Geriatrics#Geriatrician training

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Geriatric providers receive specialized training in caring for elderly patients and promoting healthy aging. The care provided is largely based on shared-decision making and is driven by patient goals and preferences, which can vary from preserving function, improving quality of life, or prolonging years of life. A guiding mnemonic commonly used by geriatricians in the United States and Canada is the 5 M's of Geriatrics which describes mind, mobility, multicomplexity, medications and matters most to elicit patient values.{{Cite journal |last1=Molnar |first1=Frank |last2=Frank |first2=Christopher C. |date=January 2019 |title=Optimizing geriatric care with the GERIATRIC 5Ms |journal=Canadian Family Physician |volume=65 |issue=1 |pages=39 |pmc=6347324 |pmid=30674512 }}

It is common for elderly adults to be managing multiple long-term conditions (multimorbidity). Age-associated changes in physiology drive a compounded increase in susceptibility to illness, disease-associated morbidity, and death. Moreover, common diseases may present atypically in elderly patients, adding further diagnostic and therapeutic complexity to patient care.

Geriatrics is highly interdisciplinary consisting of specialty providers from the fields of medicine, nursing, pharmacy, social work, and physical and occupational therapy. Elderly patients can receive care related to medication management, pain management, psychiatric and memory care, rehabilitation, long-term nursing care, nutrition, and different forms of therapy including physical, occupational, and speech. Non-medical considerations include social services, transitional care, advanced directives, power of attorney, and other legal considerations.

The decline in physiological reserve in organs makes the elderly develop some kinds of diseases and have more complications from mild problems (such as dehydration from a mild gastroenteritis). Multiple problems may compound: A mild fever in elderly persons may cause confusion, which can advance to a fall and to a fracture of the neck of the femur ("broken hip").The presentation of disease in elderly persons may be vague and non-specific, or it may include delirium or falls. (Pneumonia, for example, may present with low-grade fever and confusion, rather than the high fever and cough seen in younger people.) Some elderly people may find it hard to describe their symptoms in words, especially if the disease is causing confusion, or if they have cognitive impairment. Delirium in the elderly may be caused by a minor problem such as constipation or by something as serious and life-threatening as a heart attack. Many of these problems are treatable, if the root cause can be discovered.

Cognitive aging is characterized by declines in fluid abilities like processing speed, working memory, and executive function, while crystallized abilities such as knowledge remain stable (Anstey & Low, 2004; Murman, 2015). Age-related changes in brain structure and function correlate with these cognitive declines (Murman, 2015). Older adults show weaker occipital activity and stronger prefrontal and parietal activity during cognitive tasks, possibly reflecting compensation (Cabeza et al., 2004). Subjective cognitive complaints are common among older adults, particularly regarding working memory (Newson & Kemps, 2006). Various factors influence cognitive aging, including genetics, lifestyle, and health (Bäckman et al., 2004). Cognitive impairments can progress to mild cognitive impairment (MCI) or dementia (Mendoza-Ruvalcaba et al., 2018).

MCI is a transitional state between normal aging and Dementia, affecting 10-20% of adults over 65 (Schwarz, 2015). Geriatricians encounter MCI patients in various care settings, with diagnoses relying on clinical assessment and mental status examinations (Tangalos & Petersen, 2018). MCI is highly prevalent among older adults with depression and may persist after depression remits (Lee et al., 2006). While MCI is considered a high-risk condition for developing Alzheimer's disease, there is heterogeneity in its presentation and outcomes (Petersen et al., 2001).

Dementia is a prevalent condition in geriatric populations, affecting cognitive function and daily activities (Talawar, 2018; Mirzapure et al., 2022). Alzheimer's disease is the most common cause, accounting for 40-80% of cases (Mirzapure et al., 2022; Chulakadabba et al., 2020). Geriatric patients with dementia often have comorbidities and other geriatric syndromes, requiring holistic and integrated care (Chulakadabba et al., 2020; Nguyen et al., 2023). Geriatricians play a crucial role in dementia care, but many feel current training is inadequate and seek more structured experiences (Mayne et al., 2014). Improving access to geriatricians and enhancing general practitioners' diagnostic skills could improve timely and accurate dementia diagnosis (Mansfield et al., 2022). However, there are significant shortages of dementia specialists, particularly in rural areas (Liu et al., 2024; Christley et al., 2022). Geriatricians support comprehensive post-diagnosis information provision, including sensitive topics like advance care planning (Mansfield et al., 2022). Collaboration between specialists and family physicians is essential, with specialists often handling contentious issues like driving competency (Hum et al., 2014). Geriatric training may influence end-of-life care patterns for dementia patients (Gotanda et al., 2023). A geriatrics perspective emphasizes prevention, considering lifestyle factors that promote healthy cognitive aging (Steffens, 2018).

