Geriatric medicine: whose specialty?

The recommendation of the 1978 report of the Institute of Medicine, Washington, D.C., states that there should not be "a formal practice specialty in geriatrics." The United Kingdom has a comprehensive geriatric service based on a separate specialty of geriatric medicine. This speciality was developed before the National Health Service in 1948. The future of geriatric medicine is not clearly defined. It should continue, I believe, as a separate speciality but with deliberate policies to bring it back into "mainstream medicine." This will involve closer integration with family practice, internal medicine, and psychiatry. While I realize that the operation of the geriatric service in Edinburgh, where I work, could not simply be transplanted into an American setting, the principles of geriatric care ought to be applied within a specialist service if the increasing problems of the aging in American society are to be adequately met.