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COMMENTARY |
Geriatric Department, Medical School and University Hospitals of Geneva, Switzerland.
Address correspondence to Reto W. Kressig, Geriatric Department, Medical School and University Hospitals of Geneva, Route de Mon-Idee CH, 1226 Thonex-Geneve, Switzerland. E-mail: reto.kressig{at}hcuge.ch
John Morley's synthesis of geriatric medicine history from ancient Egypt to today with a prospect for tomorrow is a giant task even for a tireless and very involved true geriatrician (1). As always, this very useful summary for Journal of Gerontology readers will lead to contrasting appreciation from those who had the chance to be quoted and those who were forgotten. We think of interest, first, is to stress a few nongovernmental (WHO and NATO) and European initiatives that were not mentioned, and, secondly, to focus on what will be future fields of interest in geriatric medicine.
The nongovernmental (WHO and NATO) and European initiatives include the following. In the early 1990s, WHO (2) and then NATO recognized the future impact of a greying world by organizing world consensus conferences (Vienna in 1993, New York in 1995) devoted to the setting-up of different "global aging" research programs. Unfortunately, these initiatives did not lead to valuable scientific data, but had several major impacts such as: a) the appreciation that population aging was not limited to developed countries but that developing and emerging countries were involved in quicker demographic and sanitary transitions (3,4), which will bring about a significant increase of older persons creating a new generation of frail oldest-old; b) the realization that life expectancy is related to the level of the national product but does not reflect the health of a population. This has led to repeated standardized measures of disability-free life expectancy all around the world. The International Network of Healthy Life Expectancy (REVES), created and conducted by Jean-Marie Robine (France), (5) furthers our understanding of the impact of health care policy in each country on the prevalence and incidence of disability (6); and, c) the recognition that care of the aging population (from health promotion to specific prevention and care programs) is a key priority at the beginning of the 21st century (3,7).
During the same period, after a detailed report from the Population Activities Unit (8), the need for a problem-focused research program on the aging population emerged in the European Community. The Vth and then the VIth European Community framework of research contained specific recommendations to stimulate and harmonize research activities within 15 European countries to allow comparison with other parts of the world, notably with the United States (9). These programs generated several interesting initiatives: a) the constitution of research consortiums to promote the greater inclusion of aging populations in investigative protocols. The most well-known consortium is the European Alzheimer Disease Consortium (EADC) initiated by Bruno Vellas (France) and B. Wingblad (Sweden) (10); b) the different national societies of geriatrics joined their efforts in an umbrella society called the European Union Geriatric Medicine Society (EUGMS) (11,12), which organizes joint meetings with the American and Canadian societies; and c) the need to "teach the future teachers in geriatrics" was recognized, and the European Academy for Medicine of Ageing (EAMA) (13,14) was accredited by the EUGMS for this high-level training task (1). The MOBEX group, initiated by former EAMA students, represents an important European interdisciplinary network of geriatricians, physical therapists, psychologists, exercise scientists, and so forth with particular interest for mobility and exercise in elderly people. This group is promoting the implementation of novel techniques in fall prevention such as spatiotemporal gait analysis or specific exercise interventions in a growing number of geriatric facilities all over Europe. The prevention of falls network Europe (ProFaNE), a 4-year project fully supported by the European community, is another initiative to improve the European efforts made in fall prevention. Finally, the European Nursing Academy for Care of Older Persons (ENACO) was launched in November 2002 to meet the challenges for gerontological nursing in Europe (15). The collaboration with the EAMA and other professional organizations in Europe and other parts of the world, are promising elements in the development of ENACO.
As previously stressed, these various coordinated initiatives reflect the deep need to enhance research activities in the biology of aging, epidemiology, and clinical geriatrics (16). The future fields of interest in geriatric medicine will probably integrate all these areas.
For example, improved understanding and the international classification of functional limitations (ICIDH-1981 and ICF-2001) (17) led to better identification of the deep roots of the disablement process, resulting in new health educative programs. This, in turn, led to the recognition that functional decline should be anticipated by identifying the frailty process, which appears to have a multisystem biological basis that will probably be elucidated in the near future, thanks to joint efforts of American, Canadian, and European task forces (18).
This transitional process from robustness to frailty and functional decline pointed out that anti-aging medicine is an eternal myth (1). However, geriatricians should not eschew their responsibility (19). Prevention of the aging consequences needs to be considered as a true priority of geriatric medicine.
Another example is the major impetus given to the development of neurosciences research and neurodegenerative disease care programs through the development of new drugs. There is no doubt that the joined efforts of researchers from various complementary fields will lead to imaginative therapeutic initiatives, such as Alzheimer's disease immunization or embryonic stem cell therapy for curing Parkinson's disease.
A final example concerns quality of life and end-of-life issues. During the last decade, palliative and terminal care were not recognized as a noble part of (geriatric) medicine. Today, as this discipline becomes more and more important and advanced care directives more and more frequent, geriatricians have been challenged by numerous intriguing debates on euthanasia. Geriatricians must develop a heightened awareness of the danger of such trends and need to enhance their consideration of the patient's well-being and dignity (20).
These few comments are only meant to stress the emerging debate raised by John Morley's article. Geriatrics is at the beginning of its own story—its history can be considered as "brief," but it already represents a very large involvement and dedication of medical and scientific pioneers. Thanks to all of them for their valuable contribution.
Bibliography
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