Older Adults - Geriatrics

Geriatrics is the medical subspecialty concerned with the prevention and treatment of diseases in the elderly. In 1909 Dr. Ignatz L. Nascher coined the term geriatrics from the Greek "geras" (old age) and "iatrikos" (physician). Geriatricians are physicians trained in internal medicine or family practice who obtain additional training and certification in the diagnosis and treatment of older adults. Geriatricians rely on the findings of researchers and gerontologists (non-physician professionals who conduct scientific studies of aging and older adults) to help older adults "maintain the highest possible degree of function and independence and avoid unnecessary and costly institutionalization."

Gerontology was unheard of before the nineteenth century, when most people died at an early age. Those who reached old age accepted their deteriorating health

TABLE 10.9 Sex ratio for population 25 years and over by age, 2000 and 2030 Adapted from Kevin Kinsella and Victoria A. Velkoff, "Table 6. Sex Ratio for Population 25 Years and Over by Age: 2000 and 2030," in An Aging World: 2001, series P95/01-1, U.S. Census Bureau, November 2001, http://www.census.gov/prod/2001pubs/p95-01-1.pdf (accessed December 12, 2005)

TABLE 10.9
Sex ratio for population 25 years and over by age, 2000 and 2030
[Men per 100 women]
Country	2000						2030
	25 to 54 years	55 to 64 years	65 to 69 years	70 to 74 years	75 to 79 years	80 years and over	25 to 54 years	55 to 64 years	65 to 69 years	70 to 74 years	75 to 79 years	80 years and over
SOURCE: Adapted from Kevin Kinsella and Victoria A. Velkoff, "Table 6. Sex Ratio for Population 25 Years and Over by Age: 2000 and 2030," in An Aging World: 2001, series P95/01-1, U.S. Census Bureau, November 2001, http://www.census.gov/prod/2001pubs/p95-01-1.pdf (accessed December 12, 2005)
United States	98	91	85	79	72	52	98	92	89	86	81	64

as a part of aging. In the early twentieth century gerontology was born when scientists began to investigate the pathological changes that accompany the aging process.

While many developed countries have recognized the need for more geriatrics education, the United States continues to lag in offering geriatrics courses in its medical schools. As of 2003 only 30% of the ninety-one non-pediatric accredited medical specialties offered in U.S. medical schools had specific geriatrics training requirements. Among those with specific requirements, curriculum expectations were considered modest by the Association of Directors of Geriatric
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Academic Programs' (ADGAP) team at the University of Cincinnati School of Medicine's Institute for Health Policy and Health Services Research (Elizabeth J. Bragg and Gregg A. Warshaw, "ACGME Requirements for Geriatrics Medicine Curricula in Medical Specialties: Progress Made and Progress Needed," Academic Medicine, vol. 80, no. 3, March 2005).

Decline in Numbers of Geriatricians in the United States

The Alliance for Aging Research has reported that a tremendous shortage of physicians specializing in geriatrics exists, including those in the field of psychiatry known as geropsychiatrists. The Institute for Health Policy and Health Services Research at the University of Cincinnati and ADGAP estimated that there were only 6,776 active certified geriatricians practicing in the United States in 2004.

In its May 2003 Training and Practice Update, the ADGAP notes that Medicare, the primary payer for most clinical services provided by geriatricians, reduced the average reimbursement to physicians by 5.4% in 2002. ADGAP suggested that "the growing gap between Medicare reimbursement and the actual costs of delivering medical care may affect the willingness of physicians to continue focusing their careers in geriatric medicine and geriatric psychiatry." The Geriatric Care Act was introduced in 2003, which would help improve payment for geriatricians. As of mid-2006, the bill had not been passed.