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COMMENTARY |
Geriatrics, Complutense School of Medicine, Madrid, Spain.
Address correspondence to José-Manuel Ribera-Casado, Servicio Geriatria, Hospital Clinico San Carlos, c/o Prof. Martin Lagos, s/n 28040 Madrid, Spain. E-mail: jribera.hcsc{at}salud.madrid.org
Many ideas came to my mind when I read the interesting historical review written by Professor Morley (1). In these lines, I will comment only on two of them. The first one, conceptually, will underline the role that geriatrics has played for one century in the quest for a better society. My second thoughts will try to add some data to that shown in Morley's review.
Nascher introduced the word "geriatrics" at the beginning of the last century in the context of important emerging social movements: trade unions movements, retired worker rights, pre-Russian revolution, and so forth. All of them were movements that, both in Europe and in America, fought for the achievement of a less discriminative society. Elderly people were then—and sadly they are still nowadays—a good example of discrimination. The cry of Nascher, perhaps unconscious, tried to avoid or to minimize this bigotry in the medical framework, looking for a better clinical response in elderly patients through a specific model of care that took into account the "age" parameter. Three decades later, Marjory Warren started building a scientific basis for this model.
From this standpoint, we might accept the idea that the history of the development of our specialty along a century has been the history of a struggle for equity. This is true not only in the essential question—what geriatrics means—but also in the ways chosen to get desirable results. Geriatrics was born and grew up to overcome inequities. It was born to favor poor people, the "excluded" ones. Then and now, older people represent, better than any other social group, the victimized class, the forgotten ones. No matter the point of view, the aging process is a story of losses. Physical, mental, and social losses increasingly limiting the protective possibilities of an individual, both on biological grounds and—perhaps this is more important in such a competitive society—on social grounds. Since the beginning, the history of geriatrics and geriatricians has been the chronicle of a fight against losses.
This continuing quest can also be found in our working methods. We geriatricians have pioneered the search for political solutions to health problems two or three decades before epidemiologists did. Our working methods introduced expressions such as "comprehensive assessment" or "continuous care." We started working closely together with professionals coming from other health or social fields: nurses, therapists, social workers, psychologists, and so forth from the very first moment. We introduced in our daily activities the concepts of "multidisciplinary" and "interdisciplinary" work, and we put them into practice every day. We incorporated Professor Butler's term and idea of "ageism," and we were active militants against this kind of discrimination. Several working systems accepted and well-established today in other medical specialties were fostered by geriatricians: "day hospital" and "home care" programs are excellent examples. And finally, as a rule, we have always been and we are still to this day active players in any sort of social or health oriented movements or programs focused on elderly people.
I think that these minimal reflections might help toward a better and complementary understanding of our history. At the same time, we face a permanent challenge with many obstacles to confront. We have a large amount of work to do. Our professional activities go beyond clinical grounds and place us in a position where aspects such as health education of society, prevention, research, and ethical issues will have a prominent role into the next century.
I would like to add some complementary data related to Spain to those presented by Dr. Morley. Manuel Beltrán Báguena was full professor of medicine in the School of Medicine of Valencia University. He was also an active promoter and the first President of the Spanish Society of Gerontology when it was founded in 1948. From 1946 to the mid-1950s, he organized several postgraduate medical courses, which probably were the first official courses on geriatrics in any European School of Medicine. This fact was acknowledged during the IV World Congress of the IAG, which took place in Merano-Venice in the summer of 1957. The number of physicians registered in the first course in 1946 was 130. Notwithstanding this forerunner, the first geriatric chair in a Spanish School of Medicine was not established until 1999 in the Universidad Complutense (Madrid).
The "Revista Española de Geriatría y Gerontología" (Spanish Journal of Geriatrics and Gerontology) was born in 1966. Since then it has continuously been the most significant journal of our specialty written in Spanish, with a high acceptance both in Spain and in Latin American countries.
In closing, I would like to make another brief historical remark to highlight that interest in geriatrics and biogerontology in Latin American countries is also very old. In Argentina, Nobel Prize winner Bernardo Houssay worked and published research papers in these areas in the 1940s. His name appears in Nathan Shock's book quoted by Morley. Several medical professors of the Buenos Aires School of Medicine founded the Argentinean Society of Geriatrics in 1953. And, in the last half century, the number of geriatrics activities has been continuously increasing in many other Latin American countries, whose national societies, in some cases, notably Chile, Venezuela, Mexico, Brazil, and Perú, are all approaching their 50th anniversary.
Reference
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