Geriatric medicine--maturation or senescence?

Geriatric medicine is at a crossroads. Much time and effort have been given to develop training programs that aim at making physicians better able to care for the multiple and interacting problems affecting the elderly. It appears, however, that the best option at this time is to focus efforts and limited resources on undergraduate- and resident-level training. Fellowship training, given the limited number of well-qualified candidates and limited interest at this time, should largely be aimed at developing a cadre of leaders and role models who in turn will perhaps be more successful than we have been to date in fostering careers in geriatric medicine. Perhaps the increase in numbers of elderly persons will at last become a mandate for action. Presently, most physicians and health care planners recognize that demographic changes will occur, but the reality has not yet hit. In the next few decades, when there are more persons over the age of 85 than in the 65-to-85-year old group, the message may be clearer. Geriatric physicians may be able to teach by example, become administrative leaders, researchers, and makers of public policy for today and years to come. Although one might argue that geriatric medicine has gone through a difficult transition, to maturation and now, in many persons' opinion, has entered senescence, like the elderly patient of today, even in old age, there is grace, room for growth, and yes, even time to learn new tricks.