The evolution of Geriatric The evolution of Geriatric Medicine in the UK: Are there any Medicine in the UK: Are there any lessons for Taiwan?lessons for Taiwan?12 12th th January 2008 January 2008Dr David Oliver Dr David Olivereadin! University and oyal "er#shire $os%ital eadin! University and oyal "er#shire $os%ital&ecretary' "ritish Geriatrics &ociety &ecretary' "ritish Geriatrics &ociety (utline(utline): ): $ow Geriatrics and "G& started in the UK$ow Geriatrics and "G& started in the UK )): )): *volution1+,- to 1+-- *volution1+,- to 1+--))): ))): Key develo%.ents fro. 1+--/200- Key develo%.ents fro. 1+--/200-)0: )0: The state of UK !eriatricsand the "G& 200- The state of UK !eriatricsand the "G& 200-0: 0: (1stacles 2threats to our future (1stacles 2threats to our future0): 0): 3hy we need !eriatrics and how to convince others?3hy we need !eriatrics and how to convince others? 0)): 0)): 3hy the UK doesn4t have all the answers 5 our3hy the UK doesn4t have all the answers 5 our servicesare far fro. %erfect6 servicesare far fro. %erfect60))): 0))): 7ossi1le lessons for Taiwan 7ossi1le lessons for Taiwan8ro. our successes in the UK 8ro. our successes in the UKAnd our .ista#es6 And our .ista#es6 ): $ow Geriatrics&tarted in ): $ow Geriatrics&tarted in the UKthe UKAnd the role of the "G& 9founded And the role of the "G& 9founded 1+,-:1+,-: )!nat; !eriatrics?Two ancient Gree# wordsTwo ancient Gree# wordsGerasGeras9(ld/A!e: 9(ld/A!e:>>IatricosIatricos? 9elatin! to the %hysician:? 9elatin! to the %hysician:>>There should be a searate secialit! to There should be a searate secialit! to deal "ith roble#s o$ se%ilit!deal "ith roble#s o$ se%ilit!??Althou!hconceived and na.ed inU&' Althou!hconceived and na.ed inU&' !eriatrics was first fully %racticed inUK@@!eriatrics was first fully %racticed inUK@@ "ritish Geriatrics &ociety "ritish Geriatrics &ociety Ao.%endiu. Ao.%endiu. """&b's&or'&u("""&b's&or'&u(>>that bra%ch o$ i%ter%al #edici%e "hich that bra%ch o$ i%ter%al #edici%e "hich deals "ith the re)e%tio%* dia'%osis a%d deals "ith the re)e%tio%* dia'%osis a%d treat#e%t o$ diseases seci$ic to old a'etreat#e%t o$ diseases seci$ic to old a'e?@?@ MarBory 3arren 5 >the .other of MarBory 3arren 5 >the .other of "ritish Geriatrics?"ritish Geriatrics? MarBory 3arrenMarBory 3arrenMedical director3est MiddleseC $os%ital Medical director3est MiddleseC $os%itales%onsi1le for -1, 1edes%onsi1le for -1, 1ed %oor law wor#houseinfir.ary %oor law wor#houseinfir.ary when it .er!ed with the hos%ital when it .er!ed with the hos%ital7atients descri1ed as > 7atients descri1ed as >I%co%ti%e%t* sei+ures* de#e%tia*I%co%ti%e%t* sei+ures* de#e%tia* bed ridde%* elderl! sic(* u%#o)ed #uscles bed ridde%* elderl! sic(* u%#o)ed #uscles? ? ,or roer care* the! re-uire the $ull $acilities o$ the,or roer care* the! re-uire the $ull $acilities o$ the 'e%eral hosital 'e%eral hosital Areated s%ecialised !eriatric assess.ent unit 5 the firstAreated s%ecialised !eriatric assess.ent unit 5 the first in the UK in the UK&yste.atically assessedne!lected' 1edridden %atients &yste.atically assessedne!lected' 1edridden %atientsDeter.inedca%acity to i.%rove Deter.inedca%acity to i.