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The Gray Revolution and Health
85+ 80-84 70-74 75-79 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4
U.S.:
6
5
4
3
U.S. :
1900
2
1
0
6
5
Percent of total population
We know that the population of the elderly will continue to grow for another generation or more, after which it will probably stabilize at 20%. And because health care needs rise in the later years, we also know that demands on the health care system by the aged will be greater than ever before. These problems are not insoluble, though, and one of the ways society could adapt to the changing population structure is through the teaching of geriatric medicine to all health care professionals. Geriatric medicine, in the broad sense, is medicine practiced in a"Yareness of the special health requirements of the elderly. It is medicine that neither writes off the elderly as being beyond treatment because of age, nor treats the old in the same way as the young and middle-aged. In this sense, geriatric medicine is not a narrow field; it is general medicine aware of the changes that come with age, with an understanding of how these changes 10
'The proportion of older people in our population rose from 4% in 1900 to 10% in 1977 and is expected to reach 17-20% by the year 2030.' are related to the earlier years. The need for this kind of knowledge and awareness is underscored by statistical measurements of the present and the future size of our elderly population. Changing Population Trends During the first three quarters of this century the population of Americans 65 years of age and older grew from 3 million to 23 million. That growth does not mean that the basic human life span has been extended, but that increasing numbers
4
3
1970
2
1
0
Percent of total population
of people are now able to survive longer. Average life expectancy is the key to the demographic revolution. A baby born in 1900 could expect to live 48.2 years. By 1975 the average life expectancy had extended to 68. 7 years for men and to 76.5 years for women. Of babies born in 1900, only 4% were expected to reach the age of 85, but by 1974, almost one o~ every four (23.3%) could expect to reach that advanced age. Especially significant is the fact that almost three of every four (73.8%) babies born in the mid1970s can expect to reach age 65. The proportion of older people in our population rose from 4% in 1900 to 10% in 1977 and is expected to reach 17-20% by the year 2030--little more than another generation. . In other words, we are projecting a population of 51 million people 65 and older in less than 50 years. In 1975, among those 65 years and older, 38% had reached the age of 75. In just over two more decades-
1
American Pharmacy Vol. NS20, No. 5, May 1980/250
-t------
U.S.:
Stationary -~....u..--.c Population
0-4
5
6
I
4
3
2
1
0
6
5
Percent of total population
by the year 2000--almost half (44%) of those 65 and over will have reached the age of 75. Among the elderly today and in the future, a significant proportion are and will be women because women tend to live about eight years longer than men. Add to that the fact that women who marry tend to marry men three years their elder, and you find that women can expect to spend an average of 11 years as widows. In 1974 the average life expectancy for white women was 76.6 years, compared to 68.9 years for men. Among blacks and other racial groups, women lived an average of 71.2 years, compared with 62.9 years for men. We cannot fully explain why women live longer than men. We know that more boys are born than girls, but more boys die from childhood accidents, and men tend to hold more high-risk jobs than women. The National Institute on Aging is investigating these and American Pharmacy Vol. NS20, No.5, May 1980/251
'Effective health care of the elderly must be based on understanding which changes are intrinsic to the aging process and which are not.'