There are various tests to assess cognition.

These include the MMSE, the Montreal Cognitive Assessment, and GERRI (geriatric evaluation by relative's rating instrument), which is a diagnostic tool for rating cognitive function, social function and mood in geriatric patients.{{cite journal |doi=10.2466/pr0.1983.53.2.479 |title=Development and Validation of the Geriatric Evaluation by Relative's Rating Instrument (Gerri) |year=1983 |last1=Schwartz |first1=Gerri E. |journal=Psychological Reports |volume=53 |issue=2 |pages=479–88 |pmid=6647694|s2cid=46265352 }}

Elderly people require specific attention to medications. Elderly people particularly are subjected to polypharmacy (taking multiple medications) given their accumulation of multiple chronic diseases. Many of these individuals have also self-prescribed herbal medications and over-the-counter drugs. This polypharmacy, in combination with geriatric status, may increase the risk of drug interactions or adverse drug reactions.{{Cite journal |last1=Dagli |first1=Rushabh J |last2=Sharma |first2=Akanksha |date=2014 |title=Polypharmacy: A Global Risk Factor for Elderly People |journal=Journal of International Oral Health|volume=6 |issue=6 |pages=i–ii |pmc=4295469 |pmid=25628499 }} Pharmacokinetic and pharmacodynamic changes arise with older age, impairing their ability to metabolize and respond to drugs. Each of the four pharmacokinetic mechanisms (absorption, distribution, metabolism, excretion) is disrupted by age-related physiologic changes. For example, overall decreased hepatic function can interfere with clearance or metabolism of drugs and reductions in kidney function can affect renal elimination.{{Cite web |title=Pharmacokinetics in Older Adults - Geriatrics |url=https://www.merckmanuals.com/professional/geriatrics/drug-therapy-in-older-adults/pharmacokinetics-in-older-adults |access-date=2022-09-12 |website=Merck Manuals Professional Edition |language=en-US}} Pharmacodynamic changes lead to altered sensitivity to drugs in geriatric patients, such as increased pain relief with morphine use.{{Cite journal |last1=Mangoni |first1=A A |last2=Jackson |first2=S H D |date=January 2004 |title=Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications |journal=British Journal of Clinical Pharmacology |volume=57 |issue=1 |pages=6–14 |doi=10.1046/j.1365-2125.2003.02007.x |pmc=1884408 |pmid=14678335}} Therefore, geriatric individuals require specialized pharmacological care that is informed by these age-related changes.

Geriatric syndromes is a term used to describe a group of clinical conditions that are highly prevalent in elderly people.{{cite journal |last1=Cicerchia |first1=Marcella |last2=Ceci |first2=Moira |last3=Locatelli |first3=Carola |last4=Gianni |first4=Walter |last5=Repetto |first5=Lazzaro |title=Geriatric syndromes in peri-operative elderly cancer patients |journal=Surgical Oncology |date=September 2010 |volume=19 |issue=3 |pages=131–139 |doi=10.1016/j.suronc.2009.11.005 |pmid=20036531 }}{{cite journal |last1=Hartmann |first1=Erica L. |last2=Wu |first2=Christine |title=The Evolving Challenge of Evaluating Older Renal Transplant Candidates |journal=Advances in Chronic Kidney Disease |date=July 2010 |volume=17 |issue=4 |pages=358–367 |doi=10.1053/j.ackd.2010.03.012 |pmid=20610363 }}{{cite journal |last1=Abdelhafiz |first1=Ahmed H. |last2=Sinclair |first2=Alan J. |title=Diabetes in the elderly |journal=Medicine |date=January 2015 |volume=43 |issue=1 |pages=48–50 |doi=10.1016/j.mpmed.2014.10.001 }} These syndromes are not caused by specific pathology or disease, rather, are a manifestation of multifactorial conditions affecting several organ systems. Common conditions include frailty, functional decline, falls, loss of continence, and malnutrition, amongst others.{{cite journal |last1=Mallappallil |first1=Mary |last2=Friedman |first2=Eli A |last3=Delano |first3=Barbara G |last4=McFarlane |first4=Samy I |last5=Salifu |first5=Moro O |title=Chronic kidney disease in the elderly: evaluation and management |journal=Clinical Practice |date=September 2014 |volume=11 |issue=5 |pages=525–535 |doi=10.2217/cpr.14.46 |pmc=4291282 |pmid=25589951}}