%rovee/.o1ilised .ost@ 2returned .any to own ho.es e/.o1ilised .ost@ 2returned .any to own ho.es7ioneer of dischar!e %lannin! 9a revolutionary idea66: 7ioneer of dischar!e %lannin! 9a revolutionary idea66:And Ao.%rehensive Geriatric Assess.ent And Ao.%rehensive Geriatric Assess.ent MarBory 3arrenMarBory 3arreneduced1eds fro. -1,to 2,0 and increased educed1eds fro. -1,to 2,0 and increased turnover E00F6turnover E00F6&%are 1eds then used for T"GAhest Medicine&%are 1eds then used for T"GAhest MedicineGifted advocate' innovator educator' .entor and Gifted advocate' innovator educator' .entor and teacherteacherAttracted interest fro. health .inister when Attracted interest fro. health .inister when dischar!e rate reached 2HF?6dischar!e rate reached 2HF?67u1lished 2- %a%ers in the 1+,0s and H0s on 7u1lished 2- %a%ers in the 1+,0s and H0s on reha1ilitation and assess.ent of frail older %eo%lereha1ilitation and assess.ent of frail older %eo%leMost fa.ouslyIMost fa.ouslyIWarren MW Warren MW@ Aare of chronic sic#@ A case for treatin! chronic sic# in@ Aare of chronic sic#@ A case for treatin! chronic sic# in 1loc#s in a !eneral hos%ital@1loc#s in a !eneral hos%ital@ ./0 ./0 1+,EJ 1+,EJii ii:8225E@ "MJ 1+,E:8225E@ "MJ 1+,E Warren MW. Warren MW. Aare of the chronic a!ed sic#@Aare of the chronic a!ed sic#@ 1a%cet1a%cet 1+,KJ 1+,KJi i:8,15E@ :8,15E@ @@ 3arren4s classification of the 3arren4s classification of the chronic a!ed sic# 1+,K Ahronic u%/%atients? 9that is' out of 1ed:@ Ahronic u%/%atients? 9that is' out of 1ed:@> >Ahronic continent 1edridden %atients@? Ahronic continent 1edridden %atients@?> >Ahronic incontinent %atients@? Ahronic incontinent %atients@?> >&enile' Luietly confused' 1ut not noisy or annoyin!&enile' Luietly confused' 1ut not noisy or annoyin! others@? others@?> >&enile de.ents?M?reLuirin! se!re!ation fro. other&enile de.ents?M?reLuirin! se!re!ation fro. other %atients@? %atients@? MD Thesis' The care of the elderly' MD Thesis' The care of the elderly' =@$@=is1et=@$@=is1etNN2r 3arre%4s routi%e "as care$ull! studied* the 2r 3arre%4s routi%e "as care$ull! studied* the #ethod o$ ad#issio%* e5a#i%atio%* dia'%osis a%d #ethod o$ ad#issio%* e5a#i%atio%* dia'%osis a%d treat#e%t* the retur% ho#e or tra%s$er to 6o#e or treat#e%t* the retur% ho#e or tra%s$er to 6o#e or hostel* the care$ul $ollo"-u* the close co%tact hostel* the care$ul $ollo"-u* the close co%tact #ai%tai%ed "ith the relati)es* the hel obtai%ed #ai%tai%ed "ith the relati)es* the hel obtai%ed $ro# al#o%er* h!siotheraists* 7Ts a%d $ro# al#o%er* h!siotheraists* 7Ts a%d chiroodist& chiroodist& The #eta#orhosis o$ a% utterl! The #eta#orhosis o$ a% utterl! hoeless helless atie%t i%to a% acti)e* e%er'etic hoeless helless atie%t i%to a% acti)e* e%er'etic a%d e)erlasti%'l! 'rate$ul o%e "as obser)ed a'ai% a%d e)erlasti%'l! 'rate$ul o%e "as obser)ed a'ai% a%d a'ai%&a%d a'ai%&44 3asn4t 3arren really 3asn4t 3arren really %ioneerin!I@@Ao.%rehensive %ioneerin!I@@Ao.%rehensive Geriatric Assess.ent?Geriatric Assess.ent? a #ulti-di#e%sio%al* i%terdiscili%ar!* dia'%ostic rocess toa #ulti-di#e%sio%al* i%terdiscili%ar!