other aspects of the differential life expectancy between the sexes. This is one reason why women were added in 1978 to the 22-year-old Baltimore Longitudinal Study of Aging conducted at the NIA' s Gerontology Research Center. The medical profession can take a large measure of credit for the rise in life expectancy-a victory over childhood diseases that once took a great toll. Another medical achievement and contributor to increased life expectancy has been a sharp reduction in maternal and infant
4
3
2
1
0
Percent of total population
mortality. In 1950 there were more than 83 maternal deaths for every 100,000 live births in the United States. In 1975 there were fewer than 13. During those 25 years the rate of infant mortality was almost halved-from more than 29 infant deaths per 1,000 live births to only 16. These accomplishments have important consequences for the entire society, and especially for medicine and the health care community. The rising cost of health care in general is of concern to everyone. The cost spiral is especially critical when it comes to the elderly, who are major users of the health care system, particularly as the costs associated with many illnesses are increasingly deferred from infancy and childhood to the later years. Taking just one year, 1977, for example, per capita health care costs for those 65 and older amounted to $1,745, compared with per capita costs of $514 for those under age 65. Although 95% of older people in
11
Centers and Institutes far Stuilies in Aging Alabama Jacksonville State University Research Institute for Longevity jacksonville, AL 36265
K.Jznsas Kansas State University Center for Aging Manhattan, KS 66506
University of Alabama Center for the Study of Aging University, AL 35486
Kentucky University of Kentucky Sanders-Brown Research Center of Aging Lexington, KY 40506
California San Diego State University Center on Aging San Diego, CA 92115 Ethel Percy Andrus' Gerontology Center University of Southern California Los Angeles, CA 94143
Connecticut University of Bridgeport Center for the Study of Aging Bridgeport, CT 06602 District of Columbia Federal City College Institute of Gerontology Washington, DC 20001
Florida University of Miami Institute for the Study of Aging Miami, FL 33124 University of Florida Center for Gerontological Studies, Programs Gainesville, FL 32611 Eckerd College Center for Studies on Aging St. Petersburg, FL 33733
Indiana Ball State University Institute of Gerontology Muncie, IN 47306
Maryland University of Maryland, College Park Center on Aging College Park, MD 20742
Portland State University Institute on Aging Portland, OR 97207
SUNY at Buffalo Multidisciplinary Center for the Study of Aging Buffalo, NY 14260
University of Oregon Oregon Center for Gerontology Eugene, OR 97403
Syracuse University All University Gerontology Center Syracuse, NY 13210
University of Maryland, Baltimore Task Force on Aging Baltimore, MD 21201
North Carolina Duke University Center for the Study of Aging and Human Development Durham, NC 27710
Massachusetts Boston University Gerontology Center Boston, MA 02215
Ohio Miami University Scripps Foundation Gerontology Center Oxford, OH 45056
Michigan University of Michigan Institute of Gerontology Ann Arbor, Ml 48109
University of Akron Institute for Lifespan Development & Gerontology Akron, OH 44325
Wayne State University Institute of Gerontology Detroit, Ml 48202
University of Toledo Center for Studies in Aging Toledo, OH 43606
Missouri University of Missouri Center for Aging Studies Columbia, MO 65201
Oklahoma East Central University Gerontological Institute Ada, OK 74280
St. Louis University Institute of Applied Gerontology St. Louis, MO 63103
Oregon Oregon State University Program on Gerontology Family Life Department Corvallis, OR 97331
New York Malloy College Institute on Gerontology Rockville Centre, NY 11570
the United States are capable of living on their own, most have some degree of physical dependency. About 80% have some chronic condition, but only 5% are confined to their homes, and only 1% are bedridden because of their condition. These, then, are the numerical outlines of the demographic revolution that saw the population of the United States shift toward a greater proportion of people aged 65 and older. The message is clear: American medicine must focus increased attention on the elderly, for practical as well as humanitarian reasons. The Role of Research Effective health care of the elderly must be based on understanding which changes are intrinsic to the aging process and which are not. The NIA conducts and supports a variety of research aimed at differentiating between normal aging and the diseases that may accompany old age. One example of NIA' s many research interests is the pharmacology 12
SUNY at Albany Institute of Gerontology Albany, NY 12222
of aging. Older Americans constitute 11% of the population, yet consume 25% of all prescription drugs. But older people react differently from the young to drugs, which-alone or in combination with other therapeutic agents-can cause unwanted, unexplained, and often unrecognized adverse reactions. Such reactions may include druginduced forgetfulness, weakness, confusion, tremor, anxiety, and other behaviors that are frequently mistaken for symptoms of brain disease. Barbiturates and antidepressants may cause sexual dysfunction in the elderly. Even cold remedies raise blood pressure levels, and belladonna alkaloids can complicate angle closure glaucoma. In addition, older people may have trouble following complicated administration schedules if they take multiple drugs or suffer from conditions that cause visual or other impairments. There are no simple solutions to the problems of drug use among the elderly. It is essential to con-
