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The portrait of a future: expectations about an experience at a French geriatric hospital
The portrait of a future: expectations about an experience at a French geriatric hospital
“How sad it is! I shall grow old, and horrible, and dreadful. But this Picture will remain always young. It will never be older than this particular day of June....If it were only the other way! If it were I who was to be always young, and the picture that was to grow old! For that...for that I would give everything! Yes, there is nothing in the whole world I would not give! I would give my soul for that!"
Oscar Wilde in The Picture of Dorian Gray
In the beginning of the twentieth century, Oscar Wilde portrayed ageing as a horrible process. However, in the twenty-first century, this picture needs to be reinterpreted. In real life we do not have the literary capacity to freeze time in a picture, but there are solutions to promote healthy ageing.
Improved living conditions and medical care have led to increased life expectancy and to an ageing population. The fact that there are more elderly is not enough to ensure that society keeps up with this demographic change. The elderly often continue to be considered, and to consider themselves, a burden1. As an Internal Medicine Intern, this issue is a daily occurrence. The average age of patients hospitalized in the Medicine Services exceeds seventy. In the service where I work, for the past three months the average age of patients admitted was 78 years. In my follow up of these patients, I face huge differences between their chronological age and their physiological, functional, psychological, and social ages. Dependency and disability even before patients reach the age of 65 is as frequent as autonomy in people over 90 years of age and who have so much life experience to share. This context was responsible for my interest in the field of Gerontology.
The last years of life may be marked by illness and disability. Geriatrics is the medical specialty that prevents, treats or monitors changes in the elderly, particularly the changes that provoke lack of autonomy2.
In Portugal there has been an increase in population aged over 65 years. In 2010, 18% of the Portuguese population was over 65 years of age, which represents a 2% increase with regard to 20033. On a world level, forecasts indicate that the number of elderly people will triple by 2050 and will account for 79% of the population1. National evolution follows international demographic data, but the medical specialty of Geriatrics does not yet exist. The elderly population is generally seen by Internists and General and Family Medicine Practitioners.
Nonetheless, there are idiosyncrasies that are specific to healthy ageing, as well as a body of theoretical and practical knowledge to promote it. The syllabus of postgraduate training in Internal Medicine includes optional partial internships in areas of interest for the full training of Interns. The aim of a partial internship in Geriatrics is to enable the acquisition of knowledge that can be used in daily clinical practice. The fact that no Geriatrics service exists in Portugal imposes the need to move to a foreign country. The general aims of this internship period are the acquisition of technical skills in Geriatrics and gaining an understanding of the functioning of a Geriatric Unit.
The Unit chosen for the internship is located in Paris, at the Hôpital Européen Georges Pompidou, which opened in 2000, and is, thus, the most recent of the major Parisian hospitals. Creating expectations about any topic presupposes a prior research on it, for which reason we share with you the characteristics of this Unit.
The Geriatric Unit of the Hôpital Européen Georges Pompidou is composed of 26 Inpatient beds, a Day Hospital with 5 beds and an Outpatient Clinic. Professor Olivier Saint Jean, a professor of Geriatrics at the University Paris Descartes, has been the head of the Unit since its inception2,4. The Inpatient activity includes the treatment of acute illnesses of very old patients. The Outpatient Hospital welcomes patients for laboratory tests without the need for hospitalization. Its main activities include the diagnostic evaluation of changes in memory and overall geriatric assessment. The outpatient clinic focuses on the identification and treatment of debilitating diseases of the elderly.
Besides providing assistance, the Unit also conducts research involving the analysis of health systems, the provision of assistance to ageing related diseases (programme PRISMA France) and the study of the appropriateness of using more invasive therapeutic measures and the hospitalization of geriatric population. This service focuses particularly on cancer in elderly patients4.Undertaking a partial internship in Geriatrics at a Unit with these characteristics is thus relevant as a means to gaining the intended skills. Working at a Unit of this kind for a period of three months is an opportunity to assist elderly patients hospitalized for acute illness in a ward that was specifically designed for that purpose without adapting existing structures. It will equally enable a comparison with Internal Medicine wards in Portugal, which receive mostly geriatric age patients.
Following up the outpatient hospital and clinic will enhance the clinical practice with regard comprehensive geriatric assessment and a practical differentiation in the approach to the main geriatric syndromes, in which the risk of falling and dementia stand out prominently. A practical and prolonged experience in Geriatric Oncology enhanced the interest of this internship. We also hope to gain a better understanding of the organizational dynamics of this Geriatrics Unit, which may act as a model and inspiration to a similar future service in Portugal. The aim of this internship is to allow us to gain skills and acquire the tools to paint a less gloomy picture of ageing.
In the twenty first century, our role is to promote healthy ageing so that the future will portray the joy of being old, independent and able.
Lia Marques
Independent Assistant at the University Geriatric Unit of the Faculty of Medicine of the University of Lisbon
Intern at the Internal Medicine Internship at Medical Service III of the Northern Lisbon Hospital Centre; + 351 964728113 marques.lia@gmail.com
Bibliography: 1. J. Gorjão Clara. Saber viver ao entardecer... Sugestões para envelhecer com qualidade. Professor Fernando Pádua Foundation, with the support of Pfizer, 280430/08 (14).
