Geriatrics and Gerontology

Summary

Examining lifespan development, particularly the later years, has never been more important. Servicing an aging population requires diverse teams of medical doctors, biologists, psychologists, and other professionals, and training such individuals has produced dedicated schools and degrees focused exclusively on the aging process. Students interested in studying aging have never before had so many opportunities to expand their careers. Further, the need for teachers and specialists in geriatrics and gerontology is increasing rapidly.

Definition and Basic Principles

The baby boom generation is the name given to those born between 1946 and 1964. Before the first baby boomer turned sixty in 2006, geriatrics, the medical subspecialty of treating older people, and gerontology, the comprehensive field of aging studies, both experienced a substantial growth of interest. Although, in the past, old age may have been viewed as a period of disengagement, nothing is further from the truth in the twenty-first century. Aging is now often couched in terms of “successful” or “productive.” In fact, many older people remain as busy after retirement with volunteering activities and the like as when they were employed. Reframing the negative language surrounding aging has changed the perception of aging from a period of consuming goods and services to a period of continued growth and productivity. With an estimated sixty-nine million baby boomers turning sixty-five by 2029, the fields of geriatrics and gerontology have never been more in demand. The Association of American Medical Colleges estimates that by 2034, there will be a national shortage of geriatricians that could potentially number over 120,000.

Maintaining the health and well-being of older people involves extensive education, research, and policy initiatives. Thus, the field of gerontology, by necessity, is interdisciplinary. No one field encapsulates the varied systems of inquiry—especially when so many older people now remain fit and active well into their nineties.

Background and History

Gerontology as an official field of inquiry began in 1903 when Russian biologist Élie Metchnikoff coined the term “gerontology” or the “study of old men.” Six years later, Austrian physician Ignatz Nascher created the field of geriatrics and, in 1914, published the first book on geriatrics. The Social Security Act, enacted in 1935, helped to pull millions of older people and others out of poverty. The first organizations solely dedicated to studying the aging process were formed in the 1940s: the American Geriatrics Society was founded in 1942, and the Gerontological Society of America was founded in 1945. In 1957, the National Institutes of Health formed the Center for Aging Research. In 1963, physician Sidney Katz and colleagues published the seminal work on gauging the independence of older people, the index of Activities of Daily Living—a concept still widely used. Irving Rosow published Social Integration of the Aged in 1967, which laid the groundwork for later theories on aging. The White House Conference on Aging, begun in 1961, spawned a formal division on aging at the National Institutes of Health. In 1976, Robert Butler was appointed the first director of the new National Institute on Aging. The 1980s through the 2000s saw an explosion in interest in aging as the baby boomers began to reach retirement age. Countless university centers on aging and degrees in geriatrics and gerontology have been created, and at many universities, students may now declare gerontology as their major field of study.

How It Works

Theories of Aging. Scientific theories organize the how and why of empirical findings and provide an epistemology from which to examine new data. Using supported data-driven theory contextualizes known parameters, permitting a foundation of knowledge from which to build new projects and inquiries into the aging process. Previous data sets and explanations about interrelated phenomena streamline future interventions and research investigations. In geriatrics, biological theories of aging are the norm. However, the interdisciplinary nature of gerontology creates barriers to building comprehensive theories of aging. Although gerontology includes biological theories of aging, these two fields will be examined separately.

Geriatric theories on aging abound, and the more popular theories are briefly reviewed here. The free-radical theory of aging posits that self-multiplying free radicals cause damage to deoxyribonucleic acid (DNA) and healthy cells. The hypothesized antidote is the consumption of antioxidants commonly found in fruits and vegetables. The programmed theory of aging proposes that every organism has an expected lifespan. Similarly, the wear-and-tear theory likens the human body to a machine where constant use degrades the machine, eventually leading to failure. Lastly, the immune system theory holds that, with age, the human body becomes less able to fight off infection. In a world where health is increasingly viewed as more than the mere absence of disease, geriatricians use biological theories of aging to dispense health-promotion advice: Exercise both mind and body daily, maintain a well-balanced diet by consuming the daily requirements of fruits and vegetables, and remain socially engaged in meaningful activities.