Pennsylvania Pennsylvania State University Gerontology Center University Park, PA 16802 Temple University Aging Research Center Philadelphia, PA 19140 Tennessee University of Tennessee/Nashville Center on Aging Nashville, TN 37203
Texas North Texas State University Center for Studies in Aging Denton, TX 76203 Tarleton State University Institute on Gerontology Stephenville, TX 76402
Utah Rocky Mountain Gerontology Center, Joint Program, University of Utah Brigham Young University, Provo, 84602 Southern Utah University, Cedar City, 84720 University of Utah, Salt Lake City, 84112 Utah State University, Logan, 84321 Weber State College, Ogden, 84403 Wisconsin University of Wisconsin Faye McBeath Institute on Aging, Adult Life Madison , WI 53707
duct more research on age-related changes in drug absorption, distribution, metabolism, and excretion, as well as drug-drug and drug-age interactions, in order to develop reliable prescription guidelines. This new knowledge must then be shared with federal regulatory agencies, the private sector, individual physicians, pharmacists, and consumers. Health Care of the Elderly It is estimated that 40% of physician office time and 33% of hospital time are now devoted to older patients. In 40 years, though, the elderly may account for as much as 75% of total health care services. Our entire society must wrestle with the social and economic impact of the population revolution. But the medical profession has a very special responsibility to be in the forefront of a movement to satisfy the health care needs of the elderly. First, it is essential to recognize that aging is a normal process of life, and old age is therefore a normal American Pharmacy Vol. NS20, No. 5, May 1980/252
Selected Gerontological Literature AKinK U.S. Departmen t of Heal th and Human
Gerontologist Journal of Geron tology
f ournal of Chronic 01St'Q5('S
Services Superin tende n t of Doc uments U.S. Government Printing Office Washington , DC 20402
Gerontologica l Society 1835 K St. NW Suite 305 Washington , DC 20006
Jo urnal s Departme n t Maxwell House, Fairview Park Elmsfo rd , NY !0523
International fournal of AKing and Human Development Baywood Publis hin g Co mpa n y 120 Ma rine St. Farmingdale, NY 11735
Journal of Geria tric Ps11chialrtJ
Inte rn atio na l Un ive rSities Press 315 Fifth Ave . New York, NY 10016
Journal of the American Geria trics Society American Geriat rics Society . 10 Co lumbus Circle New York , NY 100 19
Journal of Lonx Term Care Administratwn Ame rican Co ll ege of Nursi ng Ho me Administ rato rs 4650 East-West Hw y. Washi ngto n, DC 200 14
Minor~ty
Aging
Natio nal Council o n Black Aging, In c. Box 8522 Durham, NC 27707
Geria trics 4015 W 65th St. Mi nn eapolis, MN 55435
Modt>rn Ma turt llf Ame rica n AssU:Cia tio n of Retired Perso ns 215 L. Beach Bl vd . Lo ng Beach , CA 90802
Pergamon Press
PerspectH 't'S on Axinx
Na ti onal Cou ncil o n Aging 1828 L St. NW Wa s hin gton, DC 20036 50t."tal Securit11 Bullt'tm Socia l Securi.tv Administration Superinte nd e-n t of Docume n ts U.S. Govern ment Printing Office Washingto n , DC 20402
Geria trics Dixest 444 Frontage Rd . Northfield , ll 60093
part of the life cycle . True, there are special considerations in the diagnosis and treatment of the elderly, but these should be practiced within the context of understanding based on knowledge . An understanding of aging should be instilled in our health professional s from the beginning, during the years of medical education when knowledge is gathered and attitudes are formed . Unfortunately, medical education in the United States has neglected the elderly. Geriatric medicine is not taught in our schools in a systematic manner. Even worse, negative attitudes toward the elderly are often shaped or reinforced in the course of a medical education . These shortcomings are felt by practitioners. For example, in a 1976 survey by the American Medical Association, three of four practicing physicians said that physicians need special training in geriatrics. Such training is not widely available today. Schools generally do not require students to become familiar with nursing homes, even though 1.2 million people are in these institutions, including 1 million elderly. Congress recognized the problem when it decided to establish the National Institute on Aging as the eleventh of the National Institutes of Health . The Research on Aging Act of 1974 created the Institute after Congress found that " no American institution ... has undertaken comprehensive systematic and intensive studies of the biomedical and behavioral aspects of aging and the related training of necessary personnel. " The new knowledge obtained from our research can be American Pharmacy Vol. NS20, No. 5, May 19801253
applied to improve services and health care practices. However, if the benefits of research are to be felt , practitioners must be equipped to use the new information we provide . Fortunately for our future selves -for we all hope to join the ranks of the aged-there are signs of change . For example: • Universities and medical schools throughout the country are establishing departments, divisions, and programs oriented toward geriatric medicine and gerontology. A few schools of pharmacy now offer geriatric programs as well. • Findings of a study conducted by the Institute of Medicine of the National Academy of Sciences underscored the need for the inclusion of gerontology and geriatrics in the training of several types of health care providers. Several geriatric residency programs have been developed, foremost among them the programs led by Dr. Leslie Libow at the Mount Sinai City Hospital in New York and the Jewish Institute for Ge riatric Care on Long Island . Since no single professional can realistically provide the sick elderly with adequate care, Libow advocates the use of a multidisciplinary team of health providers and a multileveled system of care, including home, outpatient, acute hospital, convalescent unit, and long-term institutional care. Students themselves are becoming aware of the need and are pressing for education in the diagnosis and treatment of the health problems of the elderly . In September 1977 and February 1978, for example, the American Medical Student
