Geriatric Medicine - Section of UEMS

Specialty recognition and number of specialists

In 1970s training of physicians has been recognized as an important issue in the health education and independent Sub-Chair of Geriatrics and Gerontology at the Institute of Postgraduate Medical Education in Prague was established in 1974 under the leadership of Prof. Vladimír Pacovský, president of the society. The main role of this newly established department was to initiate training of physicians in geriatric medicine. Later on, in 1983 the society succeeded in establishing geriatrics as independent new medical sub-specialty with 3 years-long professional training after the internal/general medicine common trunk. In 1980, first medical textbooks of gerontology and geriatrics have been published in Czech language. Since 1986 the number of board-certified specalists in geriatric medicine was growing steadily. Over the years more than 250 geriatricians have completed the geriatric fellowship training and board-certification (2010) in the Institute of Postgraduate Medical Education in Prague. Currently, 60 fellows are currently in training. However, due to retirement and other circumstance, only about 170 is currently working as physicians in geriatric facilities.
 

Geriatric medicine
In 2004 and later in 2009, postgraduate training of physicians in geriatric medicine has been re-structured. After significant effort of Czech Society of Gerontology and Geriatrics geriatrics medicine remained an independent “main” specialty in the family of internal medicine specialties. New fellowship program has been developed and accredited by the Czech Ministry of Health in 2009 responding to the development in Europe and compatible with UEMS-Geriatric Medicine Section recommendations. It lasts altogether 4 years with two years of he common trunk + further 2 years of specialized training in geriatric medicine with obligatory clinical practice in psychogeriatrics, neurology, rehabilitation and optional training in dermatology, palliative care, primary care or home care settings. About 20 centres have been accredited for specialist’s training since 2006.

Psycho-geriatrics
Psycho-geriatrics (old age psychiatry) became a sub-speciality of psychiatry (one year certified training) but number of specialists in CR is limited to a dozen.

Long-term-care medicine
Since 2009 a new subspecialty of Long-term-care medicine has been approved (one year certified training) and made available for board-certified physicians in a range of specialties with the aim to improve care for chronically ill older persons.

Geriatric training in other specialists´ training
Geriatric topics are part of the common trunk in internal medicine family of specialties with limited number of “geriatric conditions” being enclosed in trainee’s logbook. For Internal Medicine, one month of clinical practice in accredited geriatric training facilities is required. Recently, importance to train general practitioners (GP) in basic geriatric knowledge has been recognized and CR participated in international project to develop and pilot nation-wide training of GP

Continuing medical education
Continuing medical education in geriatric medicine for geriatricians and/or other medical specialists is ensured by several bodies: Institute of Postgraduate Medical Education, Chamber of Czech Physicians, Medical Faculties and Czech Society of Geriatrics and Gerontology, Czech Medical Association through courses, clinical training programs and congresses.

Position of Geriatric Medicine in the Czech Republic
Geriatric medicine in the Czech Republic is recognised as a medical speciality for a long time. However, its position and prestige remain rather low even if it is slowly gaining its credit. In medical faculties where academic departments exist (3 out of 8 faculties) the recognition of geriatrics has improved dramatically and students interest is increasing. In medical faculties without a formally established Chair of Geriatric Medicine its impact is rather low. It is extremely important to promote the existence of Chairs in all medical faculties and train and recruit suitable faculties for academic position.
An important achievement in 2000 was the accreditation of the Postgraduate Doctoral Studies in Gerontology, first formal research PhD program in Gerontology at Charles University in Prague (www.kav.cas.cz , Chair Prof. Topinková) which helped in promoting multidisciplinary research in gerontology and geriatrics. This is an important way how to attract young students to the field and improve the academic position of geriatric medicine as a scientific discipline. Currently 17 PhD students are enrolled in 4 years program. Other Medical Faculties have not explicit research programs in gerontology established, however clinical research is undertaken under other disciplines (e.g. internal medicine)

