What is geriatrics? The Swiss experience

For the Geriatric Institutions of Geneva, geriatrics is not just a convenient term for concealing large gaps in present medical knowledge, but a specialized branch of medicine specifically adapted to the urgent needs of the growing older adult population. These Institutions constitute a 276-bed hospital, an 80-bed extended-care facility, and a large consultation service for ambulatory patients. The staff comprises over 50 physicians and psychiatrists, multidisciplinary paramedical personnel, and a large complement of social workers. The three main goals are to: 1) address the complex medical needs of the older patient; 2) motivate the staff about the specific problems of the elderly and how to deal with them; and 3) promote awareness in the community of the complexity of problems associated with geriatric patients. The model of geriatric health-care delivery developed and practiced in Geneva is "Integrated Medicine." This is not simply a multidisciplinary approach to the multiple disorders of elderly patients, but also a particular philosophy of management with objectives specifically adapted to their unique pathophysiologic, psychiatric and social needs. The model is described as it pertains to preventive medicine, diagnosis, therapeutics, and prognosis. Integrated Medicine is not a panacea, yet it constitutes a step toward developing a health-care delivery system specifically adapted to the geriatric patient.