Association conducted special conferences on geriatrics as part of its program to devote greater attention to the subject. These, and others, are encouraging developments . They indicate the beginning of a process of learning and understanding that one da y will lead to a health care system able to respond effectively to the challenges of the demographic revolution , and the provision of the humanitarian service that the elderly both need and deserve . The question is: How do we expose every health care provider to the basic information and procedures necessary to deal with older patients? The answer lies in incorporating geriatric medicine into the basic training of every medical student, resident, and practicing physician, as well as pharmacists, nurses, and other health professionals, so that old age is viewed as a natural part of the human life cycle, albeit one with distinctive medical aspects. If geriatrics is not introduced into school curricula, we lose the opportunity to interest future health care practitioners in geriatrics or aging research. While the NIA mandate does not allow us to provide services or train physicians to care for the elderly, we have established a Geriatric Medicine Academic Award, designed to encourage faculty development in research geriatric medicine . Better understanding of the aging process and the diseases that may accompan y old age-but are not an inevitable outcome of aging-will lead to improved services to the elderly and enhanced medical care, as well as lower health care costs . o 13
U.S.:
6
5
4
3
U.S. :
1900
2
1
0
6
5
Percent of total population
We know that the population of the elderly will continue to grow for another generation or more, after which it will probably stabilize at 20%. And because health care needs rise in the later years, we also know that demands on the health care system by the aged will be greater than ever before. These problems are not insoluble, though, and one of the ways society could adapt to the changing population structure is through the teaching of geriatric medicine to all health care professionals. Geriatric medicine, in the broad sense, is medicine practiced in a"Yareness of the special health requirements of the elderly. It is medicine that neither writes off the elderly as being beyond treatment because of age, nor treats the old in the same way as the young and middle-aged. In this sense, geriatric medicine is not a narrow field; it is general medicine aware of the changes that come with age, with an understanding of how these changes 10
'The proportion of older people in our population rose from 4% in 1900 to 10% in 1977 and is expected to reach 17-20% by the year 2030.' are related to the earlier years. The need for this kind of knowledge and awareness is underscored by statistical measurements of the present and the future size of our elderly population. Changing Population Trends During the first three quarters of this century the population of Americans 65 years of age and older grew from 3 million to 23 million. That growth does not mean that the basic human life span has been extended, but that increasing numbers
4
3
1970
2
1
0
Percent of total population
of people are now able to survive longer. Average life expectancy is the key to the demographic revolution. A baby born in 1900 could expect to live 48.2 years. By 1975 the average life expectancy had extended to 68. 7 years for men and to 76.5 years for women. Of babies born in 1900, only 4% were expected to reach the age of 85, but by 1974, almost one o~ every four (23.3%) could expect to reach that advanced age. Especially significant is the fact that almost three of every four (73.8%) babies born in the mid1970s can expect to reach age 65. The proportion of older people in our population rose from 4% in 1900 to 10% in 1977 and is expected to reach 17-20% by the year 2030--little more than another generation. . In other words, we are projecting a population of 51 million people 65 and older in less than 50 years. In 1975, among those 65 years and older, 38% had reached the age of 75. In just over two more decades-
1
American Pharmacy Vol. NS20, No. 5, May 1980/250
-t------
U.S.:
Stationary -~....u..--.c Population
0-4
5
6
I
4
3
2
1
0
6
5
Percent of total population
by the year 2000--almost half (44%) of those 65 and over will have reached the age of 75. Among the elderly today and in the future, a significant proportion are and will be women because women tend to live about eight years longer than men. Add to that the fact that women who marry tend to marry men three years their elder, and you find that women can expect to spend an average of 11 years as widows. In 1974 the average life expectancy for white women was 76.6 years, compared to 68.9 years for men. Among blacks and other racial groups, women lived an average of 71.2 years, compared with 62.9 years for men. We cannot fully explain why women live longer than men. We know that more boys are born than girls, but more boys die from childhood accidents, and men tend to hold more high-risk jobs than women. The National Institute on Aging is investigating these and American Pharmacy Vol. NS20, No.5, May 1980/251
'Effective health care of the elderly must be based on understanding which changes are intrinsic to the aging process and which are not.'
