The frail future of geriatrics
Authors: Benedetta Cerasoli
Journal: The Lancet Healthy Longevity (2020)

Frailty is an increasingly used and often misused term in scientific literature. Frailty indicates a condition of increased susceptibility to stressors due to impaired homoeostatic reserves.1Morley JE Vellas B van Kan GA et al.Frailty consensus: a call to action.J Am Med Dir Assoc. 2013; 14: 392-397Summary Full Text Full Text PDF PubMed Scopus (2461) Google Scholar In the same way, observing frailty in a society, in a community, and at work is possible. We have all experienced frailty during the COVID-19 pandemic, a crisis that has caught us largely unprepared. Nevertheless, some individuals have shown their frailty more than others, probably because of pre-existing susceptibilities. People older than 70 years have been seriously affected by the consequences of this pandemic. Older people tend to have higher fatality rates and more severe forms of COVID-19 than do younger people, and experience solitude and stigmatisation.2Cesari M Proietti M COVID-19 in Italy: ageism and decision making in a pandemic.J Am Med Dir Assoc. 2020; 21: 576-577Summary Full Text Full Text PDF PubMed Scopus (124) Google Scholar Poor public attention to residents in care homes in Italy caused substantial social isolation and a large number of deaths.3Trabucchi M De Leo D Nursing homes or besieged castles: COVID-19 in northern Italy.Lancet Psychiatry. 2020; 7: 387-388Summary Full Text Full Text PDF PubMed Scopus (102) Google Scholar Primary care physicians and geriatricians, like their patients, can feel forgotten, undervalued, and abandoned by government institutions. This underappreciation has been my experience, at least, working as a junior doctor in the heart of the Lombardy region, the region most severely affected by COVID-19 in Italy. Training in geriatrics is crucial for the future of medicine. Comprehensively assessing people in all their complexity changes focus from the pure medicalised action to the care of the individual. In this context, the outcomes of interest might substantially divert from those usually considered important (eg, extension of life) to endpoints that are more person-centred (eg, quality of life, prevention of dependence, and preservation of function). A classic geriatric intervention is deprescribing, which again makes our speciality remarkable; although other specialities tend to increase the number of medications prescribed to patients (often without supporting evidence), we try to decrease the number prescribed.4Woodford HJ Fisher J New horizons in deprescribing for older people.Age Ageing. 2019; 48: 768-775Crossref Scopus (18) Google Scholar Geriatrics might be considered a frail profession, hardly finding its clear place in a world where political investments and health-care models revolve around economical profits and mechanistic hyperefficiency. We live in a world focused on the here and now and the meaning of prevention is too often misinterpreted. Our poor pandemic preparedness planning is an example of this philosophy. Investing in prevention is fundamental to reducing the onset of preventable diseases, strengthening territorial medicine and primary health care to limit unnecessary and expensive hospitalisations, and improving global health. Geriatrics has a key role in these indispensable objectives for the future, particularly considering the evidently ageing population.5Partridge L Deelen J Slagboom PE Facing up to the global challenges of ageing.Nature. 2018; 561: 45-56Crossref PubMed Scopus (547) Google Scholar People always say that children are our future. It is true that childhood belongs to the past and is something we can identify with, as we all have experienced being a child. However, we can sometimes struggle to identify with older adults, forgetting that sooner or later we will all reach that stage of life. Old age is our future; it is what awaits us. We should convert the stigma of older age as a life stage burdened by disease and sad events into a positive image of new opportunities, for both older people and for their society. Older people are our past and our future, guardians of our memory, and mirrors of our becoming. I declare no competing interests.