As we prepare the eighth edition of this book, the trajectories of demography and geriatrics seem to be moving in opposite directions. Just as the baby boom is producing a bumper crop of older persons, geriatrics has encountered serious problems in recruiting participants from either medicine or nursing. If ever there was a time when health-care providers with expertise in the care of older adults were needed, it is now.
One thing seems clear, especially in light of the demographic forecasts: we cannot simply try harder to do what we have always done. Ingenuity will be essential. We need to take greater advantage of a variety of technologies to support care by persons less steeped in geriatrics. This book is one small step in that direction.
Since the first edition of this book in 1984, modern American geriatrics has struggled to define its role. The establishment of the National Institute on Aging was designed to make aging an academic discipline. From the outset several paths were proposed. Was geriatrics a specialty, a primary care discipline, or a largely academic enterprise that would “gerontologize” other practice disciplines? The promoted clinical realm of geriatrics publicly wavered between primary care and specialty care. There were other calls for recasting geriatrics as chronic disease care expertise. In 2005, the American Geriatrics Society (AGS) Task Force on the Future of Geriatric Medicine identified five goals for the field: ensuring high-quality care for older adults, expanding the geriatrics knowledge base, increasing the number of health-care professionals employing geriatrics principles, increasing the number of geriatricians and other geriatrics providers, and advocating for better public policy to serve older adults. In 2012 the editor in chief of the Journal of the American Geriatrics Society (JAGS) urged geriatrics to focus on care of the oldest old. Geriatrics, however, covers the entire aging continuum, caring for those who are healthy older adults as well as those who have multiple comorbidities as well as facilitating end-of-life care.
Geriatrics is a meta-discipline that transcends and informs all other disciplines. It is essentially the merger of gerontological principles and methods for effective chronic care. Geriatricians are the experts in complex chronic care, especially multimorbidity, offering key prototypes for the kind of care needed today. The field of geriatrics has developed useful tools and approaches for managing complex problems, beginning with geriatric assessment and management. More recently it has created a number of approaches to coordinating care for the most challenging patients—for example, those with multimorbidty, who use a disproportionate amount of resources.
While the context of health care for older adults is evolving, basic bedside care remains focused on patients and their caregivers. As its name describes, this book is intended to provide health professionals with essential clinical information to provide excellent care for older adults. The book was written with the health professional in mind. References, suggested readings, and selected websites should support the reader.
One thing has not changed. This is an authored, not edited, book. Our goal was to make it clinically useful and to speak with a single voice. We use figures and tables to summarize material whenever possible.
The eighth edition of this book reflects some changes in authorship. With the last edition we added a distinguished nurse practitioner to the authors. This edition marks the retirement of one of our founders, Itamar Abrass. His role has been ably filled by an accomplished geriatrician, Michael Malone, who serves as the Medical Director of Senior Services and Aurora at Home at Aurora Health Care in Wisconsin. He is a Clinical Adjunct Professor of Medicine at the University of Wisconsin School of Medicine and Public Health.
We are confident that this book will help all health-care professionals work across disciplines to provide the innovative, cost-effective and person-centered care that older people and their caregivers deserve.