Geriatrics is the medical speciality particularly dealing with diseases in old age. In Norway, geriatrics is a "branch" of internal medicine. This implies that one has to specialize in general internal medicine before one can become a specialist in geriatric medicine. Geriatrics also have close connections with other specialities such as psychiatry, primary health care, neurology and rehabilitation. The Norwegian Geriatrics Society is a branch of The Norwegian Medical Association.
A geriatric patient is usually older than 70 years old. As a rule, he or she has one or more chronic diseases and often an acute disease as well, impairing his or her self-care performance and making acute hospital referral neceessary. Such patients need immediate diagnosis and treatment of their underlying medical disorders in order to prevent further functional deterioration. The risk of a permanent or long-lasting state of helplessness increases dramatically if appropriate diagnostic and therapeutic measures are delayed.
A geriatrician must have a holistic perspective. Geriatric patients do often suffer from several diseases and use many different medicines. The doctor has to consider the broad spectrum of health-related problems in order to give appropriate help. Narrowing the perspective to one single disease or one single organ is clearly inappropriate. The doctor must also work concurrently with the patient`s physical, psychological and social situation.
Geriatrics is collaborative and multiprofessional. No single profession can give high-quality help to older patients with complex health problems. One has to collaborate in a coordinated multidisciplinary team. Typical team members are doctors, nurses, physiotherapists and occupational therapists. Sometimes a speech therapist and a social worker is also available. Treatment and rehabilitation must go on concurrently. Within the health care system, treatment and rehabilitation are too often viewed as two separate entities. This is detriomental to geriatric patients. Old people with acute functional decline need immediate active rehabilitation while investigations and treatment are still going on.
A geriatrician needs extensive knowledge on normal and pathological ageing. Several diseases present differently in old patients than in the young and the middle-aged. It may be difficult to separate disease symptoms from bodily changes that have to be considered as normal in advanced age.
Quantitatively, dementia and stroke are among the most significant geriatric diseases. Other diseases often dealt with in geriatric medicine include heart diseases (particularly heart failure), chronic obstructive pulmonary disease, arthrosis, Parkinson`s disease, osteoporosis and diabetes mellitus.
No! Previously, geriatrics was a low-prestige speciality in Norway and the recruitment of doctors was poor. This has definitely improved during the later years but the number of geriatricians is still too low. The National Geriatric Programme was running in the period 1994-99, financed by the Norwegian Parliament and run by the Norwegian Board of Health. The aim of the programme was to improve the recruitment of geriatric personnel, to strengthen the multidisciplinary geriatric knowledge, and to establish models of cooperation between geriatric health care in hospitals and the community. An important purpose was to facilitate the establishment of geriatric service in all Norwegian counties. This goal is about to be achieved.
Yes, Norwegian geriatric research has improved remarkably both in terms of quality and quantity during the last ten years. Three out of four Norwegian universities all have professorships in geriatrics and a number of doctoral theses have been approved.
Geriatrics never becomes monotonous. One can work in emergency departments, in rehabilitation departments or in nursing homes. One cooperates closely with colleagues from other medical specialities as well as skillful and enthusiastic co-workers from other professions. There are several challenges and great demand are made on knowledge as well as skills and attitudes of the practitioner. Old people with complex health problems have received (and still receive) suboptimal care in the Norwegian health care system. Is is particularly meaningful to try to give better care to this patient group. The demographic changes going on in the Norwegian populations assures that the need for geriatricians will increase steadily in the coming years!
The Norwegian Centre for Resarch, Education and Service Development, Aging and Health has a comprehensive netsite, and a visit is highly recommended!
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