Frailty is marked by a decline in physiological reserve, increased vulnerability to physiological and emotional stressors, and loss of function. This may present as progressive and unintentional weight loss, fatigue, muscular weakness, and decreased mobility.{{Cite journal |last1=Pal |first1=Laura M |last2=Manning |first2=Lisa |date=June 2014 |title=Palliative care for frail older people |journal=Clinical Medicine |volume=14 |issue=3 |pages=292–295 |doi=10.7861/clinmedicine.14-3-292 |pmc=4952544 |pmid=24889576 }} It is associated with increased injuries, hospitalization, and adverse clinical outcomes.

Functional disability can arise from a decline in physical function and/or cognitive function. It is associated with an acquired difficulty in performing basic everyday tasks resulting in an increased dependence of other individuals and/or medical devices.{{Citation |last1=Edemekong |first1=Peter F. |title=Activities of Daily Living |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK470404/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29261878 |access-date=2022-09-12 |last2=Bomgaars |first2=Deb L. |last3=Sukumaran |first3=Sukesh |last4=Schoo |first4=Caroline}}{{Cite journal |last1=Aliberti |first1=Marlon J. R. |last2=Covinsky |first2=Kenneth E. |date=2019-02-01 |title=Home Modifications to Reduce Disability in Older Adults With Functional Disability |journal=JAMA Internal Medicine |volume=179 |issue=2 |pages=211–212 |doi=10.1001/jamainternmed.2018.6414 |pmid=30615064 }} These tasks are sub-divided into basic activities of daily living (ADL) and instrumental activities of daily living (IADL) and are commonly used as an indicator of a person's functional status.

Activities of daily living (ADL) are fundamental skills needed to care for oneself, including feeding, personal hygiene, toileting, transferring and ambulating. Instrumental activities of daily living (IADL) describe more complex skills needed to allow oneself to live independently in a community, including cooking, housekeeping, managing one's finances and medications. Routine monitoring of ADL and IADL is an important functional assessment used by clinicians to determine the extent of support and care to provide to elderly adults and their caregivers. It serves as a qualitative measurement of function over time and predicts the need for alternative living arrangements or models of care, including senior housing apartments, skilled nursing facilities, palliative, hospice or home-based care.

{{Main|Falls in older adults}}

Falls are the leading cause of emergency department admissions and hospitalizations in adults age 65 and older, many of which result in significant injury and permanent disability.{{Cite web |last=CDC |date=2020-12-16 |title=Keep on Your Feet |url=https://www.cdc.gov/injury/features/older-adult-falls/index.html |access-date=2022-09-12 |website=Centers for Disease Control and Prevention |language=en-us}} As certain risk factors can be modifiable for the purpose of reducing falls, this highlights an opportunity for intervention and risk reduction. Modifiable factors include:

• Improving balance and muscle strength.
• Removing environmental hazards.
• Encouraging use of assistive devices.
• Treating chronic conditions.
• Adjusting medication.

Urinary incontinence or overactive bladder symptoms is defined as unintentionally urinating oneself. These symptoms can be caused by medications that increase urine output and frequency (e.g. anti-hypertensives and diuretics), urinary tract infections, pelvic organ prolapse, pelvic floor dysfunction, and diseases that damage the nerves that regulate bladder emptying.{{Cite web |title=Urinary Incontinence in Older Adults |url=https://www.nia.nih.gov/health/urinary-incontinence-older-adults |access-date=2022-09-12 |website=National Institute on Aging |date=24 January 2022 |language=en}} Other musculoskeletal conditions affecting mobility should be considered, as these can make accessing bathrooms difficult.

Malnutrition and poor nutritional status is an area of concern, affecting 12% to 50% of hospitalized elderly patients and 23% to 50% of institutionalized elderly patients living in long-term care facilities such as assisted living communities and skilled nursing facilities.{{Cite journal |last=Evans |first=Carol |date=2005 |title=Malnutrition in the Elderly: A Multifactorial Failure to Thrive |journal=The Permanente Journal |volume=9 |issue=3 |pages=38–41 |doi=10.7812/TPP/05-056 |pmc=3396084 |pmid=22811627 }} As malnutrition can occur due to a combination of physiologic, pathologic, psychologic and socioeconomic factors, it can be difficult to identify effective interventions.{{Cite journal |last=Evans |first=Carol |date=Summer 2005 |title=Malnutrition in the Elderly: A Multifactorial Failure to Thrive |journal=The Permanente Journal |volume=9 |issue=3 |pages=38–41 |doi=10.7812/tpp/05-056 |pmid=22811627 |pmc=3396084 }} Physiologic factors include reduced smell and taste, and a decreased metabolic rate affecting nutritional food intake. Unintentional weight loss can result from pathologic factors, including a wide range of chronic diseases that affect cognitive function, directly impact digestion (e.g. poor dentition, gastrointestinal cancers, gastroesophageal reflux disease) or may be managed with dietary restrictions (e.g. congestive heart failure, diabetes mellitus, hypertension). Psychologic factors include conditions including depression, anorexia, and grief.