Gerontological theories of aging, often called social theories of aging, are diverse in scope. Although largely refuted, disengagement theory suggests individuals slowly remove themselves from society with increased age. Alternatively and largely supported by early twenty-first-century research literature, activity theory holds a positive relationship between activity levels and happiness and health. Similarly, continuity theory maintains that new roles should be substituted for lost roles. For example, volunteering can replace retirement from a paying job, or watching grandchildren can replace child-rearing. The life-course perspective on aging holds that aging is a lifelong process and adaptation and change are continuous rather than enacted by a specific age (sixty-five). These and other social theories on aging guide the development of new research endeavors and assimilate such new findings into the evolving language of aging research.

Geriatrics in the Field. Geriatricians have advanced training and certifications in medicine and aging and work in the broad field of geriatrics. Such individuals actively develop health plans, treat comorbidities, promote health and wellness, focus on preventing disease and disability, and perform clinical evaluations. Unlike other disciplines, such as cardiology, geriatrics is not focused on a single organ or disease. Therefore, other medical personnel with specialty training in aging often make up a treatment team, including osteopathic physicians, nurses, social workers, physical and occupational therapists, psychologists, and others. Such a team can create a complete wellness portfolio and assess a patient's daily activities.

Geriatricians have moved from a disease-prevention model to a health-promotion model that uses the best available research evidence, clinical knowledge, and patient feedback to create a holistic model of well-being. Such evidence-based approaches are in great demand. With rising healthcare costs, insurance companies demand proven treatments. Geriatrics as a subspecialty of medicine is essential as older adults can often differ from younger persons in symptoms related to illness and react differently to treatment methods. The success of geriatrics is vital for measures of public health as well, where reducing disability and disease would have far-reaching effects on the overburdened medical system.

Generally, a person should consider seeing a geriatrician when they turn sixty-five, although individual health complications could necessitate an earlier visit. Often, by the age of seventy-five, many older adults have multiple chronic conditions, such as sensory and cognitive impairments, which require the services of a geriatrician. Because the lifespan is seen as continuous rather than restricted by specific ages, it is essential that individual decisions made throughout one's life are well-informed, and geriatricians are a critical piece of the puzzle. Because the rate of aging is determined by the interaction of genetic and environmental conditions, which differ for every individual, older people must see a specialist. Only a qualified medical doctor should make medical decisions.

Gerontology in the Field. Applied gerontologists examine, study, and directly train older people and those who work with them in various ways. Such areas include: learning to operate hearing aids, using assistive devices, such as canes or walkers, maintaining proper nutrition, adjusting driving habits, proper use of corrective visual aids, and any other area affected by the aging process. Research by gerontologists suggests that change is the key to successful aging. Static lives produce static minds and bodies.

Gerontologists also teach and promote preventative interventions to ensure successful aging. Such interventions can retrain mental acuity, strengthen ailing muscles and skeletal structure, and teach positive behavioral methods to cope with loss and grieving. Gerontologists have led the aging revolution, where older people live longer, healthier, and more engaged lives. Accordingly, older people contribute to a level of human capital never seen before. Part of the reason for this increase in productivity is that technology is changing how productivity is perceived. No longer is physical stamina required for ongoing employment. Technology has permitted older workers to stay in the workforce, thereby increasing social contribution and delaying age-related functional declines.

Gerontologists are quick to point out that productive aging includes activities outside of standard market contributions, such as volunteering. Such a revolution has caused many to rethink the very concept of old age. Often, age is a mixture of chronological, biological, psychological, and sociological age. Functional age is a good marker of the aging process and aids in determining between three age conditions: normal aging, pathological aging, and successful aging. Another method of categorizing the diverse array of older people is simply via chronological age. Gerontologists see three subcategories of older people: young old (sixty-five through seventy-four), middle old (seventy-five through eighty-four), and old-old (eighty-five and older). Whatever the categorization method, grouping the vast, growing older population is arduous given the inherent wide variability in human aging. Further, such grouping permits large-scale comparisons of health and wellness.