other aspects of the differential life expectancy between the sexes. This is one reason why women were added in 1978 to the 22-year-old Baltimore Longitudinal Study of Aging conducted at the NIA' s Gerontology Research Center. The medical profession can take a large measure of credit for the rise in life expectancy-a victory over childhood diseases that once took a great toll. Another medical achievement and contributor to increased life expectancy has been a sharp reduction in maternal and infant
4
3
2
1
0
Percent of total population
mortality. In 1950 there were more than 83 maternal deaths for every 100,000 live births in the United States. In 1975 there were fewer than 13. During those 25 years the rate of infant mortality was almost halved-from more than 29 infant deaths per 1,000 live births to only 16. These accomplishments have important consequences for the entire society, and especially for medicine and the health care community. The rising cost of health care in general is of concern to everyone. The cost spiral is especially critical when it comes to the elderly, who are major users of the health care system, particularly as the costs associated with many illnesses are increasingly deferred from infancy and childhood to the later years. Taking just one year, 1977, for example, per capita health care costs for those 65 and older amounted to $1,745, compared with per capita costs of $514 for those under age 65. Although 95% of older people in
11
Centers and Institutes far Stuilies in Aging Alabama Jacksonville State University Research Institute for Longevity jacksonville, AL 36265
K.Jznsas Kansas State University Center for Aging Manhattan, KS 66506
University of Alabama Center for the Study of Aging University, AL 35486
Kentucky University of Kentucky Sanders-Brown Research Center of Aging Lexington, KY 40506
California San Diego State University Center on Aging San Diego, CA 92115 Ethel Percy Andrus' Gerontology Center University of Southern California Los Angeles, CA 94143
Connecticut University of Bridgeport Center for the Study of Aging Bridgeport, CT 06602 District of Columbia Federal City College Institute of Gerontology Washington, DC 20001
Florida University of Miami Institute for the Study of Aging Miami, FL 33124 University of Florida Center for Gerontological Studies, Programs Gainesville, FL 32611 Eckerd College Center for Studies on Aging St. Petersburg, FL 33733
Indiana Ball State University Institute of Gerontology Muncie, IN 47306
Maryland University of Maryland, College Park Center on Aging College Park, MD 20742
Portland State University Institute on Aging Portland, OR 97207
SUNY at Buffalo Multidisciplinary Center for the Study of Aging Buffalo, NY 14260
University of Oregon Oregon Center for Gerontology Eugene, OR 97403
Syracuse University All University Gerontology Center Syracuse, NY 13210
University of Maryland, Baltimore Task Force on Aging Baltimore, MD 21201
North Carolina Duke University Center for the Study of Aging and Human Development Durham, NC 27710
Massachusetts Boston University Gerontology Center Boston, MA 02215
Ohio Miami University Scripps Foundation Gerontology Center Oxford, OH 45056
Michigan University of Michigan Institute of Gerontology Ann Arbor, Ml 48109
University of Akron Institute for Lifespan Development & Gerontology Akron, OH 44325
Wayne State University Institute of Gerontology Detroit, Ml 48202
University of Toledo Center for Studies in Aging Toledo, OH 43606
Missouri University of Missouri Center for Aging Studies Columbia, MO 65201
Oklahoma East Central University Gerontological Institute Ada, OK 74280
St. Louis University Institute of Applied Gerontology St. Louis, MO 63103
Oregon Oregon State University Program on Gerontology Family Life Department Corvallis, OR 97331
New York Malloy College Institute on Gerontology Rockville Centre, NY 11570
the United States are capable of living on their own, most have some degree of physical dependency. About 80% have some chronic condition, but only 5% are confined to their homes, and only 1% are bedridden because of their condition. These, then, are the numerical outlines of the demographic revolution that saw the population of the United States shift toward a greater proportion of people aged 65 and older. The message is clear: American medicine must focus increased attention on the elderly, for practical as well as humanitarian reasons. The Role of Research Effective health care of the elderly must be based on understanding which changes are intrinsic to the aging process and which are not. The NIA conducts and supports a variety of research aimed at differentiating between normal aging and the diseases that may accompany old age. One example of NIA' s many research interests is the pharmacology 12
