Geriatrics - History

History

Ayurveda (>1500 BC) - the ancient Indian system of medicine has mentioned about the eight branches (Ashtanga Ayurveda) of Ayurveda viz Kayachikitsa (General Medicine), Balaroga (Paediatrics), Graha chikitsa (treatment of diseases related to Psychology), Urdhvanga chikitsa (treatment of the diseases of the Head and neck, ENT), Shalya tantra (Surgery), Damshtra (treatment of poisonous stings and bites), Jara/Rasayana (Geriatrics) and Vajikarana (Andrology). So it can be said that Geriatrics was first mentioned in Ayurveda. The term 'Geria' is very close to the Sanskrit word "Jara". Rasayana is defined as "Rasayanam cha tat jneyam yat jara vyadhi nashanam" means Rasayana is a branch of medicine which deals with the prevention of premature ageing, management of diseases and especially the management of diseases related to Old age.

According to Lascaratos and Poulacou-Rebelacou, "The study and analysis of the original medical and historical texts of the Byzantine period (324-1453 AD), written in Greek language, prove that the roots of medical care of old age could be traced from ancient Greek and Byzantine medicine."

The Canon of Medicine, written by Avicenna in 1025, was the first book to offer instruction in the care of the aged, foreshadowing modern gerontology and geriatrics. In a chapter entitled "Regimen of Old Age", Avicenna was concerned with how "old folk need plenty of sleep" and how their bodies should be anointed with oil, and recommended exercises such as walking or horse-riding. Thesis III of the Canon discussed the diet suitable for old people, and dedicated several sections to elderly patients who become constipated.

The famous Arabic physician, Algizar (circa 898-980), also wrote a special book on the medicine and health of the elderly. He also wrote a book on sleep disorders and another one on forgetfulness and how to strengthen memory, and a treatise on causes of mortality. Another Arabic physician in the 9th century, Ishaq ibn Hunayn (died 910), the son of Nestorian Christian scholar Hunayn Ibn Ishaq, wrote a Treatise on Drugs for Forgetfulness.

George Day published the Diseases of Advanced Life in 1849, one of the first publications on the subject of geriatric medicine. The first modern geriatric hospital was founded in Belgrade, Serbia in 1881 by doctor Laza Lazarević.

The term geriatrics was proposed in 1909 by Dr. Ignatz Leo Nascher, former Chief of Clinic in the Mount Sinai Hospital Outpatient Department (New York City) and a "Father" of geriatrics in the United States.

Modern geriatrics in the United Kingdom really began with the "Mother" of Geriatrics, Dr. Marjorie Warren. Warren emphasized that rehabilitation was essential to the care of older people. Using her experiences as a physician in a London Workhouse infirmary, she believed that merely keeping older people fed until they died was not enough; they needed diagnosis, treatment, care, and support. She found that patients, some of whom had previously been bedridden, were able to gain some degree of independence with the correct assessment and treatment.

The practice of geriatrics in the UK is also one with a rich multi-disciplinary history. It values all the professions, not just medicine, for their contributions in optimizing the well-being and independence of older people.

Another "hero" of British Geriatrics is Bernard Isaacs, who described the "giants" of geriatrics mentioned above: immobility and instability, incontinence, and impaired intellect. Isaacs asserted that, if examined closely enough, all common problems with older people relate back to one or more of these giants.

The care of older people in the UK has been advanced by the implementation of the National Service Frameworks for Older People, which outlines key areas for attention.