Just Steps Ahead of the Baby Boomers, American Geriatrics Society Turns 65

Just four years before the first of the nation's 77 million baby boomers turn 65, the American Geriatrics Society is about to reach that milestone. The society, founded in 1942, celebrates its 65th anniversary this June.

"You could say that the AGS has, in many respects, matured along with the population," says AGS President Jane Potter, MD, professor and chief of the section of geriatrics at the University of Nebraska Medical Center.

The Early Years
Founded by Wakefield, Rhode Island physician Malford W. Thewlis, MD, the AGS met for the first time at Atlantic City's Hotel Brighton on June 11, 1942. The society's stated mission was "to encourage and promote the study of geriatrics," Dr. Thewlis noted, using the term Ignatz Leo Nascher, MD, a pioneer in the field, had coined 30 years earlier. Dr. Nascher advocated establishing a specialty focused on the care of older adults and his work, which included the first U.S. textbook on geriatric medicine, influenced Dr. Thewlis. At AGS' first meeting, he and the other 29 physicians in attendance named Dr. Nascher the society's honorary president. They also discussed, among other clinical issues, the treatment of heart disease and anesthesia for older patients.

Over the next decade, the Society saw steady growth in membership, which was open to physicians, PhDs, "physiotherapists, hospital superintendents, registered occupational therapists, directors of homes for the aged, social and welfare workers, and other responsible lay persons." AGS counted 1,400 members by 1953, the year the Society launched the Journal of the American Geriatrics Society (JAGS), the nation's first peer-reviewed journal dedicated to healthcare for older adults. The inaugural issue of JAGS included articles on the treatment of rheumatoid arthritis, tracheotomy in the aging, and surgery for older patients.

Seven years later, the Society made its first foray into public policy advocacy -- by supporting the passage of the "Kerr-Mills bill," legislation to provide medical benefits to poor older Americans. Elements of Kerr-Mills were later incorporated into the Medicare and Medicaid programs, which were created in 1965, the same year the Older Americans Act was signed into law. Both the creation of the entitlement programs and passage of the act helped raise awareness of the unique needs of older people -- and broadened the focus and role of the AGS.

"The establishment of Medicare and Medicaid and passage of the Older Americans Act were among some key milestones in the development of geriatric medicine that are anchors for AGS' development," notes Gregg A. Warshaw, MD, AGS President from 1996 to1997 and professor of geriatric medicine at the University of Cincinnati.

The creation of the National Institute on Aging (NIA) in 1974 was another. (See related story) Among other things, the NIA established key geriatrics training awards, including awards that helped medical schools build geriatrics programs.

"These awards supported schools not for doing research, but for developing programs, which was unique and brilliant because the dividends were so substantial," says Leo Cooney, MD, AGS President from 1990 to 1991, and professor of geriatrics and chief of the section of geriatrics at Yale University School of Medicine. "Excellent geriatrics programs developed at schools where people were supported by this initiative."

In this and other ways, the founding of the NIA drew academic physicians into geriatrics -- and into the AGS.

"What characterized the AGS from its early years to 1974, when the NIA was established, was a focus on clinical services for older people in the community," Dr. Warshaw explains. "Prior to '74, AGS was made up largely of clinicians -- people who saw patients in the community and were doing a lot to improve the quality of care of people in the community, but didn't focus on influencing medical education or medical research."

Maturing as a Society and a Discipline
The years immediately following the founding of the NIA -- which were punctuated by the Veteran's Administration's (VA) creation of the nation's first Geriatric Research Education Clinical Centers -- saw an influx of academics not only into the society, but also onto its Board of Directors, and into other key positions. In 1981, Paul Beeson, MD, - the former Nuffield Professor of Medicine at Oxford who headed the 1978 Institute of Medicine study that called for increased physician training in geriatric medicine- took over as editor-in-chief of JAGS, elevating the stature of both the journal and the AGS.

"This was the time when people like Bill Reichel and Knight Steel, who had strong academic ties, set out on a mission to make AGS into a modern medical society, with an educational and research focus, while not losing sight of the need to also focus on clinical care," says L. Gregory Pawlson, MD, AGS president from 1989 to 1990, and Executive Vice President of the National Committee for Quality Assurance.