Unfortunately, the United States (US) lags behind other countries and the World Health Organization's (WHO) recommendations on preventing chronic diseases. The WHO's guide to Global Age-Friendly Cities provides eight guidelines for communities aiming for improvement: outdoor spaces, transportation, housing, social participation, respect, civic participation, communication and community support, and health services. In London and other European cities, free exercise playgrounds for older people are the norm. Costa Rica, Sardinia, Italy, and Ikaria, Greece are examples of locales possessing the right mix of cultural and social factors that permit many older people to live healthy lives into their nineties and beyond. Generally, such countries have a culture of respect for older people. For example, those who study and treat older people in Great Britain are held in high esteem. Conversely, the US has historically stigmatized older people and those who work with them. However, a slow tide of change is occurring as baby boomers prominently age in American society. However, changing preconceived notions is a slow process and stereotypes of older people still abound.

Applications and Products

Baby boomers possess a higher level of education than any previous generation. Thus, the expectation is this cohort will be savvy consumers desiring the best-proven treatments. Where daily life choices are more predictive of health status than genetic composition alone, the previous niche areas of applications and products for older people are now a rampant growth industry spanning every conceivable field.

Medicine. Medical implantation devices provide relief to ailing organs and prolong well-being. The left ventricle assist device aids the normal functioning of failing hearts, while an implanted defibrillator prevents cardiac arrest by shocking the heart back into a normal rhythm. Cochlear implants are placed directly under the skin behind the ear and return the gift of sound to many people with hearing impairments. Cameras encapsulated in pill casings that the patient swallows take a video of the intestinal track eliminating the need for costly and invasive scoping procedures. Other advances in medicine for geriatrics include new treatments for age-related macular degeneration (AMD) and diabetic macular edema; additional COVID-19 vaccines for older patients who are immunocompromised; and spinal versus general anesthesia for hip fracture surgery.

The increasing need for evidence-based medicine has produced creative solutions to gathering patient information. Wireless home-based transfer of medical information from accelerometers, glucose monitoring, and implanted devices, such as pacemakers, allows patients to provide real-time health data while remaining independent. Cell phones with Global Positioning Systems (GPS) track exercise regimens, allowing for intermittent queries about self-perceived health and well-being. For example, patients newly released from the hospital can transmit responses to doctor-initiated questions, eliminating the need for and cost of in-person follow-ups. This trend in distance-based medicine includes genetic-testing kits, available at local drug stores, that allow the user to mail in their sample for analysis. Telehealth—remote health care delivered via telecommunications equipment—is particularly important in rural areas, where many older veterans live. Following the COVID-19 pandemic in 2020 and 2021, telehealth remained a popular and convenient choice to speak to a healthcare provider without leaving one's home.

Although emerging technologies sound like science fiction, many products are closer to the marketplace than one might imagine. Thought-controlled mechanical limbs that receive feedback from the environment, such as temperature and pressure, can closely mimic an individual's lost arm or leg. In development are microscopic cleaning robots, called blood bots, which can be guided to clean plaque-filled veins and take biopsies. Noninvasive blood, saliva, and urine tests for Alzheimer's disease, cancer, and other difficult-to-detect diseases are currently in development. There is even an experimental Breathalyzer test in development that may replace expensive blood and urine analysis. Semipermanent prescription tattoos might respond to glucose levels in the bloodstream of a person with diabetes by changing color when placed under a handheld infrared light, eliminating the need for painful blood monitoring.

Common memory-storage cards, like those in a digital camera, are used as a portable patient medical archive. The cards fit into a wallet and facilitate communication and accuracy between the various health professionals many older people visit. Computerized medical information systems linked throughout healthcare networks have replaced inefficient paper-based records. Such an electronic system permits comprehensive care while anywhere in the world and coordinates the spectrum of healthcare services older people receive.

