Geriatric Medicine in an Aging Society: Up for a Challenge?

A progressive decrease in fertility, together with lengthening life expectancy, has driven a reshaping in the age distribution of the world population (1). The main consequence of this reshaping is a progressive increase in both the number and the relative proportion of older people in our society. Current fertility rates in virtually all developed countries are below replacement levels, reflecting the significant societal, cultural and lifestyle changes over the last century. A faster decline in fertility is occurring in developing countries. The latter is anticipated to reduce global geographical differences in fertility rates. The increase in life expectancy is related to a number of factors such as improved socioeconomic conditions and access to health services, early detection of disease conditions and improved short- and long-term outcomes after an illness. Mean global life expectancy has increased from 46.5 years in 1950-1955 to 66.0 years in 2000-2005. This increase has been more prominent in less developed countries although significant variation exists in these regions (2). Notably, the relative gain in life expectancy is also projected to increase at older age, i.e. by 27% at age 80, 19% at age 60 and only 9% at birth over the next 50 years. Therefore, specific subgroups within the older population, e.g. >80 years, are growing particularly fast. Geriatric Medicine, as a clinical and academic specialty in its own right, has significantly expanded over the last 20 years, particularly in the UK, a number of Western European countries, North America, Australia and New Zealand. A recent census in the UK showed that Geriatric Medicine consultants represent the largest specialty group within the National Health Service (n=1,252; 10.2% of the total workforce) (3). Moreover, the number of advanced trainees in Geriatric Medicine has increased from 433 in 2003 to 630 in 2013 (+45%). Professional national and international bodies, e.g. the British and American Geriatrics Societies and the European Union Geriatric Medicine Society, have played a significant role in promoting the importance of a focused geriatric assessment and a multidisciplinary patient-centered approach, key pillars of old age care. Moreover, they have been instrumental in developing and refining national curricula and postgraduate training competencies as well as continuing professional development opportunities. A considerable work to raise awareness and interest in Geriatric Medicine has also been conducted in medical schools. There is some evidence that targeted teaching and