Medical professional needs for geriatric care

“The geriatric imperative”, an apt phrase, was first used by Professor Ann Sommers, a health economist of Rutgers University [ 11. It is an excellent term. It embodies several concepts: increased numbers of older individuals in the population and a sense of urgency and concern for the needs of these individuals in matters of economics, housing, health, nutrition and engagement in life. The sense of urgency and concern has been articulated in the last decade by both individuals and organizations, public and private, concerned with the growing numbers of older people in the population. In the year 1900 4% of the population of the United States was sixty-five years and older. In 1940 the figure was 6;%, and by 1980 the figure had grown to 10% [2]. It is projected that by the year 2000 13% of the population of the United States will be 65 years or over, and in actual numbers this will represent 36 million people [3]. Half of this number will be over 75 years of age, and of this group 5.4 million will be over the age of 85 years. Some interesting projections have been made by Rice and Feldman in their study concerning these demographic changes and the health care needs of the elderly [4]. As more people live longer the demands for medical care are assuredly going to rise. Rice and Feldman point out that two other demographic factors will contribute to the greater use of organized medical care services, namely (1) more older individuals will be living alone and without children, and (2) the elderly will have more education and are likely to seek more health services. Rice and Feldman’s projections were based on current agespecific rates of morbidity. They point out that this assumption is more likely to lead to underestimates than to overestimates of health care utilization. They estimate that about 2.8 million persons in the year 2000 may have limitations in the activities of daily living. They estimate that visits to physicians annually by the elderly will increase from 165 million in 1980 to 230 million in the year 2000, a projected increase of about 40%. There will be a 50% increase in utilization of short-term hospitals in the year 2000 by the older age groups. By the year 2000, 2.3 million elderly persons may be residents of nursing homes, an increase of over a million residents from 1980. Expenditures for this care are estimated to be $23 billion compared with $16; billion expended in 1980. The elderly will expend, in the year 2000, for total personal health care, more than $90 billion (in 1980 dollars). This will account for over one-third of all personal health care expenditures and represents 2; times the proportion of elderly in the total population. Rice and Feldman point out that these data indicate there will be a greatly increased demand for persons with college-level education and skills in gerontology and geriatrics to care for this growing elderly population. The need for trained health care personnel knowledgable in gerontology and geriatrics has been recognized in the United States for at least 75 years. In 1909 Dr I. L. Nascher wrote a report in the New York Medical Journal on the care of older people [5]. In this paper he coined the term “geriatrics” from the Greek word geria, meaning old age, and iatrikos, meaning the physician’s ministry. He pointed out that since older people needed specialized care, individuals in the health care professions would have to be trained to meet these special needs. In 19 14 Dr Nascher brought out the first American textbook on geriatric medicine [6]. Growth of programs for the elderly came slowly, however. In 1936 the Social Security program was put into effect by the United States Government. In 1942 the American Geriatrics Society was founded. It did not begin publishing its journal, The Journal of the American Geriatrics Society, until January of 1953. The National Institutes of Health opened its section on gerontology at the Baltimore City Hospitals in 1941. Under the leadership of Nathan Shock, Ph.D., the now world-renowned longitudinal study program of physiological changes in organ systems of man as the aged was begun. Since 1941, in his laboratory, Dr Shock has steadily trained gerontologists, who have subsequently become leaders in the field. In 1945 the Gerontological Society of America was founded. In 1956 the American Medical Association organized a National Committee on Geriatrics. In 196 1 the first White House Conference on Aging was held. In 1965 Title 18 of the Social Security legislation became effective and provided for the Medicare program, and the Older Americans Act was passed by Congress as the basic federal commitment to the geriatric population. In 1974 the National Institute of Aging was established as part of the National Institutes of Health. In hearings before the Senate’s Special Committee on Aging in 1976, concern was expressed that physicians did not have the knowledge to manage the health problems of the older population [7]. In 1976 at the Anglo American Conference on the Care of Elderly, sponsored jointly by the Institute of Medicine of the National Academy of Sciences and the Royal Society of Medicine, participants voiced their concerns on the lack of expertise by most physicians in caring for the elderly. A recommendation made by the Conference was that gerontology and geriatrics be introduced into physicians’ education [8]. The first report concerning education in geriatrics in medical curricula in the United States had been