Geriatric Medicine in South Africa – a Cinderella subspecialty?
Monica Ferreira
Source : South African Family Practice, Volume 48, Issue 5, Jun 2006, p. 18
Accreditation : Department of Higher Education and Training (DHET)
Geriatric Medicine in South Africa – a Cinderella subspecialty? CPD Editorial Population ageing is a worldwide phenomenon and follows a decline in birth and death rates. Longevity and a greater number of people living to an advanced age are a major achievement for humankind. However, a consequence of the demographic shift is an escalating demand for health care as a result of increases in chronic and age-specific diseases and disabilities. The transition is more rapid in developing countries, which also have fewer resources than the developed countries to meet the challenges of an ageing population. Geriatric Medicine (GM) is a relatively recent subspecialty but has been well-established in a small number of tertiary institutions in South Africa since the 1980s. The first chair of geriatrics was installed at the University of Cape Town but was frozen by the provincial government in 2000. Nonetheless, the Division of Geriatric Medicine at that institution remains the leading geriatrics focal point in the country. The University of KwaZuluNatal has the only other chair, and only two or three other institutions, notably the University of Stellenbosch, have a geriatrics unit. The development and expansion of GM in the country has been hampered by political and financial vagaries, or institutional priorities. Advancement of the subspecialty has been bedevilled further by a shrinkage of training posts and few career opportunities for graduates in the subspecialty. The country has only seven registered geriatricians, three of whom are in private practice. A relative lack of interest in GM among the medical fraternity and a view that the subspecialty is super uous have also retarded its growth and acceptance. A countrywide survey of medical practitioners’ attitudes to Geriatric Medicine and older patients conducted in 20041 showed high levels of disinterest in the subspecialty and negativity towards such patients. Although nine in ten respondents attended older patients daily or weekly, only 3.1 % had been exposed to any post-graduate training in GM. Only a minority (6.6%) had ever considered geriatrics as a speciality. Attitudes were negative in all domains of characteristics of older patients, but least negative attitudes were correlated with shorter duration of practice (<19.7 years), younger age of the practitioner (<45.4 years), private sector employment and frequent attendance to older patients. Only 15 % viewed work with older patients positively; three-quarters viewed