* dia'%ostic rocess to deter#i%e the #edical* s!cholo'ical a%d $u%ctio%aldeter#i%e the #edical* s!cholo'ical a%d $u%ctio%al caabilities o$ a $rail older erso% i% order to de)elo aco- caabilities o$ a $rail older erso% i% order to de)elo aco-ordi%ated a%d i%te'rated la% $or treat#e%t a%d lo%' ter#ordi%ated a%d i%te'rated la% $or treat#e%t a%d lo%' ter# $ollo" u $ollo" u?? Stuc( et al 1a%cet 1994 Stuc( et al 1a%cet 1994> >A%%lyin! AGA es%ecially to %atients with frailty' functionalA%%lyin! AGA es%ecially to %atients with frailty' functional i.%air.ent and .ulti%le lon! ter. conditions is what 1esti.%air.ent and .ulti%le lon! ter. conditions is what 1est defines what we do as !eriatricians? defines what we do as !eriatricians?8oc("ood 9 A'e A'ei%' :;;4 8oc("ood 9 A'e A'ei%' :;;4 &o.e other early %ioneersI&o.e other early %ioneersI = *Cton/&.ith 9the secialit! o$ Geriatric /edici%e$or the secialit! o$ Geriatric /edici%e$or#edical #a%a'e#e%t* rehabilitatio% a%d lo%' ter# care#edical #a%a'e#e%t* rehabilitatio% a%d lo%' ter# care o$ older eole o$ older eole@? @?UA$ 91st !eriatric unit infit for %ur%ose? or >a!e/%roof? "ut services still not >fit for %ur%ose? or >a!e/%roof?"reaches of Di!nityand dee%/seated ne!ative attitudes to older"reaches of Di!nityand dee%/seated ne!ative attitudes to older %eo%le still co..on %eo%le still co..onills' trainin! and #nowled!e lac#in! ills' trainin! and #nowled!e lac#in!General hos%ital care Bust as %ro1le.atic General hos%ital care Bust as %ro1le.atic0ery few %eo%le actually receivin! a%%ro%riate falls and (7 treat.ent 0ery few %eo%le actually receivin! a%%ro%riate falls and (7 treat.entMany %eo%le still not !ettin! to stro#e units Many %eo%le still not !ettin! to stro#e units&in!le assess.ent %rocess rarely i.%le.ented &in!le assess.ent %rocess rarely i.%le.ented > > A new a.1ition? 10 %ro!ra..es under A new a.1ition? 10 %ro!ra..es under E the.esE the.esDignity In Care Dignity In Care5Di!nity in care Di!nity in care5Di!nity at the end of life Di!nity at the end of life:oined 8p Care :oined 8p Care5&tro#e &ervices &tro#e &ervices58alls and "one $ealth 8alls and "one $ealth5Mental $ealth in (ld A!e Mental $ealth in (ld A!e5Ao.%leC =eeds Ao.%leC =eeds5Ur!ent Aare Ur!ent Aare5Aare ecords Aare ecords7ealthy -geing 7ealthy -geing5$ealthy A!ein! $ealthy A!ein!5)nde%endence' 3ell "ein! and Ahoice )nde%endence' 3ell "ein! and Ahoice More than an a.1ition?More than an a.1ition?=o dedicated .oney=o dedicated .oney=o >.ust do? tar!ets=o >.ust do? tar!etsMany co.%etin! %riorities in the >hierarchy?Many co.%etin! %riorities in the >hierarchy?

"oC/tic#in!? a%%roach rather than real chan!e? "oC/tic#in!? a%%roach rather than real chan!e? sell? itwor# hard to i.%rove the >i.a!e? of !eriatrics and >sell? it to %otential recruits and to collea!ues in other s%ecialities to %otential recruits and to collea!ues in other s%ecialitiesRou need to thin# a1out the .odel of service deliveryRou need to thin# a1out the .odel of service delivery 9needs' a!e' inte!rated etc: and how it fits with eCistin!9needs' a!e' inte!rated etc: and how it fits with eCistin! local servicesGfacilities local servicesGfacilities"e careful a1out 1ein! suc#ed into !eneral internal"e careful a1out 1ein! suc#ed into !eneral internal .edicine so .uch that you ne!lect the frail and the lon!/ .edicine so .uch that you ne!lect the frail and the lon!