Geriatric medicine and geriatricians in the UK. How they relate to acute and general internal medicine and what the future might hold?

Abstract

The Royal College of Physicians and its Future Hospitals Commission has a renewed focus on general internal medicine. But in 2015, most is in effect either acute medicine or geriatric medicine. Acute physicians and 'organ specialists' looking after inpatients on specialty wards or at the acute hospital 'front door' will need sufficient skills in geriatric medicine, rehabilitation, discharge planning and palliative care, as frailty, dementia and complex comorbidities may complicate the care of older patients with predominant speciality-defining complaints. In an era where we are urged to focus on patientcentred care, patients' preference for continuity and 'wholestay', consultants must be recognised and respected. Ideally, this will require increasing numbers of geriatricians and acute physicians, more age attuned training for all; a shift in values and status. This should be backed by adequate capacity and rapid access to social and intermediate care services outside hospital, as well as adequate multidisciplinary staff and skills within the acute hospital to ensure that older patients' needs beyond the immediate complaints are not neglected. Meanwhile, geriatric medicine itself has diversified into specialised, community and interface roles, aligned with the integration agenda, and continues to contribute substantially to acute, general and stroke medicine. These developments are described here.

Factors related to medical students’ and doctors’ attitudes towards older patients: a systematic review

“…The rapidly ageing population has been associated with a growth in the number of older people with frailty and complex comorbidities who present to healthcare services. To meet this challenge, all doctors need to possess the necessary knowledge, skills and behaviours to care for older patients [ 1 ]. Recent calls for action have highlighted the need to foster positive attitudes towards older patients and caring for them [ 2 ].…”

Endovascular Therapy or Alteplase in Patients with Comorbidities: Insights from UNMASK EVT

“…Whereas geriatricians and internists may not play a role in acute stroke decision-making in North American centers, they often serve as acute stroke physicians in countries like the United Kingdom; consequently, some stroke physicians in our study from such practice settings were geriatricians and internists. 19 No restrictions with respect to case volume or experience levels were applied, and participants had both academic and non-academic backgrounds.…”

General medicine in the future perfect

“…4 Similarly, incorporation of care for the elderly physicians, and in particular those with interest in the care of patients with frailty, should be an important next step in the evolution of the acute medical service. 5 First, the provision of a hot clinic referral service aimed at prevention of admission and consequent deconditioning is an obvious gain. Second, facilitation of an urgent supported discharge service coordinating multidisciplinary care with community services seems a key target, benefiting not just patients but overburdened admission services.…”