SUNY at Albany Institute of Gerontology Albany, NY 12222
of aging. Older Americans constitute 11% of the population, yet consume 25% of all prescription drugs. But older people react differently from the young to drugs, which-alone or in combination with other therapeutic agents-can cause unwanted, unexplained, and often unrecognized adverse reactions. Such reactions may include druginduced forgetfulness, weakness, confusion, tremor, anxiety, and other behaviors that are frequently mistaken for symptoms of brain disease. Barbiturates and antidepressants may cause sexual dysfunction in the elderly. Even cold remedies raise blood pressure levels, and belladonna alkaloids can complicate angle closure glaucoma. In addition, older people may have trouble following complicated administration schedules if they take multiple drugs or suffer from conditions that cause visual or other impairments. There are no simple solutions to the problems of drug use among the elderly. It is essential to con-
Pennsylvania Pennsylvania State University Gerontology Center University Park, PA 16802 Temple University Aging Research Center Philadelphia, PA 19140 Tennessee University of Tennessee/Nashville Center on Aging Nashville, TN 37203
Texas North Texas State University Center for Studies in Aging Denton, TX 76203 Tarleton State University Institute on Gerontology Stephenville, TX 76402
Utah Rocky Mountain Gerontology Center, Joint Program, University of Utah Brigham Young University, Provo, 84602 Southern Utah University, Cedar City, 84720 University of Utah, Salt Lake City, 84112 Utah State University, Logan, 84321 Weber State College, Ogden, 84403 Wisconsin University of Wisconsin Faye McBeath Institute on Aging, Adult Life Madison , WI 53707
duct more research on age-related changes in drug absorption, distribution, metabolism, and excretion, as well as drug-drug and drug-age interactions, in order to develop reliable prescription guidelines. This new knowledge must then be shared with federal regulatory agencies, the private sector, individual physicians, pharmacists, and consumers. Health Care of the Elderly It is estimated that 40% of physician office time and 33% of hospital time are now devoted to older patients. In 40 years, though, the elderly may account for as much as 75% of total health care services. Our entire society must wrestle with the social and economic impact of the population revolution. But the medical profession has a very special responsibility to be in the forefront of a movement to satisfy the health care needs of the elderly. First, it is essential to recognize that aging is a normal process of life, and old age is therefore a normal American Pharmacy Vol. NS20, No. 5, May 1980/252
Selected Gerontological Literature AKinK U.S. Departmen t of Heal th and Human
Gerontologist Journal of Geron tology
f ournal of Chronic 01St'Q5('S
Services Superin tende n t of Doc uments U.S. Government Printing Office Washington , DC 20402
Gerontologica l Society 1835 K St. NW Suite 305 Washington , DC 20006
Jo urnal s Departme n t Maxwell House, Fairview Park Elmsfo rd , NY !0523
International fournal of AKing and Human Development Baywood Publis hin g Co mpa n y 120 Ma rine St. Farmingdale, NY 11735
Journal of Geria tric Ps11chialrtJ
Inte rn atio na l Un ive rSities Press 315 Fifth Ave . New York, NY 10016
Journal of the American Geria trics Society American Geriat rics Society . 10 Co lumbus Circle New York , NY 100 19
Journal of Lonx Term Care Administratwn Ame rican Co ll ege of Nursi ng Ho me Administ rato rs 4650 East-West Hw y. Washi ngto n, DC 200 14
Minor~ty
Aging
Natio nal Council o n Black Aging, In c. Box 8522 Durham, NC 27707
Geria trics 4015 W 65th St. Mi nn eapolis, MN 55435
Modt>rn Ma turt llf Ame rica n AssU:Cia tio n of Retired Perso ns 215 L. Beach Bl vd . Lo ng Beach , CA 90802
Pergamon Press
PerspectH 't'S on Axinx
Na ti onal Cou ncil o n Aging 1828 L St. NW Wa s hin gton, DC 20036 50t."tal Securit11 Bullt'tm Socia l Securi.tv Administration Superinte nd e-n t of Docume n ts U.S. Govern ment Printing Office Washingto n , DC 20402
Geria trics Dixest 444 Frontage Rd . Northfield , ll 60093
