Putting Geriatric Medicine on the Map

  • Medicine & Health
  • 1982

The number of elderly Americans is in the midst of doubling in less than one generation—to a total of more than 70 million. And they are heavy consumers of medical care. Though persons older than 65 account for only 13 percent of the population, they account for four out of every ten surgeries today and 44 percent of all visits to primary physicians. More than 40 percent of the elderly are currently taking five or more medications, and seniors with multiple chronic illnesses make an average of 37 annual visits to 14 different physicians, who write them 50 separate prescriptions.

With these stark realities in mind, starting in 1982 the John A. Hartford Foundation established a tight and disciplined focus on building the emerging field of geriatric medicine. A product of the A&P grocery fortune, the Hartford Foundation had been the largest funder of biomedical research in America during the mid-twentieth century decades prior to the growth of the National Institutes of Health. During this period the foundation underwrote many major medical innovations (see 1954 entry). The organization has proved equally savvy and influential in its latest focus on the health of the aged.

In the early ’80s, Hartford set up many programs to build expertise in the new field of geriatrics, and offered multiple grants to recruit physicians into it. Among other efforts, money was provided to 13 medical schools to help them recruit and train faculty. The foundation then made 16 separate grants to pioneer the field of geriatric pharmacology, improving the safety and efficiency of drug-dispensing to the aged. Next, it funded efforts to develop geriatric subspecialties in fields like surgery, internal medicine, and primary care. To attract top researchers to medical problems associated with aging, the foundation devoted $39 million to establishing the now-prestigious Paul Beeson Awards.

Eventually, 28 Centers of Excellence were established with Hartford money at academic medical centers, deepening the quality of geriatric training. Major effort was also devoted to developing the profession of geriatric nursing. Soon after, a similar push funded the rise of geriatric social work, primarily by identifying leading scholars and funding them in faculty positions. Finally, Hartford was a strong leader in efforts to help frail elderly remain in their homes rather than being institutionalized.

From 1982 to 2012, the Hartford Foundation awarded 560 grants worth $451 million solely to improve health-care provision for the elderly—funding that experts say was unusually seminal. The foundation magnified its influence by allying itself with several other savvy donors working on geriatric care, including the Atlantic Philanthropies, the Robert Wood Johnson Foundation, the Donald W. Reynolds Foundation, and others.

The result? “With program after program, they changed the health-care system and improved health-care outcomes for older adults,” states the director of the Johns Hopkins Geriatric Education Center, John Burton. The former dean of the University of Pennsylvania School of Nursing, Claire Fagin, makes a similar observation: “The contribution of the Hartford Foundation in putting geriatrics and gerontology on the map has been monumental. It is emblematic of what foundations should be doing in the sense of changing the field.”