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Geriatric care in Europe – the EUGMS Survey part I: Belgium, Czech Republic, Denmark, Germany, Ireland, Spain, Switzerland, United Kingdom

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Abstract

Quality of geriatric care depends on institutional resources e.g. hospitals, medical departments engaged in acute medicine, rehabilitation and long term care but especially in quality and quantity of well educated and trained specialists, i.e. “geriatricians”. This survey initiated by the Academic Board of the European Union Geriatric Medicine Society (EUGMS) aimed to give an European overview by mapping the current situation in number and geographical distribution of geriatricians in relation to national demographic data. The discussion focuses on special national aspects including information about the national training tenure circumstances as well as political and historical influences on the geriatric care situation. The need for an European consensus concerning training curriculum is clearly stated, but also the need for fostering geriatric medicine with look on the demographic background, which is very similar in European countries. Last but not least: The survey can function as a benchmark, which every country may use in it's own medical and political environment.

Introduction

Geriatric medicine is the specialty concerned with health related problems in older people, including acute, chronic and rehabilitation problems, in the community, long-stay and hospital settings [1]. It is of proven efficacy in health promotion, health gain, health maintenance and palliative care for older people. Geriatric medicine is an independent medical specialty in the majority of European Countries, but not in all, although the number of older patients and the complexity of their medical conditions are growing fast [2]. Indemnification and quality of geriatric medical care clearly depends on number and local density of specialized clinical resources. Therefore clinical departments and wards but also qualified personal, especially well trained physicians are of central importance. In this context every serious prediction about an adequate medical care of our aging societies will depend on statistical data of number and allocation of medical doctors specialized in geriatric medicine.

Experts have called for extended access to specialist Geriatric care for older patients admitted to European hospitals to offer coordinated and integrated multidisciplinary care, adapted to the needs of each individual, their families and caregivers [3].

Unfortunately, there are little data on the number of geriatricians in different European. It was the aim of this survey within the European Union Geriatric Medical Societies (EUGMS) member countries to give an overview of number and density of geriatricians in relation to national demographic data.

The European continent is ageing and health services are dealing with an increasing number of older patients, often well beyond their 80s. This phenomenon, known as “geriatrisation of medicine” calls for specialist care provided by trained and certified geriatricians who have knowledge and skills necessary for providing quality care for these patients. During the last two decades US and European countries have recognized an increasing gap between steadily growing number of geriatric patients and the number of geriatricians. Shortage of geriatric specialists is a threat to good medical and nursing care for older patients in developed countries and unavailability of such care discriminates against the aged persons [4].

In Europe, recognition of geriatric specialty/subspecialty varies widely among individual EU member countries. Undergraduate and postgraduate training of medical students and young specialists differs, as well as the position of academic geriatrics, number of geriatric beds [2]. European professional organizations (UEMS: Union Européenne des Médicins Spécialistes: European Union of Medical Specialists, EUGMS, IAGG: International Association of Gerontology and Geriatrics) have called for action (Silver paper). However, reliable prediction of specialists needs in Europe must be based on demographic projections and good quality of data of current numbers of specialist in geriatric medicine in European countries, their availability, and regional distribution.

Therefore EUGMS decided to conduct a survey with the aim to map the current situation in numbers and geographical distribution of geriatricians in relation to national demographic data.

Section snippets

Material and methods

National geriatric societies were invited to participate in an European survey, to give information about absolute and relative numbers of physicians certified as specialists in geriatric medicine and – if available – about their geographic distribution. As postgraduate education of specialists in geriatric medicine differs in individual European countries [5], a geriatrician was defined as a physician who completed formal specialist education according to national educational policy and became

Results

Rates of certified geriatric specialists differed extremely for ranking of all ten participating countries see Table 1.

Four countries, Czech Republic, Denmark, Germany and Spain reported more detailed regional data. It was of high interest to see, that within one nation there are existing wide variation of geriatric specialists. Table 2, Table 3, Table 4, Table 5, Czech Republic [2], Denmark [3], Germany [4] and Spain [5], show the detailed data of regional distribution.

In Germany there was a

Belgium (BEL)

Belgium is a small country with a very high degree of urbanization, which accounts for the absence of large differences between its provinces. The specialty of Geriatrics was officially introduced in 1985 as a separate subspecialty of Internal Medicine. Only recently, in 2005, the specialty was recognized as a specific specialty comparing with other subspecialties such as cardiology, pneumology. This also changed the structure of the training of residents. From 1985 through 2005 training

Addendum

All members of the EUGMS academic board were involved in the conception and design of the study; KG acquired data; KG interpreted the data and drafted the article; KG did the statistical analysis; Authors ARK, CJA, OD, TE and MJP gave advices, inputs and drafts; all other authors revised the article for important intellectual content. All authors finally approved the manuscript to be published.

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

Acknowledgment

We thank Mrs. Petra Landwehr for her excellent technical assistance.

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1

Further Members of the EUGMS Academic Board: Chassagne P.(F), Vandewoude M., University Centre of Geriatrics, Antwerpen (B), Kenny R.A. (IR), Knight P., Royal Infirmary, Glasgow, (GB), Maggi St. (I), Masotti G. (I), Cherubini A. University of Perugia Medical School, Perugia, (I).

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