/ter. ter. %erverse?: .ay fi!ht a!ainst what you are tryin! to achieve 5 .ay fi!ht a!ainst what you are tryin! to achieve 5 you need to 1attlethisyou need to 1attlethis=o !ood havin! >olls oyce? services if only a =o !ood havin! >olls oyce? services if only a s.all %ercenta!e of %eo%le receive the.s.all %ercenta!e of %eo%le receive the.7revention and %ri.ary care .atter7revention and %ri.ary care .atter>>&ofter? !ains around attitudes and care are &ofter? !ains around attitudes and care are harder to achieve 1ut vital to the %atients4 harder to achieve 1ut vital to the %atients4 eC%erienceeC%erience )0:UK !eriatrics and the "G& )0:UK !eriatrics and the "G& in 200-in 200-3here are we now?3here are we now? "G&I9for full ran!e of our activities "G&I9for full ran!e of our activities %lease Boin or use www@1!s@or!@u#:%lease Boin or use www@1!s@or!@u#:Geriatric Medicine is now the second Geriatric Medicine is now the second 1i!!est 1i!!est hosital-based hosital-based s%eciality in the UKs%eciality in the UK"G& .e.1ershi% 200-"G& .e.1ershi% 200-2'H002'H00 H8+ trainees' H8+ trainees' 1'200 consultants1'200 consultants E10 overseas E10 overseas 1H0 allied %rofessionals1H0 allied %rofessionals oles of "G&oles of "G&"i/ennial scientific .eetin!s 9K00 dele!ates: "i/ennial scientific .eetin!s 9K00 dele!ates:A!e and A!ein! 9-00 su1.issions %er annu.: A!e and A!ein! 9-00 su1.issions %er annu.:&ections 9e@!@ falls21one' stro#e' continence' %rescri1in!: &ections 9e@!@ falls21one' stro#e' continence' %rescri1in!:*ducation and trainin! *ducation and trainin!Aontinuin! 7rofessional Develo%.ent Aontinuin! 7rofessional Develo%.entAcade.ic and esearch 9includin! !rants and fellowshi%s: Acade.ic and esearch 9includin! !rants and fellowshi%s:7olicy 5 %roduces co.%endiu. of !ood %ractice 7olicy 5 %roduces co.%endiu. of !ood %ractice=ational Audits =ational AuditsAdviceGin%utto !overn.ent and .edical colle!es6 AdviceGin%utto !overn.ent and .edical colle!es6Aa.%ai!nin!' influencin! and hi!hli!htin! issues Aa.%ai!nin!' influencin! and hi!hli!htin! issueswww@1!s@or!@u# www@1!s@or!@u# $ow healthy is !eriatrics in the UK now?$ow healthy is !eriatrics in the UK now?&tren!th in nu.1ers?&tren!th in nu.1ers?Growin! evidence/1ase for what we doGrowin! evidence/1ase for what we doA!ein! %o%ulationA!ein! %o%ulation8railty' lon! ter. conditions are crucial8railty' lon! ter. conditions are crucial(ther%hysicians don4t all want co.%leC' frail(ther%hysicians don4t all want co.%leC' frailolder %atientsolder %atientsAurrent G7 %erfor.ance fra.ewor# does not Aurrent G7 %erfor.ance fra.ewor# does not incentivise the. to loo# after these %atientsincentivise the. to loo# after these %atientsGettin! care of older %eo%le ri!ht will surely hel% Gettin! care of older %eo%le ri!ht will surely hel% every %art of the syste.every %art of the syste.&o the future loo#s !ood surely?&o the future loo#s !ood surely? =ot so si.%leI@=ot so si.