Geriatric medicine and pharmacy practice: a historical perspective

Abstract

Modern geriatric medicine evolved in Britain between the 1930s and 1970s. In Australia, the first comprehensive geriatric service was described in the 1950s. However, it was not until the 1980s that geriatric medicine began to gain widespread acceptance as a medical specialty. There has been a slow but steady growth in geriatric services in most developed countries since that time, and more recently in developing nations. Various models of geriatric medical care have been developed, including geriatrician-led geriatric evaluation and management (GEM) services and shared-care services such as orthogeriatrics. The number of older people, often with multiple comorbidities and geriatric syndromes, seen in most areas of medical and surgical practice has risen significantly over recent decades, and as a result some of the principles of geriatric medicine, in particular ‘comprehensive geriatric assessment’, have been adopted outside of specialist geriatric services, including the primary care setting. Managing and preventing iatrogenic disease and polypharmacy became an important element of geriatric medicine as the range of therapeutic drugs grew and life expectancy and multi-morbidity increased. Geriatric pharmacy practice evolved in the mid-1970s in the USA, and the 1980s–1990s in other developed countries. It was recognised as a specialty with the introduction of the Certified Geriatric Pharmacist credential in 1997. This paper describes the evolution of the principles and practice of geriatric medicine and pharmacy practice.