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Commentary

Monroe Community Hospital, Rochester, New York.

Address correspondence to T. Franklin Williams, MD, Monroe Community Hospital, 435 East Henrietta Rd., Rochester, NY 14620. E-mail: frank_williams{at}urmc.rochester.edu

I am impressed with the comprehensiveness, readability, accuracy, and timeliness of this "Brief History of Geriatrics" (1). We are moving rapidly into a period in world history in which older persons, their potentials, and clinical needs will be an increasing characteristic of all of our lives. The recent 35–40 years have seen the largest increase in and development of geriatrics of any period in history, particularly in this country, and I feel privileged to have found my way into this field. Let me describe how I came to become involved in geriatrics, with the hope that it may stimulate others to write about their own distinct pathways into our field, and help stimulate more to follow.

We all begin with where we are or were when a new experience like the challenge of geriatrics hits us. My own career, from time of completing medical residency in 1954 until 1968, was focused on the challenges of endocrine and metabolic problems in patients—in clinical care, clinical research, and teaching, in a strong academic environment at the University of North Carolina, Chapel Hill. It is of note in relation to my next steps that I had come to give particular attention to diabetes mellitus and concerned about the challenges of helping patients achieve adequate control of their disease, a truly chronic and not well-addressed aspect of their lives. I also became aware of the necessity of comprehensive teamwork if we were to have a chance to be more effective. This led to a pioneering research project, one of the first funded by the then new Health Services Research Division of the Department of Health and Human Services, in which we conducted a randomized clinical trial, with patients with insulin-dependent diabetes whose diabetes was not under control, using as intervention a multidisciplinary team, working together with each patient to address all aspects that might relate to and be benefited by our input. We were able to show quite significant improvement with our enrolled patients compared with our matched control group who received their usual care. This whole experience taught me the importance of being concerned about chronic aspects of many conditions affecting patients, and the importance of interdisciplinary approaches.

It was with this background that, in 1968, I was invited to move to Rochester, New York, to take the lead in developing the response to a new commitment of the University of Rochester Medical Center, namely to address the more chronic aspects of many of the major common diseases, aspects that were receiving little attention academically or clinically. The University, both in its own interests and in responding to a community need, had just made an agreement with the government of Monroe County, New York, to provide the medical and dental staff for the large Monroe County Infirmary, which provided residency and ongoing care for over 500 chronically ill county residents who could not be cared for at home or elsewhere. I and the colleagues who I was helped to recruit established special programs for research and teaching, in cancer, heart disease, diabetes, neurological diseases including dementia, and other conditions. In addition, we took responsibility for the ongoing care of our residents and patients in the clinics we developed.

This was an exciting opportunity, a learning time for all of us; one of the first things I found myself learning was that the majority of our chronically disabled residents were older or very old people! Not all, of course; Monroe Community Hospital, as we changed the name, is residence for persons of all ages with severely disabling conditions whose home settings can no longer care for them. But, the challenge of our many older residents meant that I, as well as others, had to learn about what was just then being developed as the field of geriatrics, in order to serve our patients better as well as to contribute to our teaching and research roles in the University. This challenge meant extensive searching for published material on geriatrics, of which there was little then, and, more importantly, to be in touch with and learn from the few leaders in geriatrics who were available—mainly in Europe, as is documented in this History. It was indeed an exciting time for me, to face new challenges and opportunities, and to help build a reasonably solid program in geriatrics in Rochester. An example of how my earlier concern with the multidisciplinary approach to care of persons with diabetes helped me in my new role was that I and my colleagues quickly realized that we must use such an approach with many of our multiply disabled older patients. This led to our development of one of the first comprehensive assessment clinics, and, with a randomized clinical trial, documenting the positive results, in particular in decreasing admissions to nursing homes.

Among the greatest satisfaction of those early days, and since, have been the very promising new physicians who chose to come as fellows in our geriatric program, and to move on to their own leadership roles around our nation. Indeed, the whole growing network of people of all disciplines committed to geriatrics gives us all support and stimulation to push on.

In summary, it seems to me that I have learned and benefited greatly from the opportunity presented to me to become engaged in geriatrics, building on previous experiences, and to be a part of this history. I expect much the same is true for many others.

Reference

105. Morley JE. A brief history of geriatrics [History]. J Gerontol Med Sci. 2004;59A:1132-1152.

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