%leI@ 0: The o1stacles in our way0: The o1stacles in our wayThreats' challen!es or Threats' challen!es or o%%ortunities?o%%ortunities? Threat 1:&yste.s refor.Threat 1:&yste.s refor. D$ want old %eo%le out of hos%ital and in >co..unity? D$ want old %eo%le out of hos%ital and in >co..unity?9"ut to what alternative services?: 9"ut to what alternative services?:"ut UK !eriatricshas 1eco.e lar!ely hos%ital/1ased"ut UK !eriatricshas 1eco.e lar!ely hos%ital/1ased &o now we .ust%ersuade %ri.ary care or!anisations to&o now we .ust%ersuade %ri.ary care or!anisations to 1uy our services or ta#e over the runnin! of so.e1uy our services or ta#e over the runnin! of so.e >inter.ediate care? >inter.ediate care?Manyaren4t interested 5 des%ite the evidence/1ase forManyaren4t interested 5 des%ite the evidence/1ase for AGA etc AGA etcThere is little in the G7%erfor.ance fra.ewor# a1outThere is little in the G7%erfor.ance fra.ewor# a1out !eriatrics !eriatrics"uta %erce%tion fro. so.e G7s that !eriatrics is >easy?"uta %erce%tion fro. so.e G7s that !eriatrics is >easy? and its >what G7s do anyway? @)t doesn4t need s%ecialistand its >what G7s do anyway? @)t doesn4t need s%ecialist trainin! or a se%arate s%eciality trainin! or a se%arate s%eciality Threats 2: 8undin! and incentivesThreats 2: 8undin! and incentives &ervice fra.ewor#s around older %eo%le not funded&ervice fra.ewor#s around older %eo%le not fundedMain %erfor.ance tar!ets for hos%itals do notfocus Main %erfor.ance tar!ets for hos%itals do notfocus on acuteGsu1acute frail co.%leC older %atientson acuteGsu1acute frail co.%leC older %atientsMore aroundwaitin! lists and waitin! ti.esMore aroundwaitin! lists and waitin! ti.es7ay.ent syste.s .ean that hos%itals .a#e .oney 7ay.ent syste.s .ean that hos%itals .a#e .oney fro. elective sur!ery and lose .oney fro. acute fro. elective sur!ery and lose .oney fro. acute unscheduled careunscheduled care&o older %eo%le in 1edsare !enerally a >%ro1le.? &o older %eo%le in 1edsare !enerally a >%ro1le.? for the syste. rather than 1ein! seen as the .ain for the syste. rather than 1ein! seen as the .ain custo.ers6custo.ers6 %hreats 9+;egative attit#des and %hreats 9+;egative attit#des and ignoranceignorance =e!ative societal and .edia attitudes to older %eo%le =e!ative societal and .edia attitudes to older %eo%leMost students' doctors and nurses still say they don4t want toMost students' doctors and nurses still say they don4t want to wor# with old %eo%le 9thou!h thatwor# with old %eo%le 9thou!h that "ill "ill 1e their Bo16: 1e their Bo16:=e!ative attitudes to doctorsGnurseswho wor# with older %eo%le=e!ative attitudes to doctorsGnurseswho wor# with older %eo%le Medical values still favour >hi!h/tech? treat.ent' curative'Medical values still favour >hi!h/tech? treat.ent' curative' individualistic and 1asic science overI individualistic and 1asic science overII Ilow tech' lon! ter. incura1le conditions' health serviceslow tech' lon! ter. incura1le conditions' health services research and .ultidisci%linarity research and .ultidisci%linarity3or#in! with de.entia' incontinence' falls or frailty isn4t >seCy? 3or#in! with de.entia' incontinence' falls or frailty isn4t >seCy?aco%ia? or >1ed 1loc#in!? as havin! >social ad.issions? or >aco%ia? or >1ed 1loc#in!?