[Column] The power of geriatric medicine to drive change on the front line of care in an aged society

 It was around the end of 2023. A 95-year-old gentleman with a full head of white hair came into the consulting room supported by his son. He was a patient with spinal stenosis at the fourth and fifth lumbar vertebrae who had a strong will to rehabilitate, but who had spent several years repeating nothing but medication and injection treatment. When I asked why he had put off surgery until then, the answer came back that he had kept being told, "Why have surgery at your age? Just put up with it and live with it." It was the moment when I felt at first hand the reality of treating elderly patients, in which the individual's will to rehabilitate is hard to reflect fully — and at the same time began to envisage the Elderly-Specialized Care Task Force (TF), dedicated to surgery for patients aged 80 and over.

Our society still tends to take illness and pain in old age for granted. Because of a lack of infrastructure and the risks involved, patients are often advised to give up on treatment. In a super-aged society where more than 20% of the population is elderly, however, changing such fixed ideas is a task that has to be tackled. In 2024, health insurance medical costs for older adults came to 52.1935 trillion won, about 45% of the total. Medical costs also account for a large share of elderly household spending. In these circumstances, a structure that avoids active treatment for older adults can only increase the medical cost burden on society and on individuals alike.

It is not only a matter of cost. Health-related quality of life (HRQoL) affects many aspects of later life, including self-esteem, level of depression, participation in social activities and life satisfaction. It is also worth noting that older patients’ willingness to undergo treatment has grown compared with the past. This is the result of a spreading awareness of a healthy and independent old age and of improved access to medical information. Healthcare in later life is increasingly becoming an essential field for supporting a dignified old age.

Geriatrics, founded in 1909 by Dr. Ignatz Leo Nascher, rests on the argument that disease and treatment in later life should be handled as a separate field, matched to the physical characteristics of older people. Advanced countries in Europe and the United States, which experienced population aging before Korea, already run a variety of care models based on geriatrics.

Korea, too, needs to move faster in applying geriatrics in the field. What matters most is the role of local primary and secondary care institutions, which are the first to meet older patients on the front line of health care. A system must be put in place in which these institutions carry out standardized assessments of patient status and, based on the results, activate age-friendly care processes.

Even small hospitals need an environment in which treatment for older people can be considered and approached from the perspective of multidisciplinary collaborative care. That means not stopping at treating a single condition well, but comprehensively taking into account comorbidities and current medication, the physical characteristics of later life, and the emotional environment. To achieve this, the cultivation and dissemination of geriatric care systems tailored to primary and secondary care institutions must come first.

Accumulating experience in geriatric care and surgery is in itself likely to make the treatment process for elderly patients more refined and more efficient. Indeed, stability has recently been improving in anesthesia as well, long regarded as the greatest hurdle in surgery on elderly patients. Our hospital has also been running a dedicated team for specialized geriatric care for more than a year, precisely refining and advancing an anesthesia process tailored to elderly patients while continuing to build up a record of successful operations achieved through it.

The WHO describes treating the physical decline that comes with aging as an inevitable, natural phenomenon, and being reluctant to prevent or treat it, as a form of 'ageism' directed at oneself. This can be read as meaning that aging healthily and enjoying a dignified later life is everyone's right. Aging must come to be seen not as a path of giving up on health and enduring suffering, but as a process of moving toward the fulfillment of life.

Cultivating and applying geriatrics on the front line of care is an essential task for a super-aged society. Ultimately, care models for later life must be established in a direction that preserves and restores patients' quality of life. This single step will be an important starting point in making old age more dignified for us all. / Yoon, Kangjun, President of St. Peter's Hospital