Geriatric Medical Care Research Articles

How Do We Achieve Person-Centered Care across Health Care Settings? Expanding Ideological Perspectives into Practice to Advance Person-Centered Care

Person or patient-centered care (PCC) is touted as the gold standard in geriatric medical care across care settings. However, despite more than 3 decades of research and practice initiatives, it remains a challenge to consistently implement PCC that fully places the individual at the center of care planning and the delivery process. The lack of universal implementation of PCC, we argue, may be in large part due to the use of multiple terms and ideologies leading to an inability to coordinate efforts across medical settings. This article reviews recent ideological PCC movements (“What Matters to You,” the Age Friendly Health Systems 4 Ms/5 Ms, “Whole Health,” Patient Priorities Care, and Medicare/Medicaid person-centered care initiatives), provides a discussion of how these ideologies are implemented in a nursing home setting through preference-based care and provides implications for coordinated integration of PCC across all care settings now and into the future. We argue for the need to draw on known information and validated methodologies for assessing and implementing PCC to collectively move beyond an ideological representation of the concept into an integrated model of PCC for all older adults receiving care.

Medical care priorities of community-dwelling older adults according to three dimensions of quality of life: Quality of daily living, satisfaction and happiness from birth to death, and human vitality.

Although the maintenance and improvement of quality of life (QoL) through holistic care are important in geriatric medical care, care priorities might differ depending on three essential aspects of QoL: the quality of daily living, satisfaction and happiness from birth to death, and human vitality, which are "Seikatsu," "Jinsei," "Seimei" in Japanese, respectively. We aimed to clarify these priorities in terms of medical care and examined how the definitions of QoL affected these priorities' rankings. This cross-sectional study involved community-dwelling older adults aged ≥65 years living in Kashiwa City, Chiba Prefecture, Japan. The number of participants was 1550 (mean age, 76.1 ± 5.8 years; 699 women [45.1%]). A self-administered questionnaire distributed in advance was used to rank 12 items sought in medical care. Participants were randomly assigned to one of three groups and sent the corresponding questionnaire, which differed only in the definition of QoL. The top priorities for medical care were "effective treatment of illness," "improvement of physical function," and "maintaining a high level of activity." When QoL was defined as "the quality of daily living, satisfaction and happiness from birth to death, and human vitality," participants were significantly more likely to rank QoL improvement as one of the top three items (adjusted odds ratio, 1.46; 95% confidence interval, 1.03-2.05). As a medical care priority, older adults desire improvement of multidimensional elements of life, including human vitality. Health care providers should consider this when making medical care decisions. Geriatr Gerontol Int 2024; 24: 493-498.

Effect of Comprehensive Rehabilitation Training Based on Balance Function on Postoperative Recovery and Function of Hip Fracture in the Elderly: A Systematic Review and Meta-Analysis.

In China, the proportion of the elderly population is gradually increasing, followed by the increasing medical demands of elderly patients. Hip fracture is a common fracture in the elderly. The elderly are prone to serious postoperative complications, resulting in failure to restore normal hip function, which seriously affects patients' quality of life and further increases their mortality rate. Thus, hip fracture represents a remarkable public health issue within the realm of geriatric medical care. This study systematically evaluated the impact of comprehensive rehabilitation training, with a focus on balance function, on elderly individuals with hip fractures' postoperative recovery and functional outcomes. Results showed a significant difference in BBS scores favoring comprehensive rehabilitation training based on balance function over conventional intervention. Similarly, AM-PAC scores favored the balance-focused training. TUTG meta-analysis indicated its adoption in comprehensive rehabilitation training. FIM scores showed improvement with balance-focused training. Harris score meta-analysis also favored this approach. A funnel plot analysis revealed potential publication bias, likely due to study heterogeneity and limited publications. In conclusion, comprehensive rehabilitation training centered around balance function displayed clinical efficacy in enhancing postoperative hip joint function in elderly hip fracture patients. This approach improved balance, coordination, and posture control, facilitating lower limb function recovery and overall prognosis. It holds promise as a valuable treatment approach.

