Introduction to the geriatrics-for-specialists initiative: geriatrics specialty care at the tipping point.

It is a special pleasure for me to be invited to speak to you tonight. You represent seven crucial specialties of surgery and three closely related medical specialties. I represent the medical specialty of geriatrics, I have also been heavily involved in the Geriatrics-for-Specialists Initiative (GSI) project since 1995, and I have an additional very personal qualification for being hereFI am in many ways a classical geriatrics patient. I am not yet disabled or frail, but I carry six major chronic diagnoses in four key organ systems; my functional capacity, mental and physical, is definitely declining, fortunately very slowly. But everything takes longer to do. I take 10 medications daily. And, as a geriatrician, I am well aware of what lies ahead. So I have a personal stake in the basic mission of the GSI to enhance the well-being of older patients who suffer from diseases and conditions requiring treatment by specialists. Should I require surgery or other specialty care in the future, I want my surgeon to ‘‘be familiar with the unique requirements of the geriatric surgical patient.’’ Here I am quoting verbatim from the booklet of information provided by the American Board of Surgery (ABS) to all potential applicants for certification. Incidentally, this sentence was added in 2000 in an extremely welcome response to a letter sent to the ABS by the GSI. Why was the GSI project essential? The answer is very simple. Around 1975, it became clear to all that the population of elders in the USA and elsewhere would have a growth spurt in the decades from 1980 to 2010 and growth would become explosive from 2010 to 2030 when the babyboom generation will be passing age 65 en masse. Parenthetically, the growth spurt has far exceeded predictions because of a startling increase in human longevity in recent decades. This is dramatically illustrated in the current decade when the number of people dying at a given age is actually falling, an unprecedented phenomenon. Driven by the demographic imperative, a renaissance of the field of geriatrics began in the late 1970s, but it was limited to the specialties of internal medicine, family practice, neurology, psychiatry and, to a certain extent, emergency medicine, anesthesiology, and physical medicine and rehabiliation (Physiatry). This renaissance led to a remarkable expansion in our knowledge of the physiology and pathology of aging and the diagnosis and treatment of geriatric patients, and this knowledge has resulted in striking improvements in their medical care.