It is not always easy to be a geriatrician

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Anne Ekdahl is a geriatrician at the Vrinnevihospital in Sweden and the president of the Swedish Association of Geriatric Medicine.

As in many other countries in Europe it is not always easy to be a geriatrician. I came back from the EUGMS 2013 Congress in Venice full of power, spirit and pride in being a geriatrician: and then it was suddenly back to reality. In Sweden the National Authorities evaluating research are going to publish a report in December about the effects of Comprehensive Geriatric Assessment and in the Swedish translation the word “geriatric” does not appear. To my astonishment CGA is called something like “Structured Care of Old People”. It could be about anything. The report is otherwise well written and I can assure you that the effect of CGA/SCOP is just as good as in earlier meta-analyses – but also confirms – as many of you know – that much of the research is rather old.
I cannot help thinking that the word “geriatric” must pose some kind of a threat at least in Sweden – or why should it not be used?

Back to struggling. In my department we have performed an RCT comparing the effects of adding CGA-based care in community-dwelling frail elderly with “just” usual care. This study was possible because of a time-restricted amount of money from the Swedish Government – and now all the money has been spent. It was not that much money – about 1000 EURO per patient per year. The results are very promising not at least in terms of mortality. We are going to do health-economic evaluations but the results are not there yet and we have a small amount of data-collection to do during the next two months, so I asked for possibility to continue to take care of the patients and informed them about the good survival rate up to now – but that was not interesting to the leaders of my hospital. “Come back when you have the health-economic evaluation” they said – the mortality rate did not matter.

And I will come back. Then they will have to explain why the life of the frail old people does
not merit financial support. I do not know the results of my RCT yet – but it could be that the
better survival rate will result in more costs in total – dead patients are cheap patients. But I
hope though that the study will be able to show that we have saved money in terms of less
hospital care and more people living home instead of in institutions together with a lot of
other positive effects, we will see – but for now ONLY money talks.

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