Possibilities of occupational therapy in the elderly and senile with cognitive impairments

One of the significant modern problems of geriatrics is cognitive impairment. Moderate cognitive deficits are observed in 20% of older age groups. Ergotherapy, a multidisciplinary practice-oriented approach aimed at ensuring daily activity and meeting human needs in conditions of limitations of his psychophysiological capabilities that have arisen as a result of diseases and injuries, occupies an increasing place in geriatric medical and social technologies in our country. Objective. To assess the possibilities of occupational therapy in the system of providing medical and social assistance to elderly and senile people with cognitive impairments based on the analysis of Russian and foreign practice. Results. Ergotherapy is recommended in treatment and rehabilitation programs for patients of older age groups and, according to various authors, contributes to improving mood, cognitive abilities, physical condition and quality of life. For further development ergotherapy and the introduction of its approaches into the practice of providing geriatric medical and social care, scientific justification and development of differential diagnostic and therapeutic programs and algorithms, comparison of diagnostic data with other valid methods of assessing the functional status of older age groups; study of the possibility of optimal combination with traditional methods of physical and rehabilitation medicine, development of a methodology for individual satisfaction in the need for work and social activity in general, an assessment of its effectiveness from the standpoint of evidence-based medicine.

Evaluation of oral medications in the geriatric medical care ward based on the Guidelines for Appropriate Use of Medications for the Elderly (2018), and an analysis of the number of oral medicines in relation to the nutritional route and activities of daily living (ADL) categories

This study aimed to evaluate the use of potentially inappropriate medications (PIMs) and to examine the number of oral medicines based on the swallowing function and activities of daily living (ADL) categories in a geriatric medical care ward. A prospective investigation of oral medication use of 124 consecutive patients (male, n=58; female, n=66) admitted to a geriatric medical care ward was conducted from November 2019 to October 2020. Nutritional routes and ADL categories were quantitatively assessed, and the respective medication quantities were subjected to a statistical analysis. The average number of oral medications was 5.8 at acute care admission, 4.4 upon transfer to the geriatric medical care ward and 4.8 at discharge. Approximately 30% of oral medications were classified as PIMs, including antithrombotic agents, diuretics, antidiabetic drugs, magnesium oxide, sleep and anxiolytic medications, and antipsychotic drugs. Magnesium oxide, antipsychotic drugs, sleep and anxiolytic medications were frequently discontinued during the patient's stay at the geriatric medical care ward. The proportion of PIMs significantly decreased from 35.1% at admission, to 28.8% at ward transfer, and 24.3% at discharge (P<0.01). The number of oral medicines at discharge varied based on the nutritional route, with averages of 5.5 for oral intake, 3.6 for enteral nutrition, and 0.7 for venous nutrition. It also varied based on ADL categories, with averages of 6.0 for ADL 1, 5.8 for ADL 2, and 3.8 for ADL 3. The use of PIMs decreased in the geriatric medical care ward. A reduced swallowing function and lower ADL were associated with a decrease in the quantity of oral medicines.

Assessment if the demographic aging scale of the region's population

Background. The current process of population aging manifests itself at the regional level with varying degrees of intensity, which should be taken into account when assessing the population's need for geriatric medical care and developing social support measures.&#x0D; Aim. To give a comprehensive description of the dynamics of special indicators of population aging and to assess the demographic aging scale of the population of the Irkutsk region.&#x0D; Material and methods. A comprehensive assessment of the dynamics of population aging was carried out using 6 special indicators of population aging and 3 indicators of demographic movement. The calculation of the values of the indicators was performed in accordance with the methodological provisions on demographic statistics. The scale of aging was calculated based on the results of determining the stages of aging using 4 parameters of population aging: the level of aging, the depth of aging, aging factors, and the rate of aging. The data source was the statistical accounting tables of Rosstat for the Irkutsk region: А12а_25 natural population movement; t_pt1n general results of population migration by incoming territories; 25_2PH population by sex and age. The number of statistical accounting tables separately for each municipality of the Irkutsk region and the region as a whole amounted to 99 units for each year under study.&#x0D; Results. The dynamics of the aging level parameter indicates an aggravation of the aging processes of the population, and not due to an increase in people at the age of longevity (from 75 to 90 years) and centenarians (90 years and older), but due to the population older than working age, women from 55 years old and men from 60 years up to the age of 75 years. Indicators of aging factors that characterize reproductive and migration compensatory mechanisms are at a level that does not allow compensating for the growing processes of population aging. The value of the aging rate parameter in terms of the growth rate of the aging coefficient in dynamics indicates the stability of the demographic aging of the population. An analysis of the scale of population aging in the Irkutsk region and its districts showed that the Irkutsk region has an average value of parameters and is at an intermediate stage between the aging and old population.&#x0D; Conclusion. The scale of the aging of the Irkutsk region is primarily due to the high value of the parameter of aging factors, the parameter of the level of aging is characterized by the presence of prerequisites for the transition to a more aggravated stage of population aging.

