Overview of Geriatric Medicine
The essence of geriatric medicine as a specialty is to assess and treat the medical and rehabilitative needs of older people. This is done through a process known as comprehensive geriatric assessment (CGA). There is a body of evidence which shows that the outcomes for older people with multiple pathologies and functional problems are better if they have their treatment overseen by an interdisciplinary team (see Box 1) led by a consultant specialist in geriatric medicine.
Thus, depending on the nature of the illness and the degree of disability, the core work of a geriatric medical service may take place in a number of different inpatient areas. These include emergency treatment of older people within the general hospital. This is frequently followed by an intensive period of rehabilitation after the acute illness, both in the general hospital and in less acute settings such as community hospitals, through the utilisation of the skills of the multidisciplinary team to improve or maintain physical function in the face of illness. For a small number of patients, with ongoing requirements for specialist review, there will be a need for continuing care.
Most geriatric services also have community services, including outpatients, community outreach teams, and day hospital facilities. These services aim to support older people in the community who require specialist medical supervision of their medical condition and at times improvement or maintenance of their physical function.
In addition, some units have structured services for orthogeriatrics, movement disorders, and stroke (of which the last two may be services for patients of any age). Whilst such specialised services are highly desirable, given current staffing levels they cannot be regarded as core services. In many parts of the country these services are absent or patchy.