Pharmacology. Perhaps the field most engaged with older populations is pharmacology. Clinical drug trials deliver numerous pharmaceuticals to the market each year—many designed to treat and extend wellness into advancing age. Drugs are being developed that may fight obesity and even change one's DNA. Drug encapsulation involves the coating of medicine either to delay activation or to enter affected areas. For example, most oral medications cannot pass the blood-brain barrier, which means they do not enter the brain. Encapsulating, or masking, the active drug compound could permit the body to pass the drug into the brain, eliminating the need for invasive surgeries.

Although often with variable scientific evidence, herbs and supplements for older people have expanded exponentially in the early twenty-first century. However, geriatric researchers have found minimal scientific evidence for many of their claims. Ginkgo biloba was claimed to improve memory for many years. However, numerous large-scale clinical trials have found no such evidence. Large annual doses of vitamin D, thought to improve bone health, were found to increase fractures. Conversely, some herbs and supplements have proven effective. Omega-3 fatty acids have shown promise in improving heart health. Capsaicin, found in hot peppers, has recently been added to topical arthritis creams because of its analgesic properties. However, medicines only work when taken as directed. Medication non-adherence costs the healthcare industry millions of dollars per year. Patients frequently take the wrong dose or fail to fill the prescription, necessitating additional doctor visits. Accordingly, an industry has developed to correct this problem. Pill bottles with reminder alarms, automatic medication dispensers, and Internet-based and mobile phone text reminders assist with medication adherence are widely available.

Assistive Technology. Numerous home-based assistive devices are available to prolong independence: swing-down shelves in kitchens, easy-open door handles, and a bevy of structural changes to accommodate individuals with decreased strength, decreased stature, complications due to arthritis, and the like. Such assistive technologies have been shown to decrease the need for outside personal assistance, further prolonging independence in the home. Motion-sensor systems eliminate wandering, which is often associated with later stages of dementia. Additional home-based applications for older people include special bathtubs, mechanical chairs that climb stairs, motorized wheelchairs, and remote home monitoring of health status.

Often, advances in care for older people have spillover benefits for the rest of the population. For example, the physical and occupational therapy fields have created user-friendly work environments for employees of all ages. Accordingly, ergonomics is now a household name, and companies and therapists are building optimal sitting and standing workstations that relieve pressure and support working and moving bodies. The automobile industry has responded with adjustable gas and brake pedals, backup cameras, audible turn-by-turn directions, and parallel parking assistance.

Education.Lifelong learning colleges offer continuing education to older people through various formats. Online centers of learning and book and workbook training manuals aim to increase memory and mental speed and bolster one's brain power. Many traditional universities and community colleges offer vacant classroom seats to older people at a discount.

Physical activity is the single best way to improve one's health at any age, and there are many products and services that promote an active lifestyle. The Nintendo Wii video game system has enjoyed popularity with older people across the country. The Wii is a low-impact, hand-eye coordination system that is believed to increase balance, strength, and cognitive performance. Many senior centers have created Wii bowling leagues, and online goal-setting and health-improvement websites permit older people from across the globe to post their scores to encourage other older adults to maintain healthy lifestyles. Older people also increasingly use video game platforms to improve mental acuity and stay socially connected with others from the comfort of their homes.

Careers and Course Work

The rapidly aging baby boomers have already created numerous and varied career opportunities in geriatrics and gerontology. Educators and social workers have experienced tremendous growth opportunities in the last ten years as the need for coordination of health education and social services increases. The shortage of nurses is particularly prevalent in hospitals, nursing homes, and other retirement-oriented settings. By 2030, the projected ratio is one geriatrician for every 4,200 seniors, so future job prospects are excellent.

