GERONTOLOGY AND GERIATRICS

scientific and medical disciplines, respectively, that are concerned with all aspects of health and disease in the elderly, and with the normal aging process. Gerontology is the scientific study of the phenomena of aging, by which is meant the progressive changes that take place in a cell, a tissue, an organ system, a total organism, or a group of organisms with the passage of time. Aging is part of the development sequence of the entire life span, from prenatal growth to senescence. Gerontology, however, is concerned primarily with the changes that occur between the attainment of maturity and the death of the individual and with the factors that influence these changes. The problems of gerontology fall into four major categories: (1) social and economic problems precipitated by the increasing number of elderly people in the population, (2) psychological aspects of aging, which include intellectual performance and personal adjustment, (3) physiological bases of aging, along with pathological deviations and disease processes, and (4) general biological aspects of aging in all animal species. Gerontology utilizes the methodologies of many other scientific and medical disciplines. The goal of research in gerontology is to learn more about the aging processnot for the purpose of extending the life span but for the purpose of possibly minimizing the disabilities and handicaps of old age. Geriatrics is the branch of medical science concerned with the prevention and treatment of diseases in older people; it is thus a part of the broader field of gerontology. Before the 19th century, when most people died before reaching old age, there was little demand for physicians to specialize in the care of the elderly; declining health was regarded as an inevitable accompaniment to old age. The first to stress the importance of special studies of disease in old age was the French physician Jean-Martin Charcot in 1881, but few physicians undertook those studies until the early 20th century. It was then observed that a large number of pathological changes occurred among older people and that an understanding of the aging process might lead to less disease in the elderly. Thus was the study of gerontology begun. Marjory Warren in Britain in the 1930s demonstrated that specific care plans for chronically ill older patients, previously considered to have irremediable conditions, could prevent many of the worst consequences of aging. As people older than 65 came to constitute an increasing proportion of the population in developed nations in the 20th century, it became apparent that specialized physicians dedicated to treating the diseases associated with old age were needed; this need was recognized by the British government after World War II, resulting in improved training in geriatric medicine in that country. In the United States, the specialty is less organized than in Europe, and much of the impetus for improved training in geriatric medicine has come from internists with a personal interest in treating geriatric patients; nevertheless, an increasing number of physicians with geriatric expertise have been trained.