2. http://www.longuevieetautonomie.fr/
3. http://www.pordata.pt
4. http://www.aphp.fr
“How sad it is! I shall grow old, and horrible, and dreadful. But this Picture will remain always young. It will never be older than this particular day of June....If it were only the other way! If it were I who was to be always young, and the picture that was to grow old! For that...for that I would give everything! Yes, there is nothing in the whole world I would not give! I would give my soul for that!"
Oscar Wilde in The Picture of Dorian Gray
In the beginning of the twentieth century, Oscar Wilde portrayed ageing as a horrible process. However, in the twenty-first century, this picture needs to be reinterpreted. In real life we do not have the literary capacity to freeze time in a picture, but there are solutions to promote healthy ageing.
Improved living conditions and medical care have led to increased life expectancy and to an ageing population. The fact that there are more elderly is not enough to ensure that society keeps up with this demographic change. The elderly often continue to be considered, and to consider themselves, a burden1. As an Internal Medicine Intern, this issue is a daily occurrence. The average age of patients hospitalized in the Medicine Services exceeds seventy. In the service where I work, for the past three months the average age of patients admitted was 78 years. In my follow up of these patients, I face huge differences between their chronological age and their physiological, functional, psychological, and social ages. Dependency and disability even before patients reach the age of 65 is as frequent as autonomy in people over 90 years of age and who have so much life experience to share. This context was responsible for my interest in the field of Gerontology.
The last years of life may be marked by illness and disability. Geriatrics is the medical specialty that prevents, treats or monitors changes in the elderly, particularly the changes that provoke lack of autonomy2.
In Portugal there has been an increase in population aged over 65 years. In 2010, 18% of the Portuguese population was over 65 years of age, which represents a 2% increase with regard to 20033. On a world level, forecasts indicate that the number of elderly people will triple by 2050 and will account for 79% of the population1. National evolution follows international demographic data, but the medical specialty of Geriatrics does not yet exist. The elderly population is generally seen by Internists and General and Family Medicine Practitioners.
Nonetheless, there are idiosyncrasies that are specific to healthy ageing, as well as a body of theoretical and practical knowledge to promote it. The syllabus of postgraduate training in Internal Medicine includes optional partial internships in areas of interest for the full training of Interns. The aim of a partial internship in Geriatrics is to enable the acquisition of knowledge that can be used in daily clinical practice. The fact that no Geriatrics service exists in Portugal imposes the need to move to a foreign country. The general aims of this internship period are the acquisition of technical skills in Geriatrics and gaining an understanding of the functioning of a Geriatric Unit.
The Unit chosen for the internship is located in Paris, at the Hôpital Européen Georges Pompidou, which opened in 2000, and is, thus, the most recent of the major Parisian hospitals. Creating expectations about any topic presupposes a prior research on it, for which reason we share with you the characteristics of this Unit.
The Geriatric Unit of the Hôpital Européen Georges Pompidou is composed of 26 Inpatient beds, a Day Hospital with 5 beds and an Outpatient Clinic. Professor Olivier Saint Jean, a professor of Geriatrics at the University Paris Descartes, has been the head of the Unit since its inception2,4. The Inpatient activity includes the treatment of acute illnesses of very old patients. The Outpatient Hospital welcomes patients for laboratory tests without the need for hospitalization. Its main activities include the diagnostic evaluation of changes in memory and overall geriatric assessment. The outpatient clinic focuses on the identification and treatment of debilitating diseases of the elderly.
Besides providing assistance, the Unit also conducts research involving the analysis of health systems, the provision of assistance to ageing related diseases (programme PRISMA France) and the study of the appropriateness of using more invasive therapeutic measures and the hospitalization of geriatric population. This service focuses particularly on cancer in elderly patients4.Undertaking a partial internship in Geriatrics at a Unit with these characteristics is thus relevant as a means to gaining the intended skills. Working at a Unit of this kind for a period of three months is an opportunity to assist elderly patients hospitalized for acute illness in a ward that was specifically designed for that purpose without adapting existing structures. It will equally enable a comparison with Internal Medicine wards in Portugal, which receive mostly geriatric age patients.
Following up the outpatient hospital and clinic will enhance the clinical practice with regard comprehensive geriatric assessment and a practical differentiation in the approach to the main geriatric syndromes, in which the risk of falling and dementia stand out prominently. A practical and prolonged experience in Geriatric Oncology enhanced the interest of this internship. We also hope to gain a better understanding of the organizational dynamics of this Geriatrics Unit, which may act as a model and inspiration to a similar future service in Portugal. The aim of this internship is to allow us to gain skills and acquire the tools to paint a less gloomy picture of ageing.
In the twenty first century, our role is to promote healthy ageing so that the future will portray the joy of being old, independent and able.
Lia Marques
Independent Assistant at the University Geriatric Unit of the Faculty of Medicine of the University of Lisbon
Intern at the Internal Medicine Internship at Medical Service III of the Northern Lisbon Hospital Centre; + 351 964728113 marques.lia@gmail.com
Bibliography: 1. J. Gorjão Clara. Saber viver ao entardecer... Sugestões para envelhecer com qualidade. Professor Fernando Pádua Foundation, with the support of Pfizer, 280430/08 (14).
2. http://www.longuevieetautonomie.fr/
3. http://www.pordata.pt
4. http://www.aphp.fr