Sarcopenia and falls in older adults

The biggest social impact of Taiwan’s aging population is an increase in the need for geriatric medical care as well as an increase in the burden on social and economic wellbeing. It will have an impact on domestic consumption, domestic demand, and labor supply, as well as changes in the demographic structure. As the workforce decreases and productivity declines, there will be a succession of shifts in consumer demand and infrastructure. Sarcopenia has more detrimental effects in obese or osteoporotic populations than in the general healthy population, and it is additive to the effects of obesity and osteoporosis on metabolism and physical activity. Increased adipose tissue in the aged can also cause an increase in chronic inflammation, insulin resistance, decreased muscle synthesis, and increased muscle breakdown, increasing the prevalence of sarcopenic obesity in the elderly. According to studies, sarcopenia increases the risk of falls in the elderly and causes obese older persons to lose muscle readily on a calorie-restricted diet. As shown above, nutritional supplementation as well as moderate aerobic and resistance exercise can reduce the risk of sarcopenia and falls in the obese elderly. Falls and their associated injuries are a major health care issue among the elderly. Falls are a typical occurrence in the elderly and are related to increased morbidity and disability. It is predicted that in such a community, two-thirds of unintentional injury deaths are caused by a fall. And increase geriatric mobility, so pay attention to sarcopenia and frailty problems in the elderly, and early and active intervention can avoid subsequent disability and the disadvantages of sarcopenia and frailty. Keywords: Sarcopenia, malnutrition, falls, frailty, geriatric syndrome, osteosarcopenia

A systematic review and qualitative analysis of geriatric models of care for rural and remote populations.

Much is known about the healthcare needs of rural and remote communities; however, understanding how to best deliver geriatric models of care in these settings has received less attention. The purpose of this systematic review was to identify necessary key components of existing models of geriatric care serving rural or remote populations. A systematic literature review was conducted using MEDLINE, CINAHL and EMBASE databases to identify articles that described models of geriatric care serving rural or remote populations. A qualitative case study and key component analysis approach was used to identify necessary model components. Eight articles were included. We identified eight distinct components that may improve the successful delivery of models of geriatric care serving rural or remote populations. Environmental assessments were done in six of eight models. Model integration with the local healthcare system, local provider leadership, and local provider education in geriatrics were present in five of eight models. Three of eight models used high-risk screening principles and included geriatrician consultation. One model described active community engagement, and one used telemedicine. Future geriatric care delivery models designed to serve rural or remote populations are encouraged to use an evidence-based framework based on eight distinct model characteristics found in the literature that aim to support the ideal provision of effective and accessible geriatric medical care.

The medical activity and satisfaction of geriatric care of Mongolia residents.

Nowadays, process of aging of population covers all countries of the world. In current conditions, an important moment is increasing medical activity of elderly population and old persons. The purpose of the study is to investigate social hygienic characteristics of medical activity and satisfaction with geriatric care of the elderly residents of Mongolia. The sociological survey of 726 residents of Mongolia older than able-bodied age, 75 out of which were in nursing homes, was carried out using specially designed questionnaire that included questions on assessing medical activity and satisfaction with geriatric care. The negative correlation was established between good assessment of one's own health and age of respondents. The study revealed that 90.9% of respondents noted presence of chronic pathology, but only 21.1% of them were registered in dispensary. In age group under 65 years, 75.8% of persons capable to serving themselves made up 75.8% and in age group 75 years and older only 48.1%. The analysis established that 50.2% of elderly and senile persons consulted geriatrician, while 48.3% of those who did not consult this specialist were unaware of its existence. The number of cases of respondents visiting geriatric doctor in place of their residence was higher in cities. The respondents who received geriatric medical care were completely satisfied with it in 52.7%. The causes of dissatisfaction with geriatric medical care in aimags (regions) were inattentive attitude of medical staff, low effectiveness of treatment and insufficient availability of free provision of medications. The identified social hygienic characteristics of medical activity and satisfaction with geriatric care of the elderly and senile residents of Mongolia should be taken into account in developing measures to improve this type of care in Mongolia.

