[Specialism in geriatrics and training as a geriatrician. The development of geriatrics as a medical specialty].

Two geriatricians--Belgian and Dutch--have attempted to define their ideas and principles regarding clinical geriatrics based on their work. They strongly recommend the establishment of geriatric hospital departments which are in level and prestige equal to other hospital departments. As attending specialist the geriatrician is responsible for the overall-management of elderly patients with multiple pathology, delicate balances, specific clinical syndromes, mutual involvement of somatic and mental disorders, loss of functions, etc. The execution of this task is based on clinical expertise, knowledge of specific provisions for the elderly in the community and on teamwork with the nursing and paramedical staff of the geriatric department who know how to deal with geriatric patients. Close co-operation with other specialists is necessary to guarantee the quality of the care. Geriatricians and other specialists need to complement each other. In addition it is necessary that the geriatrician select one or more areas of special interest in the extensive professional field in order to carry out clinical research. It is important that geriatric patients are not admitted in hospital departments where they happen to be referred to, but where they have the best chance of recovery. As the geriatric department offers a specific approach, it is recommended that the very old will be admitted there in the first place unless they urgently need other specialist treatment. The elderly who are in serious distress as far as general care is concerned, but do not need hospital expertise, have to be taken care of in other ways.