(lder %eo%le the.selves often do not wish to 1e on s%ecialist(lder %eo%le the.selves often do not wish to 1e on s%ecialist wards for older %eo%le and .ay not see the.selves as old@ wards for older %eo%le and .ay not see the.selves as old@Many %rofessionals still don4t see the need for a se%arateMany %rofessionals still don4t see the need for a se%arate s%eciality s%eciality o!er Do1son o!er Do1sonDoctors ran4 myocardial in.arction as most ust ha)e a chie$ co#lai%tA%d the 7ld Droc( does%4t >ust ha)e a chie$ co#lai%tIthe 7ld Droc( has $i$tee% chie$ co#lai%ts& 6o" i% Ithe 7ld Droc( has $i$tee% chie$ co#lai%ts& 6o" i% the "orld are !ou 'oi%' to coe "ith all o$ the#F the "orld are !ou 'oi%' to coe "ith all o$ the#F Hou4re o)er"hel#ed& .esides* he4s had a %u#ber o$ Hou4re o)er"hel#ed& .esides* he4s had a %u#ber o$ these thi%'s $or $i$t! !ears or so& Hou4re %ot 'oi%' to these thi%'s $or $i$t! !ears or so& Hou4re %ot 'oi%' to cure so#ethi%' he4s had $or $i$t! !ears& 6e has hi'h cure so#ethi%' he4s had $or $i$t! !ears& 6e has hi'h blood ressure& 6e has diabetes& 6e has arthritis& blood ressure& 6e has diabetes& 6e has arthritis& There4s %othi%' 'la#orous about ta(i%' care o$ a%! o$ There4s %othi%' 'la#orous about ta(i%' care o$ a%! o$ those thi%'sthose thi%'s@?@@@@?@@@ Threat ,: *ducation' Trainin! and Threat ,: *ducation' Trainin! and Acade.iaAcade.ia"G& survey su!!ested that in H0F of .edical schools'"G& survey su!!ested that in H0F of .edical schools' little or no !eriatrics 1ein! tau!ht little or no !eriatrics 1ein! tau!ht8undin! structure and %erfor.ance fra.ewor# for research8undin! structure and %erfor.ance fra.ewor# for research .a#es it hard for acade.ic de%art.ents of !eriatrics to.a#es it hard for acade.ic de%art.ents of !eriatrics to survive survive&everal %rofessorial units closed or %rofessors not&everal %rofessorial units closed or %rofessors not re%laced re%laced3hich wea#ens %osition within .edical schools 3hich wea#ens %osition within .edical schools&till insufficient !eriatric .edicine content in %ost!raduate&till insufficient !eriatric .edicine content in %ost!raduate curriculae curriculaeAnd =&8 &tandard for > And =&8 &tandard for >all health ro$essio%als to recei)eall health ro$essio%als to recei)e aroriate trai%i%' a%d ha)e aroriate s(ills aroriate trai%i%' a%d ha)e aroriate s(ills? has not? has not ha%%ened ha%%ened 0): Aonvincin! collea!ues' 0): Aonvincin! collea!ues' co..issioners 9and older co..issioners 9and older %eo%le: that we %eo%le: that we are are neededneeded The 1est ar!u.ents The 1est ar!u.ents 9and the ones to 9and the ones to use in Taiwan 5 in answer to Dere# Ahan4s use in Taiwan 5 in answer to Dere# Ahan4s Puestion:Puestion:(lder %eo%le are the(lder %eo%le are the main c#stomers main c#stomers of health and socialof health and social care careDemographic change Demographic change .eans this will continue .eans this will continue&o older %atients with frailty' .ulti%le lon!/ter. conditions&o older %atients with frailty' .ulti%le lon!/ter. conditions and disa1ility' needin! AGA.ultidisci%linary in%ut willand disa1ility' needin! AGA.ultidisci%linary in%ut will continue to 1econtinue to 1e central to health care central to health care 9not .ar!inal: 9not .ar!inal:There is %lenty ofThere is %lenty of evidence .or interventions evidence .or interventions)f we a%%ly the.')f we a%%ly the.' both patients and the whole systemboth patients and the whole system willbene.it willbene.it so winGwin 9Luality' access' ca%acity' cost: so winGwin 9Luality' access' ca%acity' cost:These .i!ht 1e the ri!ht ar!u.entsThese .i!ht 1e the ri!ht ar!u.ents "UT "UTIwe have to 1eIwe have to 1e more o#tspo4en and #nreasonable more o#tspo4en and #nreasonable in .a#in! this case in .a#in! this case Gawande 9 a neurosur!eon:@ Gawande 9 a neurosur!eon:@ >The >The way we a!e now?