163 EVALUATING THE ROLE OF THE GERIATRIC DAY HOSPITAL IN MEDICATION OPTIMISATION

Abstract Background The geriatric day hospital (GDH) provides outpatient geriatric medical, nursing and rehabilitation care to older adults. The aim of this study was to assess whether medication optimisation occurs in this setting. We believe the GDH would be an ideal location for mediation optimisation due to the stable community dwelling patients and close follow up by specialised physicians. Methods Electronic patient records of the new patients ≥65 years seen in the GDH over a 3-month period were reviewed. Potentially inappropriate prescriptions (PIPs) and potentially prescribing omissions (PPOs) were identified using the STOPP/START prescribing tool on admission to the GDH and again at discharge from the GDH. Results One-hundred and sixty-seven patient records were reviewed; mean age 80.8 (SD6.5) years, 62.9% female, median clinical frailty scale score 6 (IQR5–6), mean number of conditions 5.79 (SD3), mean number of medications 7.57 (SD3.7). Patients had a median of 4 (IQR2–7) consultations. The number of patients prescribed at least 1 STOPP-PIP reduced by 10% (42.4% vs 38%; p &amp;lt; 0.001). Vasodilator drugs in patients with orthostatic hypotension were deprescribed most frequently (6.5% vs 3%; p &amp;lt; 0.001). PPOs were reduced by 36% (47.5% vs 30.6%;p &amp;lt; 0.001). The largest improvement was identified in the prescription of vitamin D in patients experiencing falls (17.4% vs 13.8%;p &amp;lt; 0.001). Logistic regression was performed to ascertain the influence of age, gender, falls, dementia, co-morbidity number and medication number on the likelihood of a patient experiencing a PIP or PPO. For every medication prescribed, the odds of experiencing a PIP increased by 11.8% (OR1.187, 95%CI 1.052–1.339). Being female increased the odds of experiencing a PPO by 21.7% (OR2.17, 95%CI 10.53–4.468). Conclusion Medication optimisation is key in avoiding side effects from potentially inappropriate medications. The frequency of patient attendances coupled with geriatricians’ expertise makes the GDH an ideal setting for medication optimisation in multi-morbid frail community-dwelling older adults.

Knowledge, Attitudes and Treatment Practices of Medical Doctors towards Care of Elderly Patients Accessing Clinical Care at Hospitals in Kampala Uganda

The global trend towards an increasing aging population demands for adequate geriatric medical care services to cater for health needs of the aging population seeking clinical care in hospitals. In Uganda, geriatric care as a specialty in medicine is still at infancy stage, and this is further worsened by the fact that the current curricula followed in training health workers lacks a component dedicated to elderly care. There is therefore need to assess knowledge, attitudes and treatment practices of medical doctors towards clinical care for elderly persons.

Challenges of Implementing the 4Ms in Federally Qualified Health Centers and Private Academic Medical Centers

As our country increases our capacity to provide quality interprofessional geriatric medical care to older adults, we find challenges that are unique to the setting. Many older adults receive care in Federally Qualified Healthcare Centers where implementing Age-Friendly Care is critical. Implementing the 4M’s in this setting has specific challenges including lack of geriatric trained staff, staff turnover, leadership engagement and financial sustainability. When implementing Age-Friendly Care within a large-scale complex academic health system, equally difficult challenges surface. With less nimble infrastructures, changes in one service area can have a domino effect and create larger barriers in other parts of the system. Instituting the 4M’s in an academic health system environment requires a careful strategic approach and support from many areas of organizational leadership. This talk will focus on strategies to anticipate and adapt implementation plans to best address barriers that are unique to the setting.

Physician assistants in geriatric medical care

BackgroundThe US population is maturing. As of 2020, over 52 million (16%) people are age 65 or older. With a citizenry that is increasingly “gray,” the nation is short of medical providers who specialize in geriatric medical care. For example, the number of geriatrician physicians per 10,000 adults 65 years and older has decreased since 2000, with approximately 5300 in 2018. Nurse practitioners in geriatric medical care numbered 598 in 2018. Considering that the projected needs by 2030 will be over 30,000, the trajectory of geriatricians is becoming increasingly inadequate for the aging population. Physician assistants (PA) are another class of providers that are filling this geriatric medical care role, although little has been published. To address this role of PAs a study was undertaken.MethodsThe National Commission on Certification of Physician Assistants databank provided the number and characteristics of PAs in geriatric medicine and compared them to all other certified PAs. Analyses included descriptive statistics, Chi-Square, and Wilcoxon Rank Sum tests for comparisons between PAs practicing in geriatric medical care vs. all other PA specialties. Where a comparison between PAs in geriatrics and other specialties was made, a P value of .05 or less was considered statistically significant.ResultsAs of 2018, there were 794 certified PAs, or 0.8% of the certified PA workforce, in geriatric medical care. This cadre has grown significantly since 2013, both in total number (increasing over 373%) and as a percentage of the PA workforce. The median age of certified PAs in geriatrics is 45 years, and 79% are female. Almost half (46%) of PAs in geriatric medicine work in extended care facilities or nursing homes, which differs from PAs in non-geriatric care. Another 8% work in government facilities and 8% in rehabilitation facilities. In 2018, the mean annual income for this PA group was $106,680.ConclusionsAs the American population continues to age, the relative growth of PAs in geriatric medicine makes them a natural part of the solution to the projected physician geriatrician deficit. The role of PAs in geriatric medical care remains to be explored.