With these changes came a greater emphasis on research presentations at the Society's annual scientific meeting; greater collaboration with the American Foundation for Aging Research (which began taking part in the meetings); the building of geriatric fellowships; and the recruitment of Linda Hiddemen Barondess from the American College of Physicians, an organization at the forefront of education and research.

Taking the helm as Executive Vice President in 1982, Barondess computerized operations at the Society's New York City headquarters, and added staff. "I saw very early on," she notes, "how important it was for us to recruit talented individuals to the staff and I've been fortunate to be able to work with many talented individuals over the years." Barondess also spearheaded major programs to boost flagging membership, revenues, and public and private support for research conferences, training programs and other initiatives. In addition to promoting research and training, she expanded AGS' roles in public policy advocacy and public education.

"I think the tremendous growth the Society saw starting in the 80s is due to multiple factors and one is the vision of Linda Barondess - it's her vision and her persistence and she deserves a lot of credit," says Joseph Ouslander, MD, AGS president from 1999 to 2000 and both professor of medicine and nursing and the director of the division of geriatric medicine and gerontology at Emory University. "There has also been a great deal of good professional voluntary leadership in the AGS that has made it stronger. And this, in turn, has engendered a lot of support from the VA, the Hartford Foundation, the Reynolds Foundation, and the Atlantic Philanthropies as well as industry and other organizations."

Throughout the 80s and 90s, AGS and its members played lead roles in establishing geriatrics as a discipline in medicine. As more academic physicians entered the field, Dr. Warshaw notes, support for certification in geriatrics grew. "The academics were saying, "We need to be able to certify ourselves and our trainees to have some kind of credibility in medical schools to create more curriculum and research,"" he explains. In 1988, the American Board of Internal Medicine and American Board of Family Medicine developed the first certification exams in geriatric medicine -- with AGS members making vital contributions. Members were also influential in the subsequent development of guidelines for fellowship training, and the creation of certified geriatrics programs at medical schools.

"An awful lot happened during this period," says Dr. Cooney. "We went from having a few folks at a few schools to active programs at virtually all schools, and many of the accrediting councils deciding that geriatrics should be a requirement for medical students and residents, particularly in internal and family medicine. AGS and AGS members were a force in virtually all those activities. "

AGS Begins to Reach Out to Educate Others on the Unique Healthcare Needs of Older Adults
It was at this time that AGS also stepped up its efforts to influence public policy and the nation's healthcare delivery system. In 1989, the Society opened its Washington DC office. AGS' efforts paid off, among other ways, in greater federal support for the training of geriatrics healthcare professionals, says Dr. Pawlson, who was a Robert Wood Johnson Health Policy Fellow in DC during the mid to late 80s and helped lead AGS' efforts to broaden its advocacy role. Subsequent work to strengthen AGS' network of state affiliates - which are involved in advocacy at the state level -- complemented policy advocacy in the capitol.

In '89, the Society also published the first edition of its Geriatrics Review Syllabus: A Core Curriculum in Geriatric Medicine, a self-assessment program and evidence-based review that drew on the growing output of research in aging that followed the NIA's creation. Within four years, more than 15,000 copies of the GRS had been sold, further boosting recognition of geriatrics and understanding of older adults' unique healthcare needs. Membership in the Society and meeting attendance were growing significantly as well.

"I went to my first AGS meeting in 1978 and there was a plenary session to which everyone came - it was in a single room that held under 300 people," recalls Dr. Potter. "Now we have a couple thousand people in multiple sessions."

Though Dr. Nascher envisioned geriatrics as an analogue to pediatrics, by the early 90s it was clear that this wouldn't be the case.

"In the U.S., about 80% of children receive their care from pediatricians; but we realized by the '90s that there wouldn't be enough geriatricians to provide general care to all older adults," Dr. Warshaw recalls. "There was this recognition that we needed to reach out and do a better job training other physicians and healthcare professionals to care for older people, and that the geriatrician's role would be more focused on research, training and caring for particularly high risk older people."

As a result, many of the Society's efforts over the last two decades have aimed at expanding educational programs to include other physicians and healthcare professionals and the public, and boosting advocacy to raise awareness of the importance of appropriate elder care among the public and legislators.