part of the life cycle . True, there are special considerations in the diagnosis and treatment of the elderly, but these should be practiced within the context of understanding based on knowledge . An understanding of aging should be instilled in our health professional s from the beginning, during the years of medical education when knowledge is gathered and attitudes are formed . Unfortunately, medical education in the United States has neglected the elderly. Geriatric medicine is not taught in our schools in a systematic manner. Even worse, negative attitudes toward the elderly are often shaped or reinforced in the course of a medical education . These shortcomings are felt by practitioners. For example, in a 1976 survey by the American Medical Association, three of four practicing physicians said that physicians need special training in geriatrics. Such training is not widely available today. Schools generally do not require students to become familiar with nursing homes, even though 1.2 million people are in these institutions, including 1 million elderly. Congress recognized the problem when it decided to establish the National Institute on Aging as the eleventh of the National Institutes of Health . The Research on Aging Act of 1974 created the Institute after Congress found that " no American institution ... has undertaken comprehensive systematic and intensive studies of the biomedical and behavioral aspects of aging and the related training of necessary personnel. " The new knowledge obtained from our research can be American Pharmacy Vol. NS20, No. 5, May 19801253
applied to improve services and health care practices. However, if the benefits of research are to be felt , practitioners must be equipped to use the new information we provide . Fortunately for our future selves -for we all hope to join the ranks of the aged-there are signs of change . For example: • Universities and medical schools throughout the country are establishing departments, divisions, and programs oriented toward geriatric medicine and gerontology. A few schools of pharmacy now offer geriatric programs as well. • Findings of a study conducted by the Institute of Medicine of the National Academy of Sciences underscored the need for the inclusion of gerontology and geriatrics in the training of several types of health care providers. Several geriatric residency programs have been developed, foremost among them the programs led by Dr. Leslie Libow at the Mount Sinai City Hospital in New York and the Jewish Institute for Ge riatric Care on Long Island . Since no single professional can realistically provide the sick elderly with adequate care, Libow advocates the use of a multidisciplinary team of health providers and a multileveled system of care, including home, outpatient, acute hospital, convalescent unit, and long-term institutional care. Students themselves are becoming aware of the need and are pressing for education in the diagnosis and treatment of the health problems of the elderly . In September 1977 and February 1978, for example, the American Medical Student
Association conducted special conferences on geriatrics as part of its program to devote greater attention to the subject. These, and others, are encouraging developments . They indicate the beginning of a process of learning and understanding that one da y will lead to a health care system able to respond effectively to the challenges of the demographic revolution , and the provision of the humanitarian service that the elderly both need and deserve . The question is: How do we expose every health care provider to the basic information and procedures necessary to deal with older patients? The answer lies in incorporating geriatric medicine into the basic training of every medical student, resident, and practicing physician, as well as pharmacists, nurses, and other health professionals, so that old age is viewed as a natural part of the human life cycle, albeit one with distinctive medical aspects. If geriatrics is not introduced into school curricula, we lose the opportunity to interest future health care practitioners in geriatrics or aging research. While the NIA mandate does not allow us to provide services or train physicians to care for the elderly, we have established a Geriatric Medicine Academic Award, designed to encourage faculty development in research geriatric medicine . Better understanding of the aging process and the diseases that may accompan y old age-but are not an inevitable outcome of aging-will lead to improved services to the elderly and enhanced medical care, as well as lower health care costs . o 13