Christine K. Cassel

"On April 20, 1988, throughout the United States and Canada, the first certification examination in will be administered. Those who pass will be awarded a certificate "of recognition of added competence" in geriatrics. This is a landmark event, for several diverse reasons. has emerged as a well-defined field of expertise. Since the now almost legendary committee, chaired by , issued its report in 1979,1 stating that there was clearly a distinct area of geriatric medicine that could be identified by its special body of knowledge and approach to patient care, there has been growing acceptance of that assertion. While at first many in academic medicine and community practice were skeptical, saying "I have been taking care of old people for years already," there is an increasing understanding of better ways to evaluate patients, establish the goals of treatment, and achieve those goals."

"The science of has advanced dramatically. As recently as 20 years ago, theories of the were just beginning to emerge and were largely theoretical. ... In the last 2 decades, advances in genetics and have led to extraordinary new understandings in how cells age, how programs cells to die, and how plays a role in the lifespan of organisms. ... The dual challenges for the 21st century are to link progress in basic science and clinical research to effective clinical care, and to create a health care system with properly trained physicians to provide evidence-based care for the growing numbers of older people."

"The landscape of the US continues to undergo change. As market forces are invoked to drive lower cost, better access, and improved quality, the entities in the health care market continue to diversify. For instance, (with personal electronic health records), // (with the promise of an affordable nonprofit employer health care system), / (combining a health plan with s), emerging -- relationships, and (in discussion to acquire ) represent major relatively recent developments. CVS/Aetna is the most well-developed of these changes. Nearly 6 years ago, the growth of retail clinics was described as a potentially positive disruptor, especially in the expansion of access and convenience.1 Many clinicians were concerned about lack of continuity and delegation of care to nonphysicians, yet these clinics seemed to offer a more accessible and less costly point of care compared with emergency department visits or even physicians’ office visits. If retail clinics could overcome the limits of legacy electronic health records to connect to other components of patients’ care, this model could even create a virtual comprehensive “system” as a point of connectivity and care coordination."