Geriatric medicine in the medical curriculum: A MUST in the globally aging world

@#Geriatrics is a branch of medicine concerned with diagnosing, treating, and preventing diseases in older people and problems specific to aging. The World Health Organization (WHO) has reported that the number of people aged 65 or older is projected to grow from an estimated 524 million in 2010 to nearly 1.5 billion in 2050. The burden of diseases in the aging population will dramatically impact healthcare expenses in low- and middle-income countries and even developed ones. A preventive approach is essential. The role of medical institutions and inclusion of geriatrics in the medical curriculum have become important. However, incorporating geriatrics into the medical curriculum is associated with various issues and challenges: compact preexisting curriculum, attitudes of teachers and students, and shortage of teaching geriatricians. An individualized institutional approach to curricular integration guided by the American Geriatrics Society’s minimum required competencies for the undergraduate will circumvent these challenges.

Stop Discussing New Medical Specialty Boards

The Korean society is rapidly aging and the health care needs for aged people are increasing. In this context, some physicians claim to establish new medical specialty board (MSB) for geriatric medical experts but also MSB for primary medical care specialists, clinical pharmacologists, and public health experts. In Korea, basic concept for the specialty board system is still under debates and the legal support for the system is poor. At present, doctors with MSBs in private sectors supply 92.4% of primary medical care but the National Health Care System requires more primary care physicians than specialists in Korea. Therefore, the government must invest in the education of doctors more to improve the public health care system. The proposal of the new MSB for geriatric medicine must be gradually developed according to the national long-term health plan, social needs, and national budget for the public benefit. Please stop discussing unprepared new MSBs.

Perspectives and Challenges for Geriatric Medicine / 대한내과학회지

Korean society is aging rapidly. Overall, 13.1% of the Korean population was elderly (age ≥ 65 years) in 2015, and this rate is expected to reach 40.1% in 2060. To prepare for this change, the Korean government has developed a long-term care insurance service and supports regional medical centers for the aged. It has established laws about life-sustaining treatment and directives to improve end-of-life care. Although the long-term care insurance currently provides ‘ in-home service’ and ‘ aged care facilities,’ it does not cover rehabilitation hospitals, which can prevent elderly individuals from accessing certain medical services. With the changing demographics, medical care requires change. Conventional medical care must be upgraded to provide suitable care for an aged society. It is important to support the activities of daily living, rather than simply prolonging life. This will require providing homeand community-oriented medical care to improve quality of life. It will also be necessary to train more geriatricians who understand the characteristics of elderly patients, provide comprehensive geriatric assessments, and lead other physicians in team-based medicine. Internists are already engaging in multidisciplinary collaboration and end-of-life care, which are critical qualities of leading geriatricians. Further discussion and consensus is needed regarding the training of geriatric medicine specialists in Korea.

El envejecimiento en Costa Rica: una perspectiva actual y futura / The ageing process in Costa Rica: a current and future perspective

El artículo es descriptivo sobre el envejecimiento en su definición, alcances demográficos, organizativos, red de cuido y perspectivas de la realidad actual y futura en la que está inmersa Costa Rica, como un fenómeno poblacional explosivo, dadas sus altas esperanzas de vida, especialmente en el grupo poblacional de 80 y más. Se analiza el estado actual de la Red de Atención Integral a la Persona Adulta Mayor dentro de la Seguridad Social, así como acciones por realizar de parte de las diferentes instancias públicas y privadas, tomando muy en cuenta su integralidad. Finalmente, se reflexiona sobre las necesidades inminentes que planteará una población envejecida, y las estrategias para enfrentarlas adecuadamente.

This article describes the ageing process, as well as its definition, demographic data and organization; the elderly care network and the current and future perspectives of its reality in Costa Rica. This is part of a population phenomenon characterized by high life-expectancy of the population group 80 years and older. The article makes an analysis of the Integral Care Network for the Elderly (Red de Atención Integral a la Persona Adulta Mayor), sponsored by the social security system; and suggests actions that must be carried out by other relevant public and private institutions, also taking into account the integrality among them. Finally, the article presents some thoughts about the imminent needs of an increasingly ageing population and suggestions on how to deal with it.