Functional abilities, independence, and quality of life issues are central concerns to geriatricians and their patients. Elderly people generally want to live independently as long as possible, which requires them to be able to engage in self-care and other activities of daily living. A geriatrician may be able to provide information about elder care options, and refer people to home care services, skilled nursing facilities, assisted living facilities, and hospice as appropriate.

Frail elderly individuals may choose to decline some kinds of medical care, because the risk-benefit ratio is different. For example, frail elderly women routinely stop screening mammograms, because breast cancer is typically a slowly growing disease that would cause them no pain, impairment, or loss of life before they would die of other causes. Frail people are also at significant risk of complications following surgery and the need for extended care, and an accurate prediction—based on validated measures, rather than how old the patient's face looks—can help older patients make fully informed choices about their options. Assessment of older patients before elective surgeries can accurately predict the patients' recovery trajectories.{{cite journal | vauthors = Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, Takenaga R, Devgan L, Holzmueller CG, Tian J, Fried LP | display-authors = 6 | title = Frailty as a predictor of surgical outcomes in older patients | journal = Journal of the American College of Surgeons | volume = 210 | issue = 6 | pages = 901–908 | date = June 2010 | pmid = 20510798 | doi = 10.1016/j.jamcollsurg.2010.01.028 | name-list-style = vanc }} One frailty scale uses five items: unintentional weight loss, muscle weakness, exhaustion, low physical activity, and slowed walking speed. A healthy person scores 0; a very frail person scores 5. Compared to non-frail elderly people, people with moderate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in the hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes. Frail elderly patients (score of 4 or 5) who were living at home before the surgery have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people.

Some diseases commonly seen in elderly are rare in adults, e.g., dementia, delirium, falls. As societies aged, many specialized geriatric- and geriatrics-related services emerged{{Cite web | vauthors = Burton JR | date = 2008 |url=http://www.americangeriatrics.org/specialists/geri_for_spec_update_fall_08.pdf |title=Geriatrics-for-Specialists Initiative (GSI) | quote = Increasing Geriatrics Expertise in Surgical and Related Medical Specialties | work = The American Geriatrics Society (AGS) |access-date=9 February 2016 |archive-url=https://web.archive.org/web/20090325055546/http://www.americangeriatrics.org/specialists/geri_for_spec_update_fall_08.pdf |archive-date=25 March 2009 |url-status=dead}}{{cite journal | vauthors = Solomon DH, Burton JR, Lundebjerg NE, Eisner J | title = The new frontier: increasing geriatrics expertise in surgical and medical specialties | journal = Journal of the American Geriatrics Society | volume = 48 | issue = 6 | pages = 702–4 | date = June 2000 | pmid = 10855612 | doi = 10.1111/j.1532-5415.2000.tb04734.x }} including:

• Geriatric cardiology or cardiogeriatrics.
• Geriatric dentistry.
• Geriatric dermatology.
• Geriatric diagnostic imaging.
• Geriatric emergency medicine.
• Geriatric nephrology.
• Geriatric neurology.
• Geriatric oncology.
• Geriatric physical examination of interest especially to physicians & physician assistants.
• Geriatric psychiatry or psychogeriatrics (focus on dementia, delirium, depression and other psychiatric disorders).
• Geriatric public health or preventive geriatrics
• Geriatric rehabilitation.
• Geriatric rheumatology (focus on joints and soft tissue disorders in elderly).
• Geriatric sexology (focus on sexuality in aged people).
• Geriatric subspeciality medical clinics (such as geriatric anticoagulation clinic, geriatric assessment clinic, falls and balance clinic, continence clinic, palliative care clinic, elderly pain clinic, cognition and memory disorders clinic).

