Intended for healthcare professionals

Education And Debate

Demographic shifts and medical training

BMJ 1999; 319 doi: (Published 20 November 1999) Cite this as: BMJ 1999;319:1358
  1. Shah Ebrahim, professor of epidemiology of ageing (
  1. Department of Social Medicine, University of Bristol, Bristol BS8 2PR

    Let me die a young man's death,

    not a clean and inbetween

    the sheets holywater death

    not a famous-last-words

    peaceful out of breath death.

    Roger McGough1 1

    We all want to go quickly when the time comes—but most of us linger and more of us will become enmeshed with health services before we die. Most of us will see our 85th birthday, but unfortunately for a quarter of us, that will be through the haze of a dementia syndrome or some other chronic disease or disability.

    Summary points

    Increasing subspecialisation in medicine produces doctors who are unable to deal with the complexity of multiple pathology found in most older people

    Undergraduate medical education reforms are forcing specific training in geriatric medicine out of the curriculum

    Postgraduate education requires reorganisation, including mandatory attachments in geriatric medicine, to ensure that all doctors are capable of managing elderly patients appropriately

    Globalisation of employment for doctors and nurses means that curriculums in developing countries may not meet the needs of those who practise in industrialised countries

    Traditional medical careers are changing so that many doctors will need to gain new skills and consider career changes over the course of their lives

    Demographic change and medical training

    Industrialised countries will see a massive increase in the numbers of both young old (age 60-74) and old old (age 75 or more) over the next two decades. The postwar baby boom generation will become the young pensioners in 2020 and the numbers of very elderly people will also increase substantially from current levels. In Great Britain, the number of people aged 85 years and over has increased by 25% over seven years.2 Populations in developing countries are ageing more rapidly than those in the developed world, and this has implications for medical training in these places. The growing globalisation of employment for many health professionals, particularly …

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