Effect of an interprofessional care concept on the hospitalization of nursing home residents: study protocol for a cluster-randomized controlled trial

BackgroundThe rising number of nursing home (NH) residents and their increasingly complex treatment needs pose a challenge to the German health care system. In Germany, there is no specialized geriatric medical care for NH residents. Nursing staff and general practitioners (GPs) in particular have to compensate for the additional demand, which is compounded by organizational and structural hurdles. As a result, avoidable emergency calls and hospital admissions occur.In the SaarPHIR project (Saarländische PflegeHeimversorgung Integriert Regelhaft), a complex intervention focusing on a medical care concept was developed in a participatory practice-based approach involving NH representatives and GPs. The complex intervention addresses the collaboration between nurses and GPs and aims to help restructure and optimize the existing daily care routine. It is expected to improve the medical care of geriatric patients in NHs and reduce stressful, costly hospital admissions. The intervention was pilot-tested during the first 12 months of the project. In the present study, its effectiveness, cost-effectiveness, and safety will be evaluated.MethodsThe study is a cluster-randomized controlled trial, comparing an intervention group with a control group. The intervention includes a concept of interprofessional collaboration, in which GPs group into regional cooperating teams. Teams are encouraged to cooperate more closely with NH staff and to provide on-call schedules, pre-weekend visits, joint team meetings, joint documentation, and improved medication safety. At least 32 NHs in Saarland, Germany (with at least 50 residents each) will be included and monitored for 12 months. The primary endpoint is hospitalization. Secondary endpoints are quality of life, quality of care, and medication safety. The control group receives treatment as usual. Process evaluation and health economic evaluation accompany the study. The data set contains claims data from German statutory health insurance companies as well as primary data. Analysis will be conducted using a generalized linear mixed model.ConclusionA reduction in hospital admissions of NH residents and relevant changes in secondary endpoints are expected. In turn, these will have a positive impact on the economic assessment.Trial registrationGerman Clinical Trials Register: DRKS00017129. Registered on 23 April 2019. https://www.drks.de/drks_web/setLocale_EN.do.

Regional variance in the use of urine dipstick test for outpatients in Japan.

The urine dipstick is a simple diagnostic module for detecting proteinuria, haematuria and glycosuria and is favourably accepted in East Asia despite debates regarding its accuracy and target population, claiming that quantitative tests for a high-risk cohort should be more cost-effective. However, the current status of utilizing this test in these countries is not widely known due to lack of extensive data. We aimed to clarify the current nationwide and regional status of utilization of the urine dipstick test in an outpatient care setting and to determine the regional factors associated with adoption of this method. This cross-sectional study used openly accessible data from the national claim database that included the health insurance claims data of the Japanese population in 2017. In total, 67 125 386 urine dipstick tests were performed compared with 1 862 700 quantitative urine protein tests and 17 544 949 urine sediment microscopy tests. Dipstick tests were employed principally for those who are >65 years old (60.3%) and, although the male population (52.5%) is generally larger, the female population is larger in age of 15 to 39 years and >85 years. Multivariate analysis with several regional parameters revealed that the test was performed more commonly in the areas that accommodate greater elderly population (P < .01). Despite a heated dispute, the urine dipstick test is performed even more frequently than the quantitative biochemical or microscopic sediment tests, especially in regions holding the larger elderly population, which suggests that the test forms a part of geriatric medical care.

