Geriatricians must move with their patients into the community

Less than 50 years ago the plight of sick older people in the United Kingdom was pitiful. Chronically sick old people were left to languish bedridden in the most miserable of circumstances. The specialty of geriatric medicine developed in the 1950s as a response to the particular health needs of frail older people.1 Timely response to crises, comprehensive assessment of needs, multidisciplinary management focused on reducing disability, and helping older people to remain at home while recognising the needs of family carers became the underlying principles. These elements have become accepted and implemented in many countries, with convincing evidence of effectiveness.2 Britain is still unique, however, in the extent to which geriatricians work in the acute hospital sector, and a major triumph of elderly care medicine has been the unquestioned access of acutely ill older people to district general hospitals. With these successes it is therefore surprising that geriatric medicine is now …