Reflections in Internal Medicine
The geriatric management of frailty as paradigm of “The end of the disease era”

https://doi.org/10.1016/j.ejim.2016.03.005Get rights and content

Highlights

  • New models of care are needed for addressing the complex needs of frail elders.

  • Geriatric concepts (as frailty) are growingly adopted by other medical specialties.

  • Integrated care centered on the geriatrician is needed for managing frail elders.

  • Geriatricians must enforce respect for their role, background, and capacities.

  • Underestimating the geriatrician's role in an aging world is clearly paradoxical.

Abstract

The sustainability of healthcare systems worldwide is threatened by the absolute and relative increase in the number of older persons. The traditional models of care (largely based on a disease-centered approach) are inadequate for a clinical world dominated by older individuals with multiple (chronic) comorbidities and mutually interacting syndromes. There is the need to shift the center of the medical intervention from the disease to the biological age of the individual. Thus, multiple medical specialties have started looking with some interest at concepts of geriatric medicine in order to better face the increased complexity (due to age-related conditions) of their average patient. In this scenario, special interest has been given to frailty, a condition characterized by the reduction of the individual's homeostatic reserves and increased vulnerability to stressors. Frailty may indeed represent the fulcrum to lever for reshaping the healthcare systems in order to make them more responsive to new clinical needs. However, the dissemination of the frailty concept across medical specialties requires a parallel and careful consideration around the currently undervalued role of geriatricians in our daily practice.

Section snippets

Inadequacy of traditional healthcare models

The absolute and relative number of older persons is increasing worldwide [1]. This phenomenon implies the urgent need to revise the structures and the methodologies of current healthcare systems, which were originally designed for younger patients with single acute diseases. The traditional paradigm of stand-alone disease medicine has become out-of-date in a clinical world dominated by older individuals characterized by multi-morbidity and mutually interacting syndromes.

Already in 2004,

Geriatric practice in different medical specialties

Nowadays, the assessment and treatment of age-related conditions is no longer a unique challenge for geriatricians. A wide spectrum of medical specialties is facing the consequences of global aging in the routine clinical practice. The older age of their patients has forced many specialties at reconsidering their traditional models of care because unable to satisfy the emerging clinical needs. In this context, the success of care models involving the geriatrician in the co-management of older

The underestimated value of the geriatrician

In spite of the recent achievements of geriatric medicine, it is evident that its major concepts are too often misinterpreted and misused outside of its field [21]. In the literature, there is a worrying tendency to consider the geriatrician a specialist in scales and questionnaires. The assessment instruments are repeatedly confused with/considered equivalent to the practice of the geriatric specialty. There is the alarming idea that the comprehensive geriatric assessment may exist independent

Frailty as paradigmatic target of geriatric care

As mentioned, frailty may represent the fulcrum on which reshaping our healthcare systems as repeatedly requested by public health agencies. At the same time, it might become the tombstone for our specialty if geriatricians will not enforce respect for their background and capacities.

Although every one of us agrees on the theoretical definition of frailty [13], more than 40 different instruments have been developed and validated over the past years to determine the frailty status [28]. The most

Conclusions

We believe there is an increasing risk of a geriatric medicine done by non-geriatricians. Unfortunately, it is not true that simply seeing older patients means being experts in geriatric practice. Probably, such an ambiguity is closely related to the lack of a formal geriatric training in many countries. Despite the global aging phenomenon, medicine for older persons is too often delegated to specialists lent to geriatrics. Sometimes, this choice is forced by the absence of geriatricians, who

Learning points

  • The sustainability of healthcare systems is threatened by the absolute and relative increase in the number of older persons

  • The traditional paradigm of stand-alone disease medicine has become out-of-date in a clinical world dominated by older individuals presenting multiple chronic comorbidities and mutually interacting syndromes

  • Several medical specialties have started looking with interest at some geriatric concepts (and frailty is a paradigmatic example) in order to better face the increased

Conflict of interest

All authors are geriatricians. The authors state that they have no conflicts of interest.

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