what is geriatrics

What is geriatrics?

What is geriatrics?

Geriatrics is the branch of medicine dealing with care of the aged. Although some doctors specialize in this, all healthcare workers are finding that care of older people forms an increasing proportion of their caseload.

When are we old?

Ageing, or a natural progressive decline in body systems, starts in early adulthood. But it only becomes obvious several decades later and this is when we call ourselves old. One arbitrary way to define old age more precisely is to say that it begins at conventional retirement age (i.e. 60 or 65 years). But organ systems of individuals age at different rates and many old people live well into their 80s and beyond. So commonly accepted terms are: young olds (65-74 years), old olds (75-84 years) and oldest olds (85+).

"To me, old age is always fifteen years older than I am."
Bernard Baruch (1870-1965), US financier and presidential adviser.

The social and biological characteristics of these three groups are sufficiently distinct for them to be meaningful. Nonetheless, some people appear to be old well before 65 years and some old olds can appear younger than young olds. The point is that precise classification is an arbitrary generalization and that old people form a very heterogeneous group.

"Forty is the old age of youth; fifty is the youth of old age."
French proverb.

Population trends and survival curves

Survival curves indicate how close we are to achieving our full (i.e. maximum) life expectancy. The perfect rectangular survival curve would be reached if average life expectancy was the same as maximum life expectancy. Over the last century we have gradually been moving towards this. This is called the squaring or rectangularisation of survival.

Rectangularisation of survival curves in humans

It is not clear whether the gains in average life expectancy mean extra years of severe ill health, disability and dependency or whether the years of active life are increasing.

How big is the increase in years of active life?

The increases in average life expectancy mean that the population of older people has been growing at a rate of 2.8% per year world-wide.

A parallel trend has been a reduction in fecundity and fertility and so the overall population growth (all ages) has been less, only 1.6% per year. The consequence is an ageing society, with a proportionately high (and increasing) number of older people.

Population pyramids in different parts of the world

Population pyramid - Asia (1995 and 2025)

Population pyramid - Latin America (1995 and 2025)

Population pyramid - Europe (1995 and 2025)

In 1980 the developing countries accounted for over half of all old people; now the figure is approaching 2/3. This has occurred because the rate of increase in the elderly is higher in these countries. As a result, by the year 2030, most countries are expected to have a similar age structure

Health trends and societal impact

The main reasons for the ageing of society are socio-economic but better healthcare has improved survival for specific diseases. The existence of more old people and more survivors of serious diseases has meant an increase in the incidence of morbidity and non-life-threatening but disabling chronic diseases and conditions. Healthcare workers need to cope with increased pressure on health and social care resources.

As society ages, there may come a time when there are not enough young people to finance care of the old. However, the actual cost of older people depends partly on the society in which they live. For example, an old man who lives with his family in a small village in an undeveloped country is likely to cost less than a retired banker in a developed country, but also to be less healthy. A retired banker is likely to have accumulated sufficient wealth to provide for himself to at least some extent in old age.