Programs such as the Society's longstanding partnership with the John A. Hartford Foundation on the Geriatrics-for-Specialists Initiative, launched in 2002, were outcomes of these efforts. A stepped-up campaign to recruit non-physicians into the AGS was another. Though membership in the Society had been open to all healthcare professionals from the start, and the practice of geriatrics was highly interdisciplinary, AGS leaders realized they had to do more to recruit geriatric nurse practitioners, nurses, physician assistants, social workers, pharmacists and other providers into both the organization and leadership roles. Increasingly interdisciplinary, membership grew significantly thanks to recruitment efforts. It now nears 6,500. AGS' staff also grew and now includes 27 full- and part-timers.

"Over the years, staff have been key to advancing the Society's goals; we owe them a debt of appreciation," says Dr. Potter.

Another milestone in AGS' efforts to reach out to an increasingly broad group of healthcare providers was publication of the first edition of AGS' pocket-sized Geriatrics at Your Fingertips (GAYF) in 1998. Concise and portable, GAYF made comprehensive, up-to-date information on geriatrics care available to an even wider audience.

"Geriatrics at Your Fingertips was meant to more broadly provide a concise source of information needed to make clinical decisions in real time for anyone providing care for older people," notes David B. Reuben, MD, director of the UCLA Multicampus Program in Geriatric Medicine and Gerontology and AGS President from 2005 to 2006 . Dr. Reuben conceived of and continues as GAYF's lead author.

Reaching out further-to older adults and their caregivers - AGS established the Foundation for Health in Aging (FHA) in 1999. In addition to advancing the principles and practice of geriatric medicine and supporting aging research, the foundation is charged with educating the public and legislators and encouraging older adults and their caregivers to advocate for quality care.

"There was this recognition that there's so much to accomplish in public education, that to improve quality care we also needed to partner with older adults and their children -- and this is what led to the FHA," Dr. Potter recalls.

The FHA, which offers a free referral service to connect older adults with geriatrics practitioners, published its award winning caregiver's guide, Eldercare at Home, in 2004 and launched its acclaimed consumer Web site, www.healthinaging.org, in 2005. The Health in Aging Advocacy Center, www.americangeriatrics.org/advocacy, a Web-based advocacy site for members and others interested in improving healthcare for older Americans, debuted last spring. Equipped with software from Get Active, one of the leading vendors of advocacy software, the site makes joining AGS' advocacy efforts, and encouraging friends and others to do the same, quick and easy.

"Our next step after expanding our public education work was to engage the public in advocacy efforts," explains Dr. Potter. "As the database of geriatric medicine has grown and we've learned more about what is required for optimal care of older individuals, it's much more apparent that we need to be more engaged in policy to address the broader system. Just delivering good healthcare is insufficient unless the healthcare system is in alignment."

Meeting the Challenges of an Aging Population
Efforts to ensure that the healthcare system provides adequate compensation for geriatrics healthcare providers are key to addressing a leading challenge the Society faces in coming years: recruiting promising professionals into geriatrics. Relatively low compensation, among other issues, is a disincentive to enter the field. Though geriatrics enjoys a far higher profile today than in 1942 - it was formally recognized as a subspecialty of internal medicine in 2006 - the current shortage of geriatrics healthcare professionals is expected to grow.

The Society has taken a number of steps to encourage medical school students to consider geriatrics. Plans call for expanding these efforts to other healthcare professionals as well. In addition, AGS' new "Five Highways" strategic plan, adopted last year, reiterates the Society's commitment to recruiting health professionals into geriatrics. The plan also calls for a greater emphasis on raising awareness of the need for geriatrics care and advocating for public policy supporting it, and confirms AGS' commitment to building the geriatrics knowledge base and increasing the number of healthcare professionals employing the principles of geriatrics care.

Recruiting the next generation of professionals into geriatrics, into the Society and into leadership positions at AGS and other organizations and institutions committed to improving care for older adults will be key, Dr. Reuben and others agree.

"I think the next 5 to 10 years will be absolutely critical," Reuben says. "There are many geriatrics leaders who have been in their positions 20 years and these people are going to be taking different jobs or retiring. So we're facing this whole transition to new leadership in geriatrics. Making sure new leaders are prepared, have good ideas, and are empowered to implement them is going to be one of the most important issues. AGS also needs to make sure new people are integrated into the leadership of the society. We'll need new faces."