by a task force chaired by John Morley and Yves Rolland, to enhance care in nursing homes (Table 2).
Table 2 The IAGG Task Force recommends the following.
| No. | Recommendation |
|---|---|
| Recommendation 1 | Effective leadership structures are established, that where possible, include an expert physician (medical director), and an expert registered nurse (nursing director) and skilled administrator |
| Recommendation 2 | An international alliance is formed to develop nursing home leadership capacity and capabilities |
| Recommendation 3 | To showcase international exemplars of excellence in nursing home practice to raise awareness of the demonstrable benefits for older people and high standards achieved through expert practice |
| Recommendation 4 | To create positive working conditions for nursing home practitioners with attractive career development opportunities, recognition and similar rewards enjoyed by health care workers in comparable roles within the acute care services |
| Recommendation 5 | That nursing home quality indicators are developed that are sensitive to clinical and care needs and the right of older people to care that is dignified and respectful |
| Recommendation 6 | The use of physical and chemical restraints should be reduced to those that are absolutely indispensable |
| Recommendations 7 | That ‘meaningful activities’ be offered to residents to provide physical and mental exercise and opportunities to participate within the nursing home and in community life, enhancing personal autonomy, social relationships (including intergenerational relationships), and social support |
| Recommendation 8 | That evidence‐informed pain assessment and management programmes are introduced into all nursing homes |
| Recommendation 9 | That evidence‐informed end of life and palliative care programmes are introduced into all nursing homes |
| Recommendation 10 | National drug approval agencies consider requiring drug trials that are age appropriate and inclusive of nursing home residents before they are approved |
| Recommendation 11 | IAGG develop international certification courses for nursing (care) home health professionals |
| Recommendation 12 | Pilot the use of ‘Community of Practice Models’ as a practice improvement method for nursing homes, utilizing both face‐to‐face interdisciplinary training and virtual team support |
| Recommendation 13 | A universal ethical approach to obtaining informed consent and monitoring the appropriateness of research is developed |
| Recommendation 14 | Develop nursing home research capacity in developing nations |
| Recommendation 15 | An investment is made in research priorities that address major public health problems and inequalities that affect older people receiving long‐term care. Research priorities for which a high need is recognised include:A worldwide survey of different models of care, nursing home structure and issues in improving quality of care is undertakenA worldwide survey of older persons and their families is undertaken to determine their preferences for long‐term careA cross‐national, prospective epidemiological study measuring function and quality of life in nursing homesDevelopment of culturally appropriate standardised assessment instruments including those involving social participatory methodsA function‐focused approach to the prevalence of geriatric syndromes, their impact on function, and development of strategies to improve care for these syndromes needs to be developedResearch that evaluates the impact of different models of care against trajectories of physical and cognitive function |
Teaching geriatric medicine
The teaching of medical students about the medical care of sick elderly people had long been recommended, but it was not until 1949 that Lord Amulree was appointed to University College Hospital, a London teaching hospital. Further advance had to wait until 1965, when Sir Ferguson Anderson became the first UK Professor of Geriatric Medicine. After this, progress was slow; but by 1998, almost all the London teaching hospitals had a professorial chair in the specialty, and increasing numbers of chairs in geriatric medicine were made in the country as a whole. These academic departments were usually based on an active geriatric unit with good community links. The curricula vary but could include biological and sociological gerontology in addition to clinical geriatric medicine. Postgraduate research courses leading to the degrees of MSc and PhD had been set up. Some universities have a cluster of associated chairs, such as the University of Manchester with two chairs in geriatric medicine and one each in cognitive gerontology, old‐age psychiatry, gerontology, biological gerontology, and social gerontology.
However, research on attitudes of medical students toward older people has shown that they tend to lose their initial interest and empathy for older people as they train and qualify. A survey of their attitudes before qualification showed that they had empathy for, and a ‘bedside interest in’, the elderly, which disappeared after graduation when the doctors considered their career prospects.22 Parkhouse and McLaughlin23 found that no doctor who had graduated in 1974 wished to enter geriatric medicine. Lambert et al.24 showed that little had changed in a review of career preferences among newly qualified doctors: preferences for geriatric medicine remained very low at 0.9%, well below general medicine and surgery, although above genetics. Factors blamed included the prejudice of medical teachers against geriatric medicine, poor image/role of the geriatrician, and mediocre working conditions. As a result, recruitment of medical staff into the specialty was poor. The Royal College of Physicians responded in 1972 and 1977 with a range of recommendations, including integration of geriatric medicine with general medicine, appointment of consultant physicians with a special interest in geriatric medicine, and rotation of junior training posts between the two specialties.25,26 The College also introduced the Diploma of Geriatric Medicine in 1986 to encourage general practitioners to gain interest in the care of older people.
Achievements of geriatric medicine
Gerontology: the science of the ageing process
Interest in gerontology in the UK was stimulated by the support of charitable foundations and the enthusiasm of a few individuals. The Nuffield Foundation created a medical and biological Research Committee, which gave grants to Howell for his research, to Dr Alex Comfort to work with Sir Peter Medawar at Birmingham and later at University College London, and to Professor Sir Frederick Bartlett at the University of Cambridge to establish a research unit to investigate the psychological aspects of ageing. The Nuffield and Ciba Foundations supported Vladimir Korenchevsky (1880–1959), a Russian biologist who had studied under Pavlov and Metchnikoff. His enthusiasm for the science of ageing culminated in his becoming director of the Oxford Gerontological Institute. He was a driving force behind the creation of the International Association of Gerontology (IAG). The Ciba Foundation supported the IAG, which held its first meeting in 1950 in Liège, Belgium. The first meeting of the clinical section of the IAG was held in Sunderland in the UK in 1958 and was chaired by Dr Oscar Olbrich.
