Geriatrics as a Specialty

**3**

**Chapter 1**

*Edward T. Zawada*

**1. Introduction**

Introductory Chapter: Geriatrics

Geriatrics has been identified as a subspecialty by virtue of a board certification since the mid-1980s by the American Board of Internal Medicine. The original core of knowledge was primarily the extension of the diagnoses and management of diseases of organ systems to the three age groups over the age of 60 years: youngold was 60–70, old was 70–80, and old-old was over 80 years of age. At that time I became interested in geriatrics by focusing on elders with renal and urology diseases [1]. At the beginning I researched the anatomic and physiologic changes of the kidney and urinary system, and then later each other major organ system of the body. My work in renal and urologic diseases led to editing my first book in the field [2]. As I delved into caring for the elderly, I became exposed to the knowledge of problems which are outside of the individual organ systems like "falls" or problems which affect every organ system like "geropharmacology." Over the decades since then, the role of the geriatrician who is the primary care provider for the elderly requires knowledge in a multitude of other specialties beyond internal medicine such as ophthalmology, ENT, audiology, neurology, orthopedics, and physiatry. I will present the earliest skills needed for the care of the elderly followed by the newest skills now incorporated into the subject matter of geriatrics. The chapters in

One of the first skills I learned when preparing for practice in geriatrics was that of geriatric assessment. I saw the amazing statistics of increased diagnostic accuracy, prevention of iatrogenic problems, and improved functional status which translated to better quality of life. We developed this tool for our practice [1] and spent the next 2 years unraveling difficult diagnostic and management problems for the patients in our clinic. Our multidisciplinary team included a nurse, physician, pharm. D., social worker, mental health expert, physical therapist, occupational therapist, dietician, and speech therapist. Our day consisted of intake by the nurse, exam by the physician, sequential evaluation by each of the other team members, and contact by the physician to the patient's referring physician. After a preliminary meeting of the team, the patient and family were invited to a brainstorming session in which the findings were reviewed and additional questions were invited. Then a second team meeting finalized our findings and recommendations which were again presented to the family and patient and transmitted to the referring physician. I realized that the complex problems of the elderly with their age-related lack of compensation ability, their multiple comorbid conditions, and the large number of socioeconomic issues that influenced the quality of life of these patients could

this book mostly represent a catalog of the newer skills.

**2. Previous geriatric skills**

**2.1 Geriatric assessment**