• Geriatric orthopaedics or orthogeriatrics (close cooperation with orthopedic surgery and a focus on osteoporosis and rehabilitation).
• Geriatric cardiothoracic surgery.
• Geriatric urology.
• Geriatric otolaryngology.
• Geriatric general surgery.
• Geriatric trauma.
• Geriatric gynecology.
• Geriatric ophthalmology.
• Perioperative medicine for Older People having Surgery (POPS)

• Geriatric anesthesia (focuses on anesthesia & perioperative care of elderly).
• Geriatric intensive-care unit: (a special type of intensive care unit dedicated to critically ill elderly).
• Geriatric nursing (focuses on nursing of elderly patients and the aged).
• Geriatric nutrition.
• Geriatric occupational therapy.
• Geriatric pain management.
• Geriatric pharmacy.
• Geriatric optometry.
• Geriatric physical therapy.
• Geriatric podiatry.
• Geriatric psychology.
• Geriatric speech-language pathology (focuses on neurological disorders such as dysphagia, stroke, aphasia, and traumatic brain injury).
• Geriatric mental health counselor/specialist (focuses on treatment more so than assessment).
• Geriatric audiology.

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A number of physicians in the Byzantine Empire studied geriatrics, with doctors like Aëtius of Amida evidently specializing in the field. Alexander of Tralles viewed the process of aging as a natural and inevitable form of marasmus, caused by the loss of moisture in body tissue.{{citation needed|date=August 2022}}{{Cite journal |last=Schäfer |first=Daniel |date=2002 |title='That Senescence Itself is an Illness': A Transitional Medical Concept of Age and Ageing in the Eighteenth Century |journal=Medical History |volume=46 |issue=4 |pages=525–548 |doi=10.1017/S0025727300069726 |pmid=12408094 |pmc=1044563 }} The works of Aëtius describe the mental and physical symptoms of aging. Theophilus Protospatharius and Joannes Actuarius also discussed the topic in their medical works. Byzantine physicians typically drew on the works of Oribasius and recommended that elderly patients consume a diet rich in foods that provide "heat and moisture". They also recommended frequent bathing, massaging, rest, and low-intensity exercise regimens.{{cite journal | vauthors = Lascaratos J, Poulacou-Rebelacou E | title = The roots of geriatric medicine: care of the aged in Byzantine times (324-1453 AD) | journal = Gerontology | volume = 46 | issue = 1 | pages = 2–6 | year = 2000 | pmid = 11111221 | doi = 10.1159/000022125 }}

In The Canon of Medicine, written by Avicenna in 1025, the author was concerned with how "old folk need plenty of sleep" and how their bodies should be anointed with oil, and recommended exercises such as walking or horse-riding. Thesis III of the Canon discussed the diet suitable for old people, and dedicated several sections to elderly patients who become constipated.{{cite journal | vauthors = Howell TH | title = Avicenna and his regimen of old age | journal = Age and Ageing | volume = 16 | issue = 1 | pages = 58–59 | date = January 1987 | pmid = 3551552 | doi = 10.1093/ageing/16.1.58 }}{{cite journal | vauthors = Howell TH | title = Avicenna and the care of the aged | journal = The Gerontologist | volume = 12 | issue = 4 | pages = 424–426 | date = 1972 | pmid = 4569393 | doi = 10.1093/geront/12.4.424 }}{{cite journal | vauthors = Pitskhelauri GZ, Dzhorbenadze DA | title = [Gerontology and geriatrics in the works of Abu Ali Ibn Sina (Avicenna) (on the 950th anniversary of the manuscript, Canon of Medical Science)] | language = ru | journal = Sovetskoe Zdravookhranenie | volume = 29 | issue = 10 | pages = 68–71 | date = 1970 | pmid = 4931547 }}