Geriatrics involves completing a Bachelor's degree, four years of medical school, a three-year internship in general medicine and aging populations or subspecialty, such as immunology or cardiology, and often a one- to two-year program in geriatrics. Typically labeled a geriatrician, the individual spends their days compassionately caring for older people's medical and quality-of-life issues. Geriatric nurses have earned a specialized Bachelor's or Master's degree and often play a major role in the daily care of those with infirmities. In the mid-2020s, only about fifty-five to sixty physicians were exploring fellowships in psychiatric geriatric care annually. Because of this, older individuals will not receive treatment for disorders, such as dementia, that are associated with aging.

Conversely, gerontology accreditation varies with the specialty. Employment-specific Master's-level course work is typically required for most therapist-oriented careers, such as physical therapy or counseling. Completing Doctoral-level coursework is necessary for clinical careers, clinical geropsychologist, educators, university professors, and other aging-related careers, such as dentistry, pharmacy, policy, and political science. Physical or occupational therapists spend their days retraining aging muscular and structural systems, and counselors commonly deal with depression, loss, grieving, and other aging-related mental health issues. Clinical geropsychologists commonly treat more extensive cognitive-impairment topics, such as dementia and mild to moderate mental health problems.

Social Context and Future Prospects

In the early twenty-first century, aging in America was viewed through the experience of the baby boomers—born between 1946 and 1964—who started turning sixty in 2006. The most educated of any senior cohort, baby boomers grew up during unprecedented economic growth and possess a unique view of aging. The boomers are not taking retirement lying down: This group is more redirected than retired. Traditional leisure activities, continuing education, volunteering, and often part-time employment have replaced the full-time workweek. The baby boomers, in particular, expect an unprecedented retirement lifestyle. In response to this expectation, retirement communities now resemble theme parks with golf courses, activity centers, and staff solely dedicated to planning events.

Prospects have become a reality. In central Florida, an entire city was developed for the retired. Specialized golf cart highways and parking spaces connect shopping malls and doctor offices to homes. Daily activities include concerts, speeches, exercise facilities, and college classes. If such retirement cities become the norm, a complete redefining of aging will likely occur. Active and engaged theories of aging will continue to replace outmoded theories, such as the concept of disengagement. Whether the stigma of aging and corresponding stereotypes will also be replaced is yet to be determined.

The coronavirus disease 2019 (COVID-19) pandemic had a profound impact on the older population in the US and around the world, with eight out of every ten deaths reported in the US occurring in adults over the age of sixty-five. The isolation that was already an issue for many older citizens was compounded during the pandemic when older people were forced to stay home during lockdowns. The virus spread rampantly in nursing homes and other long-term care facilities where older people live. Because older people are at a higher risk of dying from the COVID-19 virus, many anticipated that isolation and precautions, such as mask-wearing, would remain in place even after vaccination. This "new normal" forced many people to rethink their retirement and continued to bring great changes to the lives of retirees. Additionally, many caregivers who work as home health aides and in long-term health facilities were at increased risk of contracting the virus during the pandemic, which caused a shortage of workers in the field.

Biotechnology holds great promise for the future of aging research. Caloric-restrictive diets have extended longevity in mice, and such research has led investigators to explore the possibility of “turning off” mechanisms responsible for fat storage. Drugs, such as rapamycin, have also been shown to delay the onset of aging and diseases associated with old age, such as Alzheimer's disease, in mice. In 2021, the FDA approved Aduhelm, the first drug available to treat the underlying disease process rather than just the symptoms of Alzheimer's. Emerging research suggests that B vitamins may decrease depression, phenolic compounds might kill specific cancer cells, a juice elixir may prevent the common cold, and capsaicin, mentioned earlier in connection with arthritis, may also promote weight loss. Perhaps the most visible biotechnology project involves using stem cells to regenerate aging cells. Advances that continue to increase the longevity of life will continue to benefit older people, combatting cardivasclar and neurodegeratnive diseases, and descreasing the prevelence and severity of illness, such as cancers and diabtes. Personalized medicine can help older adults target their healthcare goals. Technology, including robotics and artifical intelligence, will make healthcare smarter. However, leading a healthy and active lifestyle remains the key recipe for healthy old age.

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