When this book was originally conceived, geriatrics was still in its developmental phase. It was unclear then whether geriatrics would emerge as a subspecialty on its own or as a basis for educating others in the elements of caring for frail older persons. Much has happened in the intervening two decades. It now appears that the majority of care for older persons will remain in the hands of primary care practitioners; but those ranks have changed. Nurse practitioners are much more evident. At the same time, the importance of chronic disease care in general is more widely appreciated. Many of the principles of good geriatrics care can apply as readily to this larger topic; they are captured within this text.
We continue to view this book as a practical guide, designed for use by a wide variety of present and future practitioners. It presumes a good basic working knowledge of medicine and stresses those aspects of care that are important in helping older persons to live more comfortable lives.
Each new edition provides the opportunity (indeed the need) to look back over the time since its predecessor to determine just how much has changed. The past 5 years or so saw some important developments our understanding of aging, including the emergence of genetics as a potentially potent clinical process. Some new drugs emerged. Some concepts, such as the role of hormone replacement therapy, were reexamined. Medical practice now endorses concepts such as evidence-based medicine and is still struggling to produce the evidence on which to base it, but some well-established practice guidelines are still not widely adopted. But the largest changes seem to have occurred in the way health care is organized and financed. Prospective payment has been extended to many forms of care beyond the hospital. Managed care continues to evolve.
We hope that when we look back on the next 5 years, they will be viewed as period of great mastery of geriatric principles and active incorporation of new and more effective methods of providing care. As we draw ever closer to that demographic horizon when the aging population will demand more-efficient methods to provide necessary and affordable care, we will certainly need a medical work force that is well versed in geriatrics. If this book helps to achieve that goal, we will have accomplished something of value.