The Arab physician Algizar ({{circa|898}}–980) wrote a book on the medicine and health of the elderly.{{cite web | url = http://www.islam.org.br/al_jazzar.htm | title = Al Jazzar | archive-url = https://web.archive.org/web/20080706155736/http://www.islam.org.br/al_jazzar.htm | archive-date=6 July 2008 | work = www.islam.org }}{{cite journal | vauthors = Ammar S | title = Ibn Al Jazzar and the Kairouan medical school of the tenth century AD | journal = Vesalius: Acta Internationales Historiae Medicinae | volume = 4 | issue = 1 | pages = 3–4 | date = June 1998 | pmid = 11620335 | doi = | url = http://www.bium.univ-paris5.fr/ishm/vesalius/VESx1998x04x01.pdf }} He also wrote a book on sleep disorders and another one on forgetfulness and how to strengthen memory,{{cite web | url = http://www.medarus.org/Medecins/MedecinsTextes/al_jazzar.htm | title = Algizar | language = French | archive-url = https://web.archive.org/web/20160407202425/http://medarus.org/Medecins/MedecinsTextes/al_jazzar.htm | archive-date=7 April 2016 | work = medarus.org }}{{Cite web|url=https://www.nlm.nih.gov/hmd/arabic/bioI.html#jazzar|title=Islamic Medical Manuscripts: Bio-Bibliographies - I|website=www.nlm.nih.gov}}{{cite book | vauthors = Bos G |title=Ibn al-Jazzār on forgetfulness and its treatment: critical edition of the Arabic text and the Hebrew translations with commentary and translation into English |date=1995 |publisher=Royal Asiatic Society of Great Britain and Ireland |location=London |isbn=978-0-947593-12-4}}{{pn|date=January 2025}} and a treatise on causes of mortality. Another Arab physician in the 9th century, Ishaq ibn Hunayn (died 910), the son of Nestorian Christian scholar Hunayn Ibn Ishaq, wrote a Treatise on Drugs for Forgetfulness.{{cite web|url=https://www.nlm.nih.gov/exhibition/islamic_medical/islamic_08.html|title=Islamic Culture and the Medical Arts: Specialized Literature|website=www.nlm.nih.gov}}

George Day published the Diseases of Advanced Life in 1849, one of the first publications on the subject of geriatric medicine.{{cite journal | vauthors = Barton A, Mulley G | title = History of the development of geriatric medicine in the UK | journal = Postgraduate Medical Journal | volume = 79 | issue = 930 | pages = 229–234 | date = April 2003 | pmid = 12743345 | pmc = 1742667 | doi = 10.1136/pmj.79.930.229 | doi-access = free }} The first modern geriatric hospital was founded in Belgrade, Serbia, in 1881 by doctor Laza Lazarević.{{cite journal | vauthors = Kanjuh V, Pavlović B | title = New bibliography of scientific papers by Dr. Laza K. Lazarević. | journal = Glas SANU–Medicinske Nauke | date = 2002 | volume = 46 | pages = 37–51 | url = http://scindeks.nb.rs/article.aspx?artid=0371-40390246037K&lang=en | archive-url= https://web.archive.org/web/20120325142042/http://scindeks.nb.rs/article.aspx?artid=0371-40390246037K&lang=en | archive-date=25 March 2012 }}

The term geriatrics was proposed in 1908 by Ilya Ilyich Mechnikov, Laurate of the Nobel Prize for Medicine and later by 1909 by Ignatz Leo Nascher,{{cite web|url= http://www.americangeriatrics.org/about_us/ags_awards/naschermanning_award/|title= Nascher/Manning Award|access-date= 1 November 2012|archive-url= https://web.archive.org/web/20121020095954/http://americangeriatrics.org/about_us/ags_awards/naschermanning_award/|archive-date= 20 October 2012|url-status= dead}} former Chief of Clinic in the Mount Sinai Hospital Outpatient Department (New York City) and a "father" of geriatrics in the United States.{{cite book |title=Profiles in Gerontology: A Biographical Dictionary |page=256 |chapter=Ignatz Leo Nascher| vauthors = Achenbaum WA, Albert DM |year=1995 |publisher=Greenwood |isbn=9780313292743 }}

Modern geriatrics in the United Kingdom began with the "mother"{{cite journal | vauthors = Denham MJ | title = Dr Marjory Warren CBE MRCS LRCP (1897-1960): the mother of British geriatric medicine | journal = Journal of Medical Biography | volume = 19 | issue = 3 | pages = 105–110 | date = August 2011 | pmid = 21810847 | doi = 10.1258/jmb.2010.010030 }} of geriatrics, Marjory Warren. Warren emphasized that rehabilitation was essential to the care of older people. Using her experiences as a physician in a London Workhouse infirmary, she believed that merely keeping older people fed until they died was not enough; they needed diagnosis, treatment, care, and support. She found that patients, some of whom had previously been bedridden, were able to gain some degree of independence with the correct assessment and treatment.{{Cite web |title=Vignette: Marjory Warren (1897-1960) |url=https://www.mddus.com/resources/publications-library/insight/q3-2019/vignette-marjory-warren |access-date=2022-08-16 |website=MDDUS |language=en}}

The practice of geriatrics in the UK is also one with a rich multidisciplinary history. It values all the professions, not just medicine, for their contributions in optimizing the well-being and independence of older people.

