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Learning Objectives

  • Become familiar with similarities and differences in postgraduate (or post basic medical qualification) geriatrics training and clinical practice around the world.

  • Learn about age-related health care policy initiatives in different nations.

Key Clinical Points

  1. Since the backgrounds and training of geriatricians vary widely, so do skillsets and professional roles.

  2. In most countries, there are still not enough geriatricians to serve the special needs of vulnerable older people.


Throughout the world, the aged proportion of the population is increasing. The number of older persons has tripled over the past 50 years and will more than triple again over the next 50 years. In contrast with the slow process of population aging experienced by the more developed countries, population aging in most of the less developed countries is taking place in a much shorter time period and is occurring in a larger population. Such rapid growth will require far-reaching economic and social adjustments in most countries. Effective and efficient health care for the chronic health problems facing this growing population of older adults will be a daunting challenge for all countries.


Notwithstanding some heterogeneity, life expectancy is increasing across the globe. In most industrialized countries, this increase in life expectancy has mostly occurred over the past century. However, in the most recent decades, its pace has progressed at an unprecedented speed, reaching estimates far beyond those predicted by most international organizations such as the United Nations. The increase in life expectancy has resulted in an increased proportion of individuals reaching the eighth and ninth decades of life. Aged individuals are consistently found to be the fastest growing segment of the population, and the rate of growth is more rapid in developing compared to developed countries (Figure 13-1). As life expectancy increases, there has been a wide decline in fertility rates, resulting in a decreasing dependency ratio: a smaller number of working age adults for each aged person. This trend has great and challenging implications for national approaches to support services for older adults. Since wealth and resources vary greatly across countries, priorities for health and social services vary as well. Many developing countries previously focused on infectious diseases and maternal-child health, but as they too face rapidly aging populations, they are now confronting the same challenges to health care as have developed countries in recent decades.

FIGURE 13-1.

Growth over time in the aged population in developed and developing countries. All numbers are millions of people. (Reproduced with permission from US Census Bureau, Current Population Reports: 65+ in the United States.)


As age increases, there is a progressive, exponential increase in the occurrence of most chronic, degenerative, and progressive ...

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