Optimising drug treatment for elderly people: the prescribing cascade

Old age has always been with us.The ancient Egyptians and the author of the 12th chapter of Ecclesiastes were familiar with the common disabilities of later life.Survival into what we still regard as old age was not unusual in classical Greece (table).The average length of human life has increased over the centuries as living conditions have improved and childhood mortality has fallen; the maximum lifespan of our species is determined largely by our genes and will be the same as it ever was.Doctors and philosophers of antiquity commented on age associated illness.Hippocrates noted conditions common in later life, and Aristotle offered a theory of aging based on loss of heat.Two thousand years were to pass before anything better was written on the subject.Francis Bacon proposed a scientific programme of epidemiological investigations into the longevity of people living in different places and under different conditions. 1 He also noted that the pursuit of knowledge depended on "the fresh examination of particulars," advice that underlaid the systematic observation of nature that complemented the active experimentation advocated by his contemporary William Harvey.During the 18th and 19th centuries several physicians wrote specifically about the diseases of later life and their treatment.These included Cheyne 2 and Day 3 in Britain and Rush 4 in the United States.Charcot's lectures on the medicine of old age aroused scientific interest in the field and became available in English translation in 1881. 5 The word "geriatrics" was invented by Ignatz L Nascher, a Vienna-born immigrant to the United States in 1909. 6(It is not clear who is to blame for the barbarous miscoining of "gerontology"-the study of old men-for "geratology"-the study of old age.)Nascher's initiative provided a stimulus for social and biological research on aging, 7 but clinical geriatrics did not flourish in the United States.The American Geriatrics Society was founded in 1942, but as a thriving and influential medical specialty geriatric medicine was essentially a product of the British NHS. Old age in classical Greece