Another innovator of British geriatrics is Bernard Isaacs, who described the "giants" of geriatrics mentioned above: immobility and instability, incontinence, and impaired intellect.{{cite web|url=https://www.bgs.org.uk/a-giant-of-geriatric-medicine-professor-bernard-isaacs-1924-1995-post-1|title=A giant of geriatric medicine - Professor Bernard Isaacs (1924-1995)|publisher=British Geriatrics Society|access-date=23 October 2018}}{{cite book |title=An introduction to geriatrics | vauthors = Isaacs B |date=1965 |publisher=Balliere, Tindall and Cassell |location=London }} Isaacs asserted that, if examined closely enough, all common problems with older people relate to one or more of these giants.

The care of older people in the UK has been advanced by the implementation of the National Service Frameworks for Older People, which outlines key areas for attention.{{cite web |url= http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/OlderPeoplesServices/fs/en | archive-url = https://web.archive.org/web/20070103221354/http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/OlderPeoplesServices/fs/en | archive-date = 3 January 2007 | work = Department of Health | title = Older People's information}}

In the United States, geriatricians are primary-care physicians (D.O. or M.D.) who are board-certified in either family medicine or internal medicine and who have also acquired the additional training necessary to obtain the Certificate of Added Qualifications (CAQ) in geriatric medicine. Geriatricians have developed an expanded expertise in the aging process, the impact of aging on illness patterns, drug therapy in seniors, health maintenance, and rehabilitation. They serve in a variety of roles including hospital care, long-term care, home care, and terminal care. They are frequently involved in ethics consultations to represent the unique health and diseases patterns seen in seniors. The model of care practiced by geriatricians is heavily focused on addressing working closely with other disciplines such as nurses, pharmacists, therapists, and social workers.

In the United Kingdom, most geriatricians are hospital physicians, whereas others focus on community geriatrics in particular. Although originally a distinct clinical specialty, it has been integrated as a specialization of general medicine since the late 1970s.{{cite journal | vauthors = Barton A, Mulley G | title = History of the development of geriatric medicine in the UK | journal = Postgraduate Medical Journal | volume = 79 | issue = 930 | pages = 229–34; quiz 233–4 | date = April 2003 | pmid = 12743345 | pmc = 1742667 | doi = 10.1136/pmj.79.930.229 }} Most geriatricians are, therefore, accredited for both. Unlike in the United States, geriatric medicine is a major specialty in the United Kingdom and are the single most numerous internal medicine specialists.

In Canada, there are two pathways that can be followed in order to work as a physician in a geriatric setting.

1. Doctors of Medicine (M.D.) can complete a three-year core internal medicine residency program, followed by two years of specialized geriatrics residency training. This pathway leads to certification, and possibly fellowship after several years of supplementary academic training, by the Royal College of Physicians and Surgeons of Canada.
2. Doctors of Medicine (M.D.) can opt for a two-year residency program in family medicine and complete a one-year enhanced skills program in care of the elderly. This post-doctoral pathway is accredited by the College of Family Physicians of Canada.

Many universities across Canada also offer gerontology training programs for the general public, such that nurses and other health care professionals can pursue further education in the discipline in order to better understand the process of aging and their role in the presence of older patients and residents.

In India, Geriatrics is a relatively new speciality offering. A three-year post graduate residency (M.D) training can be joined for after completing the 5.5-year undergraduate training of MBBS (Bachelor of Medicine and Bachelor of Surgery). Unfortunately, only eight major institutes provide M.D in Geriatric Medicine and subsequent training. Training in some institutes are exclusive in the Department of Geriatric Medicine, with rotations in Internal medicine, medical subspecialties etc. but in certain institutions, are limited to 2-year training in Internal medicine and subspecialities followed by one year of exclusive training in Geriatric Medicine.

In July 2007, the Association of American Medical Colleges (AAMC) and the John A. Hartford Foundation{{cite web|url=http://www.jhartfound.org/|title=The John A. Hartford Foundation|website=www.jhartfound.org}} hosted a National Consensus Conference on Competencies in Geriatric Education where a consensus was reached on minimum competencies (learning outcomes) that graduating medical students needed to assure competent care by new interns to older patients. Twenty-six (26) Minimum Geriatric Competencies in eight content domains were endorsed by the American Geriatrics Society (AGS), the American Medical Association (AMA), and the Association of Directors of Geriatric Academic Programs (ADGAP). The domains are: cognitive and behavioral disorders; medication management; self-care capacity; falls, balance, gait disorders; atypical presentation of disease; palliative care; hospital care for elders, and health care planning and promotion. Each content domain specifies three or more observable, measurable competencies.

