Description of specialty

Geriatric medicine is concerned with all aspects of health and illness in older adults, across a range of care settings. It is the largest medical specialty. It involves intellectually stimulating work, frequent multidisciplinary collaboration, and the potential to make an enormous impact on the lives of older people. Geriatricians treat a wide variety of general medical conditions, but also possess the specialist skills that are needed to diagnose and manage conditions in patients with multiple comorbidities and in those living with frailty, a syndrome characterised by low physiological reserve. 

Older people may have different patterns of disease presentation compared to younger adults, and they respond to treatments and therapies in different ways. They frequently have complex social and care needs that are intricately related to their acute and chronic medical conditions. The ability to take a holistic, multidisciplinary view rather than focusing on a single problem or organ is a vital skill for geriatricians. This is recognised in the findings of the Royal College of Physicians’ Future Hospital Commission report, and subsequent workstreams. 

There is no defined age at which geriatric medicine starts to apply, but the people who gain most from specialist geriatrician input are those who have frailty syndrome, physical and mental complexity, and several comorbidities. Strict age-based services risk denying expertise to younger patients with complex needs who would gain from the care of a geriatrician. Patients commonly present with delirium, dementia, polypharmacy and falls due to declining mobility. Specialist input is needed to improve outcomes, for example reducing the risk of death or institutionalisation. Comprehensive geriatric assessment (CGA) involving a multi-domain assessment performed by a multidisciplinary team (MDT) will identify patient needs that can be addressed in an individualised plan. 

In addition to being experts in the ‘core business’ of the modern acute hospital, and having the largest group of consultants who work in community settings, geriatricians are playing an increasing role in the joint management of patients under the care of other specialty fields, for example in acute medicine, stroke, emergency medicine, trauma and orthopaedics, general surgery, end-of-life care, specialist old age psychiatry and oncology. 

There is growing interest and expansion in service models where geriatricians work at interfaces with primary and community care or work for most of their time in the community. In these service models, though they often maintain involvement in secondary care acute geriatrics or general medicine, geriatricians may undertake a variety of roles including support to intermediate care teams, locality multidisciplinary teams, community hospitals and care homes. These are described in more detail along with some examples of service models involving close GP/geriatrician collaboration in the 2016 joint BGS/RCGP paper on integrated services for older people with frailty.