@ way we a!e now?@ >There is' however' a s#ill to it' a develo%ed 1ody of %rofessionalThere is' however' a s#ill to it' a develo%ed 1ody of %rofessional eC%ertise@? eC%ertise@?>> Until ) visited .y hos%ital4s !eriatrics clinic and saw the wor# thatUntil ) visited .y hos%ital4s !eriatrics clinic and saw the wor# that !eriatricians do' ) did not fully !ras% the nature of that eC%ertise? !eriatricians do' ) did not fully !ras% the nature of that eC%ertise?> >The Bo1 of any doctorI@ is to su%%ort Luality of life' 1y which he .eantThe Bo1 of any doctorI@ is to su%%ort Luality of life' 1y which he .eant two thin!s: as .uch freedo. fro. the rava!es of disease as %ossi1le'two thin!s: as .uch freedo. fro. the rava!es of disease as %ossi1le' and the retention of enou!h function for active en!a!e.ent? and the retention of enou!h function for active en!a!e.ent? Most doctors treat disease' and fi!ure that the rest will ta#e care ofMost doctors treat disease' and fi!ure that the rest will ta#e care of itself@ And if it doesn4tMif a %atient is 1eco.in! infir. and headin!itself@ And if it doesn4tMif a %atient is 1eco.in! infir. and headin! toward a nursin! ho.eMwell' that isn4t really a .edical %ro1le.' is it?? toward a nursin! ho.eMwell' that isn4t really a .edical %ro1le.' is it??> >To a !eriatrician' thou!h' it is a .edical %ro1le.@ 7eo%le can4t sto% theTo a !eriatrician' thou!h' it is a .edical %ro1le.@ 7eo%le can4t sto% the a!in! of their 1odies and .inds' 1ut there are ways to .a#e it .orea!in! of their 1odies and .inds' 1ut there are ways to .a#e it .ore .ana!ea1le' and to avert at least so.e of the worst effects@@@@? .ana!ea1le' and to avert at least so.e of the worst effects@@@@? Ar!u.ent 1:Ar!u.ent 1: D*M(GA7$)A&: D*M(GA7$)A&: 1+01: 1+01: H-'000 TKH yearsH-'000 TKH years2001: 8@1 Million2001: 8@1 Million 3o#rce+ D Wanless 6eport =))( Ar!u.ent 2:Ar!u.ent 2: real/life? eCa.%les fro. &t Tho.as4 hos%italhos%ital $arari D et al$arari D et al %he older personsH assessment and liaison%he older personsH assessment and liaison team IO1-LJ+ eval#ation o. comprehensive geriatricteam IO1-LJ+ eval#ation o. comprehensive geriatric assessment in ac#te medical inpatients assessment in ac#te medical inpatients)ge )geing )ge )geing :#ly =))* :#ly =))*3etting+ 3etting+ ur1an teachin! hos%ital@ur1an teachin! hos%ital@ 3#b"ects+ 3#b"ects+ acute .edical in%atients a!ed -0U years@acute .edical in%atients a!ed -0U years@ Intervention+ Intervention+ .ultidisci%linary AGA screenin! of all acute.ultidisci%linary AGA screenin! of all acute .edical ad.issions a!ed -0U years leadin! to 9a: ra%id transfer.edical ad.issions a!ed -0U years leadin! to 9a: ra%id transfer to !eriatric wards or 91: case/.ana!e.ent on !eneral .edicalto !eriatric wards or 91: case/.ana!e.ent on !eneral .edical wards 1y (lder 7ersons Assess.ent and