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Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
I hate making predictions, especially about the future. Yogi Berra
IN the Journals of Gerontology's Future History series, Robert Kane tackles the issue of Geriatrics at the Crossroads (1). As Dr. Kane examines the vital signs, the diagnosis is grim. The subject's history is difficult to read and the symptoms are dramatic. The subject is in extremis.
The facts of the case are not in dispute. Despite modest successes, there are fewer persons attracted to the field of geriatrics as judged by examination candidates. Efforts to gerontologize the medical curriculum have had marginal success. The profession appears to be schizophrenic about its role in healthcare.
Alarmingly, the therapeutic recommendations are elusive. Dr. Kane carefully outlines the options and concludes that the best course of action is surgical—a move toward redefining a smaller niche in chronic care expertise.
A team of national and international consultants is drawn to the bedside (2–9). The responses to the perceived illness of geriatric medicine by these consultants highlight the controversy. Several argue that the subject is not sick. Rather than being at a crossroads, geriatrics is early in the journey and making good progress. To their view, Dr. Kane's prediction of the subject's demise is greatly exaggerated.
One argues that rather than drastic surgery on the scope of geriatric practice, the best hope is for a generalistic approach and Darwinian patience. Success will come, states another, if we keep doing what we already do well. On the contrary, several argue for more dramatic measures to greatly enlarge the practice niche, for example, to encompass an entire geriatric hospital system. Another argues that the prognosis is bright because of advances in models of care just on the horizon, such an antiaging, health promotion, and rehabilitation.
As always, the consultants bring differing perspectives to the sickbed. As always, the result of these discussions is that we learn and gain new perspectives. The arguments range from watchful waiting to intensive therapy, just as in patient care. Those of us who are intensely interested, but in the role of family, must weigh each of these thoughtful and provocative insights. The solutions are not clear, but at least the options have been carefully reviewed. Now, on to the plan of care.
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| All GSA journals | The Gerontologist |
| Journals of Gerontology Series B: Psychological Sciences and Social Sciences | |
