COMMENTARY ON SPECIAL ARTICLE
Happy Birthday to the Journal: Best Paper of the 1980s
Elizabeth L. Cobbs, MD
I was a bit startled to learn that the Journal of the AmericanGeriatrics Society (JAGS) and I are the same age. (Actually,I’m 10 days older, having arrived earlier than expected on asnowy December night as my mother scrambled to finishher Christmas cards.) I was further dismayed when, pagingthrough issues of the 1980s, I found the dominant adver-tisement was for sedatives such as diazepam, featuringphotographs of vigorous looking 70-year olds engagedin activities such as painting in oils and playing tennis.Were the 1980s as enlightened as they had seemed at thetime?
In this issue, the Journal reprints the paper chosen asbest representing the work of the 1980s with a lasting effectin the field of aging: ‘‘The National Institutes of Health(NIH) Consensus Development Conference Statement:Geriatric Assessment Methods for Clinical Decision-Making.’’1 A close runner-up was the ‘‘Report of the Insti-tute of Medicine: Academic Geriatrics for the Year 2000,’’which put forth recommendations for training academicgeriatric leaders; establishing geriatric ‘‘centers of excel-lence’’; attracting students, residents, fellows, and facultyinto geriatrics; and developing financial resources tosupport academic geriatric medicine.2 Geriatric medicinetoday rests on the foundation illustrated by these two papers.
The 1980s saw sweeping changes affecting the care ofolder adults and the training of health professionals car-ing for older adults in the United States. The fact that thegeriatric assessment paper comes from NIH underscores theimportant role that the federal government plays in opti-mizing the health of older Americans. NIH began produc-ing consensus statements in 1977 to evaluate complexissues.3 The consensus development conference format hasproduced 116 independent statements, developed bynonadvocate, nonfederal panels of experts and based onevidence, questions, and statements presented by investi-gators. Most of the consensus statements from the 1970sand 1980s are no longer valid, but the geriatric assessmentpaper continues to hold its own. It is the third of five NIHConsensus Statements that focus specifically on healthconcerns of older adults. ‘‘Treatable Brain Disease in theElderly’’ (1979) and ‘‘Estrogen Use and Post Menopausal
Women’’ (1979) are both outdated. Subsequent NIH Con-sensus Statements pertaining to older adults included‘‘Treatment of Sleep Disorders of Older People’’ (1990)and ‘‘Diagnosis and Treatment of Late Life Depression’’(1991), both still valid. None of these had the significance ofgeriatric assessment. In another venue of the federal govern-ment, the Omnibus Budget Reconciliation Act of 1987aimed to extensively reform the care of persons in nursinghomes and resulted in the creation of new platforms for themandatory use of multidisciplinary geriatric assessment,employing tools such as the Minimum Data Set andaccompanying instruments, which are in widespread usetoday.
Beginning in 1988 (subsequently revised and re-viewed), the American Geriatrics Society Public PolicyCommittee recommended that elements of comprehensivegeriatric assessment (CGA) be incorporated into the care offrail, older patients, that further research on CGA be apriority for funding agencies, that CGA be part of thecurriculum for all medical training programs, and thatMedicare and other insurers recognize aspects of CGA asreimbursable services.4 Momentum in expansion of ge-riatric medical training grew, and new funding becameavailable for a variety of educational experiences. In 1988,an examination for added qualifications in geriatric medi-cine was offered to eligible internists and family physicians.By the end of the decade, multidisciplinary CGA hadbecome an important component of geriatric medicaleducation and practice.
Despite the limited evidence supporting the effective-ness of specific geriatric assessment activities and the lack ofdirect reimbursement to providers under Medicare, geri-atric assessment remains a flagship of geriatric medicinetoday and a cornerstone of health care for older adults withfunctional impairments. Assessment programs vary acrossdifferent settings, but most are aimed at serving older per-sons at risk for progressive functional decline, suboptimalcare, institutionalization, and death. Healthcare organiza-tions that provide comprehensive care to older adults (suchas the Department of Veterans Affairs) systematically in-corporate multidisciplinary geriatric assessment into pro-cesses of care. Indeed geriatric assessment forms the founda-tion for patient-centered plans of care, which are needed toachieve the best combination of disease-modifying andpalliative treatments in accordance with the values ofseriously ill patients and their families. Geriatric assessmentis an effective tool to guide clinical decision-making inpalliative and rehabilitative care.
Address correspondence to Elizabeth L. Cobbs, MD, Washington DCVeterans Affairs Medical Center, George Washington University 2b-418,2150 Pennsylvania Avenue, NW, Washington, DC 20037.E-mail: [email protected]
From the Washington DC Veterans Affairs Medical Center, GeorgeWashington University, Washington, DC.
JAGS 51:1495–1496, 2003r 2003 by the American Geriatrics Society 0002-8614/03/$15.00
As JAGS and I turn 50, there are things to celebrate.Geriatric assessment seems to have held up better thandiazepam. And my mother is still writing Christmas cards.
REFERENCES
1. Consensus Development Panel – Solomon D and Members of the Panel.
National Institutes of Health Consensus Development Conference Statement:
Geriatric Assessment Methods for Clinical Decision-Making. J Am Geriatr
Soc 1988;36:342–347.
2. Report of the Institute of Medicine. Academic Geriatrics for the Year 2000.
Committee on Leadership for Academic Geriatric Medicine. J Am Geriatr Soc
1987;35:773–791.
3. Consensus Statements. NIH Consensus Development Program [On-line]. Avail-
able: http://odp.od.nih.gov/consensus/cons/cons.htm, Accessed April 27, 2003.
4. The American Geriatrics Society-Position Paper. Comprehensive Geriatric
Assessment Statement [On-line]. Available: http://www.americangeriatrics.
org/products/positionpapers/cga.shtml, Accessed April 27, 2003.
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