Changes in physiology with aging may alter the absorption, the effectiveness and the side effect profile of many drugs. These changes may occur in oral protective reflexes (dryness of the mouth caused by diminished salivary glands), in the gastrointestinal system (such as with delayed emptying of solids and liquids possibly restricting speed of absorption), and in the distribution of drugs with changes in body fat and muscle and drug elimination.{{cite journal |last1=D'Souza |first1=A L |title=Ageing and the gut |journal=Postgraduate Medical Journal |date=2007 |volume=83 |issue=975 |pages=44–53 |doi=10.1136/pgmj.2006.049361 |pmc=2599964 |pmid=17267678 }}

Psychological considerations include the fact that elderly persons (in particular, those experiencing substantial memory loss or other types of cognitive impairment) are unlikely to be able to adequately monitor and adhere to their own scheduled pharmacological administration. One study (Hutchinson et al., 2006) found that 25% of participants studied admitted to skipping doses or cutting them in half. Self-reported noncompliance with adherence to a medication schedule was reported by a striking one-third of the participants. Further development of methods that might possibly help monitor and regulate dosage administration and scheduling is an area that deserves attention.{{citation needed|date=October 2022}}

Another important area is the potential for improper administration and use of potentially inappropriate medications, and the possibility of errors that could result in dangerous drug interactions. Polypharmacy is often a predictive factor.{{cite journal | vauthors = Cannon KT, Choi MM, Zuniga MA | title = Potentially inappropriate medication use in elderly patients receiving home health care: a retrospective data analysis | journal = The American Journal of Geriatric Pharmacotherapy | volume = 4 | issue = 2 | pages = 134–143 | date = June 2006 | pmid = 16860260 | doi = 10.1016/j.amjopharm.2006.06.010 }} Research done on home/community health care found that "nearly 1 of 3 medical regimens contain a potential medication error".Choi et al., 2006.{{full|date=January 2025}}

Elderly persons sometimes cannot make decisions for themselves. They may have previously prepared a power of attorney and advance directives to provide guidance if they are unable to understand what is happening to them, whether this is due to long-term dementia or to a short-term, correctable problem, such as delirium from a fever.

Geriatricians must respect the patients' privacy while seeing that they receive appropriate and necessary services. More than most specialties, they must consider whether the patient has the legal responsibility and competence to understand the facts and make decisions. They must support informed consent and resist the temptation to manipulate the patient by withholding information, such as the dismal prognosis for a condition or the likelihood of recovering from surgery at home.

Elder abuse is the physical, financial, emotional, sexual, or other type of abuse of an older dependent. Adequate training, services, and support can reduce the likelihood of elder abuse, and proper attention can often identify it. For elderly people who are unable to care for themselves, geriatricians may recommend legal guardianship or conservatorship to care for the person or the estate.

Elder abuse occurs increasingly when caregivers of elderly relatives have a mental illness. These instances of abuse can be prevented by engaging these individuals with mental illness in mental health treatment. Additionally, interventions aimed at decreasing elder reliance on relatives may help decrease conflict and abuse. Family education and support programs conducted by mental health professionals may also be beneficial for elderly patients to learn how to set limits with relatives with psychiatric disorders without causing conflict that leads to abuse.{{cite journal | vauthors = Labrum T | title = Factors related to abuse of older persons by relatives with psychiatric disorders | journal = Archives of Gerontology and Geriatrics | volume = 68 | pages = 126–134 | year = 2017 | pmid = 27810660 | doi = 10.1016/j.archger.2016.09.007 }}

{{col div|colwidth=20em}}

• Aging in Place
• Aging-associated diseases
• Alliance for Aging Research
• Commission for Certification in Geriatric Pharmacy
• Elderly care
• Gero-Informatics
• Nosokinetics
• Life extension
• Geriatric medicine in Egypt
• Transgenerational design
• Physical & Occupational Therapy in Geriatrics (journal)
• Gerontological nursing
• Geriatric Dentistry
• Activist Ageing{{colend}}

{{reflist|30em}}

{{refbegin}}

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{{refend}}

• [http://www.merck.com/mrkshared/mm_geriatrics/home.jsp Merck Manual of Geriatrics]
• [http://ec.europa.eu/health-eu/my_health/elderly/index_en.htm Health-EU Portal] – Care for the elderly in the EU
• [http://www.americangeriatrics.org American Geriatrics Society]

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Category:Ageing