Reply to: The Future of Geriatrics
One of the issues undermining the future of Geriatrics that Dr. Morley mentioned in his editorial is the low number of geriatricians. Medical schools have the potential to change it. It has already been shown that short-term training in aging for early-stage medical students is able to change medical students’ attitudes toward aging (1). Medical school curricula should be pervaded by ageing knowledge and teaching since the first years, starting from biology and cell senescence, anatomy and anatomical change with ageing, and so on through the whole medical course until deprescribing and advanced directives planning. Medical students should be involved in preventative interventions for healthy ageing at population level, making themselves ambassadors of good lifestyles and copying strategies aimed at enhancing intrinsic capacity in young and middle age people and limiting losses in older persons. On the contrary, if ageing is faced up at the end of the medical school and seen only as a pathological and ending time of life, ageism of medical students will keep to be disconcerting (2).
Hopefully, in the near future, Geriatrics will contribute to design randomized clinical trials (RCTs) and will change the way evidence based medicine (EBM) is applied in clinical practice. RCTs can already take advantages of some of the basic concepts of Geriatrics such as inclusion and stratification of participants according to function and frailty, whereas, in the era of multimorbidity (3), EBM is already facing the difficulty of applying disease-specific guidelines to people affected by more than one disease at a time, similarly in older and young-adult patients.
Whereas advances in the care of older persons in nursing homes have been made worldwide, still there is an urgent need of upgrading acute hospital wards admitting older persons. Geriatric hospitals may be a myth, but patient-centered hospitals are not (4). Geriatrics could contribute to a clear guidance to health policy makers and managers on how to effectively implement new organizational models; geriatricians employed in the staff of each ward from the emergency room to the intensive care unit as well as frailty hospital units are not a blasphemy!
But among the views I have about the future of Geriatrics, one overcomes them all; Geriatrics will not be confined to geriatric age anymore. Many studies have revealed that aging begins in the uterus or even earlier and that, throughout our life-span, brick by brick, we build our age (5). Models on ageing are evolving beyond the last years of life and novel theories, such as the one of the microbiota during the first 1000 days of life and future health (6), are grabbing the attentions of many scientists not only in the field of Geriatrics.
If the increase in life-expectancy is the greatest goal ever reached by humanity, one of the greatest achievements of medicine will be preparing the society to ageing well and Geriatrics has the potential to do it in the future.