderly people. Foundations such as the Hartford Foundation and the Donald W. Reynolds Foundation gave needed philanthropic support, especially to junior faculty and to clinician educators. Societies such as The Alzheimer's Disease and Related Disorders Association brought public attention to a number of conditions that often affect elderly people. Finally, The American Boards of Internal Medicine and Family Practice provided academic credibility to geriatrics by introducing the "Added Qualifications in Geriatric Medicine" certification.

It is, however, the demographic imperative of the growth of the elderly population that has finally captured the attention and interest of the academic leaders and policy makers of American medicine. Geriatrics now has a "seat at the table" in most American medical centers. The further growth and development of geriatrics, and its place in American academic medicine in the next few decades, will depend on the ability of geriatricians to advance the science and teaching of geriatric medicine.

The future of this field is now firmly in the hands of the present and developing leaders of American geriatrics. These individuals, and their students, must move the scientific base of geriatric medicine forward, develop models of care that are centered on the goals and needs of older individuals, and ensure that every physician caring for adults in the country is knowledgeable and skilled in the most effective and appropriate methods of caring for older Americans.

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