[The challenge of geriatric medicine in the twenty-first century].
During the last generation the population in Israel has doubled and the number of hospital beds per capita has declined to the lowest number in the OECD. This has implications on the number of physicians and nurses, as well as the nation's capacity to educate medical staff, while there are no increases in the infrastructure. Shortening the length of stay for acute medical conditions to an average of about three to four days is the main consequence of this situation. About 800,000 elderly people over 65 years of age are now living in Israel. Many of them suffer from acute conditions with complicating chronic morbidities. Currently, they are the main victims of the present crisis in medical services in Israel. Aging is accompanied by a decline in the physiological reserves leading to increased morbidity, decreases in function and a prolonged period for returning to normal function after trauma or acute disease. During the twentieth century, the science of medicine progressed rapidly. The pathogenesis of many conditions, either chronic or acute, was recognized, as well as the structure of the human genome and many pharmaceutical, as well as other technologies, were developed for the cure and care of diseases. Nevertheless, understanding the aging process remains a challenge. Geriatric medicine is a medical specialty that deals with a process--the process of aging, which is like pediatrics, and unlike other specialties that concentrate on systems (cardiovascular, gastroenterology, blood, immune system etc.). The added value of the geriatrician in medical practice is in the knowledge of the scientific background of aging, as well as the practical implications concerning physical and cognitive decline of function with aging and its accompanying morbidity. The practice of Geriatric Medicine is the art of connecting the biological and medical sciences to the function and the environment of the individual aging person. It requires dedicating a lot of time and patience on the part of the physician, to retrieve the information, to build confidence in the relationship with the patient and to lead the patient to continue living with an optimal quality of life in his remaining years. During the last decades, the number of geriatricians in Israel has doubled, obligatory clerkship in Geriatric Medicine is part of the medical schools' curriculum and Geriatric Medicine is part of the board curriculum in Internal Medicine and Family Medicine. Thus, Geriatric Medicine maintains the art of medical practice, using the recent knowledge in biology and medical sciences, and dealing with the population with the highest level of morbidity and lowest function. The Geriatric Medicine approach to the old person who needs medical help has to lead medical practice in the near future, so that we can preserve the great achievements of medicine during the twentieth century.
Yitshal N
YN
Berner
D000368:Aged; D000375:Aging / Q000502:physiology*; D002982:Clinical Clerkship / Q000379:methods; D003479:Curriculum; D004501:Education, Medical / Q000379:methods*; D005853:Geriatrics / Q000193:education / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel; D007902:Length of Stay; D011788:Quality of Life; D013038:Specialization