Impact of Geriatric Hotlines on Health Care Pathways and Health Status in Patients Aged 75 Years and Older: Protocol for a French Multicenter Observational Study

BackgroundIn France, emergency departments (EDs) are the fastest and most common means for general practitioners (GPs) to cope with the complex issues presented by elderly patients with multiple conditions. EDs are overburdened, and studies show that being treated in EDs can have a damaging effect on the health of elderly patients. Outpatient care or planned hospitalizations are possible solutions if appropriate geriatric medical advice is provided. In 2013, France’s regional health authorities proposed creating direct telephone helplines, “geriatric hotlines,” staffed by geriatric specialists to encourage interactions between GP clinics and hospitals. These hotlines are designed to improve health care pathways and the health status of the elderly.ObjectiveThis study aims to describe the health care pathways and health status of patients aged 75 years and older hospitalized in short-stay geriatric wards following referral from a geriatric hotline.MethodsThe study will be conducted over 24 months in seven French university hospital centers. It will include all patients aged 75 and older, living in their own homes or nursing homes, who are admitted to short-stay geriatric wards following hotline consultation. Two questionnaires will be filled out by medical staff at specific time points: (1) after conducting the telephone consultation and (2) on admitting the patient to a short-stay geriatric medical care. The primary endpoint will be mean hospitalization duration. The secondary endpoints will be intrahospital mortality rate, the characteristics of patients admitted via the hotline, and the types of questions asked and responses given via the hotline.ResultsThe study was funded by the National School for Social Security Loire department (École Nationale Supérieure de Sécurité Sociale) and the Conference for funders of prevention of autonomy loss for the elderly of the Loire department in November 2017. Institutional review board approval was obtained in April 2018. Data collection started in May 2018; the planned end date for data collection is May 2020. Data analysis will take place in the summer of 2020, and the first results are expected to be published in late 2020.ConclusionsThe results will reveal whether geriatric hotlines provide the most effective management of elderly patients, as indicated by shorter mean hospitalization durations. Shorter hospital durations could lead to a reduced risk of complications—geriatric syndromes—and the domino chain of geriatric conditions that follow. We will also describe different geriatric hotlines from different cities and compare how they function to improve the health care of the elderly and pave the way toward new advances, especially in the organization of the care path.Trial RegistrationClinicalTrials.gov NCT03959475; https://clinicaltrials.gov/ct2/show/NCT03959475International Registered Report Identifier (IRRID)DERR1-10.2196/15423

The “Fierce Urgency of Now”: Geriatrics Professionals Speaking up for Older Adult Care in the United States

The “Fierce Urgency of Now”: Geriatrics Professionals Speaking up for Older Adult Care in the United States

Creating a sustainable assessment tool and follow-up plan to improve care transitions for the frail elderly patient population: The TPRAS project

Abstract A variety of health care professionals effectively collaborating is often required to successfully coordinate care transitions of complex, frail older adult patients who are experiencing co-morbidities and cognitive decline. This paper describes an interprofessional approach using quality improvement methodology to iteratively develop and improve an acute geriatric medical unit's discharge planning and care transitions processes. The approach has shown early signs of positive outcomes at the patient, provider, and organizational levels. Health care leaders may use a similar approach in their efforts to improve patient, family and provider experiences and outcomes associated with discharge and care transitions planning for the older complex adult patient population.

Fresh Approach for Geriatric Medical Care

Universally it is almost a common knowledge that the elderly is not interested in prolongation of their life. Perhaps the ones who are ambulatory and are able to perform their activities of daily living are not looking forward for a longdrawn- out life, but a life where they feel comfortable without being dependent on anyone. Perhaps most of their time may be spent in contemplating and taking measures on how not to fall ill, and continue being independent.

Geriatric medicine and pharmacy practice: a historical perspective

AbstractModern geriatric medicine evolved in Britain between the 1930s and 1970s. In Australia, the first comprehensive geriatric service was described in the 1950s. However, it was not until the 1980s that geriatric medicine began to gain widespread acceptance as a medical specialty. There has been a slow but steady growth in geriatric services in most developed countries since that time, and more recently in developing nations. Various models of geriatric medical care have been developed, including geriatrician‐led geriatric evaluation and management (GEM) services and shared‐care services such as orthogeriatrics. The number of older people, often with multiple comorbidities and geriatric syndromes, seen in most areas of medical and surgical practice has risen significantly over recent decades, and as a result some of the principles of geriatric medicine, in particular ‘comprehensive geriatric assessment’, have been adopted outside of specialist geriatric services, including the primary care setting. Managing and preventing iatrogenic disease and polypharmacy became an important element of geriatric medicine as the range of therapeutic drugs grew and life expectancy and multi‐morbidity increased. Geriatric pharmacy practice evolved in the mid‐1970s in the USA, and the 1980s–1990s in other developed countries. It was recognised as a specialty with the introduction of the Certified Geriatric Pharmacist credential in 1997. This paper describes the evolution of the principles and practice of geriatric medicine and pharmacy practice.