Academic geriatric medicine
Only 3 academic departments (out of 8 medical faculties) exist: Charles University Prague, 1st Medical Faculty, Department of Geriatrics (Chair Professor E. Topinková, MD, PhD) Charles University, Medical Faculty Hradec Králové, Department of Gerontology and Metabolism (Chair: Professor L. Sobotka, MD, PhD) Masaryk University Brno, Medical Faculty, Department of Internal Medicine, Geriatrics, Primary Care and Nursing (Chair: Professor H. Kubešová, MD, PhD). Other 8 Medical Faculties have no formal Chair established.
Undergraduate training in gerontology and geriatrics
Undergraduate training of health professionals has much shorter history compared to professional training. First officially recognized courses in geriatric medicine for medical students have been reported since the academic year 1991/2 (two Faculties of Medicine Charles University in Prague), at the same year social gerontology course was introduced at 1st Faculty of Medicine. The situation is changing very slowly despite the international and national recommendation to establish independent chairs and clinical departments of geriatrics at each medical faculty. The barriers for nation-wide dissemination of geriatric teaching programs are low number of potential faculty, low priority of the field and insufficient scientific production. A well established program in social gerontology for medical students exists at Medical Faculty Charles University in Plzen. In recent years undergraduate training of other paramedical staff (e.g. nurses, occupational and physiotherapists) was introduced at several universities (Praha, Ceské Budejovice, Ostrava, Brno, Pardubice, Olomouc, Zlin among others). Its acceptance and results are promising.

Czech Society of Gerontology and Geriatrics, Czech Medical Association (CGGS)
Česká gerontologická a geriatrická společnost, Česká lékařská společnost
CGGS was established in 1962. But it was only in early 80s when demographic ageing of the population and growing number of older persons together with their increasing need for medical, rehabilitative, nursing and community care speeded up further development of the field. Growing interest in clinical issues resulted in re-naming of the society as Czech Society of Gerontology and Geriatrics in 1993 shortly after splitting of the Czech and Slovak Republic in 1992.
The mission of the CGGS (www.cggs.cz ) from the very beginning was to improve care practice and care delivery of older people. This mission is being accomplished through complex tasks covering clincal practice and care, education, research and policy.
Current activities involve organization of congresses, conferences and meetings, ongoing scientific and educational activities and publications. Lot of effort is being put to policy and national programs to improve elderly care.
Annual Congress of Geriatrics and Gerontology takes place yearly with rotating hosting cities (Prague, Ostrava, Hradec Kralove). Several other important conferences and meetings take place each year (National Congress of Gerontology in the city of Hradec Kralove, Prague Days of Gerontology, Gerontological Days on regional level (Brno, Zlin, Ostrava, Karlovy Vary ect.).

Geriatric care in healh care system
At the health system level the wide spectrum of services for the elderly exist in the Czech Republic (acute care geriatrics, postacute care, long-term care and nursing care, specialised psycho-geriatrics, out-patients geriatric clinics, home care and home help, residential care and assisted living).
After the “velvet revolution” in 1990s the transformation of political and economic system was taking place followed by transformation of other sectors including education and health care. In 1992 a “National Gerontological Program” was launched by the Ministry of Health but due to shortage of money and low political priority it was stopped 3 years later. However, even during its short existence at least a dozen of geriatric centers were financially supported by this program. Transformation of chronic care begun but currently - almost 20 years later - is still ongoing with endless discussions about the optimal division of acute and chronic care provision, responsibility of health and/or social sectors, care quality and ways of its financing. Currently, many problems persists as for example insufficient number of acute geriatric beds (545 beds per 10 million population), low overall number of chronic care beds and facilities (9.6 nursing care beds per 1000 persons 65+), their uneven geographic distribution and availability, long waiting lists for placement, low staffing and financing and uneven quality of care. Compared to institutional long-term care, new and positive development occurred in community care. Home care agencies started operating in early 1990s and currently are providing full spectrum of home services from home help, meals on wheels, personal assistance, home nursing and, in some regions even rehabilitative or palliative care and end of life care. However, there are inequalities in its distribution throughout the country and in some regions help is inaccessible.

Udated 10/8/2012 by Prof. Eva Topinkova, MD, PhD

Prof. PhD

Eva Topinková

Prof. Dr., PhD

Pavel Weber