A Comparative Study of Health Checkup Results between Early and Late Elderly / General Medicine

<b>OBJECTIVE</b>: The present study assessed the validity of the benchmark, 75 years old, that divides elderly people into an early and a late stage, based on health checkup results for two consecutive years. We also investigated prevalent health problems and improvement trends.<br><b>METHODS</b>: This retrospective study was conducted on 1,416 subjects (1,007 early and 409 late elderly subjects) who received health checkups at the Health Care Center of the St. Marianna University School of Medicine Hospital between April 2006 and March 2007. The survey consisted of blood pressure, required blood test results, diagnoses according to the criteria defined by Kawasaki city, outcomes, and the presence or absence of a primary care doctor.<br><b>RESULTS</b>: The number of subjects with anemia and/or renal dysfunction was significantly greater in the late elderly than the early elderly (p<0.01). The results of the survey demonstrated that 79.6% of the early elderly and 87.4% of the late elderly had primary care doctors (p<0.01). In the early elderly, 57.0% of the subjects with primary care doctors and 43.2% of those without primary care doctors showed improvement; the subjects with primary care doctors showed significant improvement compared to those without primary care doctors (p<0.05). In the late elderly, 50.2% of the subjects with primary care doctors and 54.2% of those without primary care doctors showed improvement, resulting in no significant difference between the subjects with and without primary care doctors.<br><b>CONCLUSIONS</b>: We found differences in the detected health problems and outcomes between the early and late elderly. These results support the appropriateness of the current age segmentation and future prospects for medical care in detecting and managing health problems in the elderly.

Algunas estrategias de prevención para mantener la autonomía y funcionalidad del adulto mayor / Autonomy and functional status in the elderly: some prevention strategies

La meta de la geriatría es mantener la autonomía y funcionalidad de los adultos mayores a pesar del cúmulo de daño adquirido con anterioridad. En este artículo, se enfatiza la necesidad de un programa de vacunación que incluya las vacunas antineumococica, anti herpes zoster, tétano y difteria. La pesquisa del cáncer cérvico uterino, de mama y colo rectal. Un IMC entre 25 kg/m2 y 30 kg/m2 en mayores de 75 años produce la menor mortalidad cardio vascular y general. Los factores más importantes en la ocurrencia de caídas son: disminución de la fuerza muscular, dificultad en la marcha y uso de medicamentos. Se enfatiza la necesidad de evaluar la conducción segura de automóviles. Analizamos, los efectos deletéreos del déficit de vitamina D, presente en la mayoría de los adultos mayores, en el riesgo de caer, sistema inmune, mortalidad general y enfermedades neurodegenerativas

The goal of geriatric medicine is to maintain autonomy and functionality in elderly people, in spite of damage accumulated earlier in life. In this review we emphasize the importance of vaccination programs for elderly people, including vaccines such as anti pneumococcal, anti herpes zoster, tetanus y diphtheria and also, the need of programs of early diagnosis of cervical cancer, breast cancer and colorectal cancer. Research shows that a Body Mass Index between >25 kg/m2 and 30 kg/m2 in persons over 75 years of age, reduces cardiovascular deaths and deaths in general. Research also demonstrates that diminishing of muscular strength, difficulty to walk, plus the use of medications are the most important factors to be taken into account in preventing falls. It is very important to periodically evaluate safe car driving. Vitamin D deficit increases incidence of falls, immune system alterations, neurodegenerative illness and mortality

Geriatrics Education and Training Experience in the United States

Over the last several decades great strides have been made in the United States to meet the needs of an aging American population. This paper reviews the development of geriatric medicine in the United States, which is cha- racterized by leadership and investment from both the public and private sector. The establishment of the National Institute of Aging, as well as, Centers of Excellence and initiatives from the Veterans Administration supported the development and growth of geriatric medicine training programs. While significant advances have been made, we continue to be faced with the challenge of an aging population and not enough geriatricians to care for them. Current strategies will need to intensify geriatric training at the medical student level and teach all physicians, regardless of specialty, how to take care of older patients.

The Plan Suggestion for the Efficient Future Medical Care of Old Patients in the Community

In the future, geriatric care needs much more financial cost because korea is changing to an aging society rapidly and most of old people have health problems. It is important to have a comprehensive blueprint of the medical care of old patients, linking this with a welfare of old people. The government has to bring up and draw guidelines how to handle old patients and how much to treat them, before starting a national nursing insurance for old handicapped patients. Without a blueprint of old people care, we are in danger to encounter a huge financial leakage due to inefficient care system for old patients. Presently, old patient medical care are being randomly performed according to doctor's decision on a individual base. The multi-organ injury chronic diseased case tend to be rejected by doctors and will be referred to the higher level of medical center. Since old wealthy patient with a good economic and physical condition is a good target of making a money, this kind of old people will be welcomed and many lucrative cares will be applied under the name of anti-aging therapy. This consumptive environment must be changed to an efficient and economic system. The key content of a desirable system is a self-community of old-age people, which the lesser sick help the more sick and the lesser old patients help the more elderlies. The all around plan-building by the government is absolutely needed to provide a efficient medical treatment system for old patients with organizing the elderly as well as improving the regulations. Now, the government is ready to implement a national nursing insurance to solve the problems of the aging society. However, without a well prepared master plan for the future matters, we will meet other obstacles which could see in a tardy growing society.