Key words:

Geriatrics, population dynamics, aging, geriatric doctor, older adults, geriatric

institute, history, geriatric medicine.

Abstract:

The demographic and epidemiological transition experienced by the world

population, including the Latin American and Caribbean countries, are associated
with an aging population and an increased prevalence of chronic diseases that
influence functional dependence and increased direct and indirect medical costs. It
is expected that 1 of 4 Mexicans will be 60 years old or older by the year 2050. Since
1985, universities in this country have developed academic programs to train
medical and paramedical staff in the care of older adults. The Institute of Geriatrics,
of Mexicos Ministry of Health, was founded by a presidential decree on July, 2008.
Its goals are to develop training programs in Geriatrics and Gerontology based on
excellence, to promote and develop original research on aging and to participate in
the creation of health policies and programs aimed at providing high-quality medical
services for the elderly.

Prominent physicians had already talked about peculiarities of problems and illness
among elderly subjects, but it was not until the beginning of XX century that emerge
two disciplines specially devoted to the study of problems in ageing; Gerontology
and Geriatric Medicine.

In Mexico during Spanish colony, the care of elderly was dedicated only to the social
and physical handicapped by monastic orders that founded hospices and hospitals
to take care of elderly. At the end of XIX and beginning of XX century Mexican
government and private groups developed public welfare for elderly. It was not until
seventies, last century, which gerontology was important in our country due to an
increasing in life span and decreasing in child mortality. Different institutions
interested in gerontology were created but geriatrics as a medical specialty emerge
only with the first two university programs in Mexico in the Universidad Nacional
Autonoma de Mexico in 1992 and Universidad de Guadalajara in 1995. Most of the
Geriatrics services are in Mexico City an the first service founded out of this place
was at the Antiguo Hospital Civil de Guadalajara in 1994. History of Geriatrics in
Mexico just begins but its future is promissory even when a delay in its development
is evident.
Introduction:

The term geriatrics designates medical care for the elderly, this group that is not
easy to define accurately. This medical specialty should pay attention to the clinical
aspects present in the diseases as well as to the prevention of them and especially
to the social aspects that may influence the health of the elderly such as: loneliness,
isolation, dependency, etc.

The present paper describes in a simple way the history and the development of
geriatrics in Mexico and the objectives of its realization are detailed below:

General objective :
To summarize the history and development of geriatrics in Mexico.

Specific objective :
To identify the origin of geriatric in Mexico
To describe the teaching of geriatrics as a medical specialty
To analyze the current condition of geriatrics in Mexico.

Knowing the history and development of geriatrics will help us to make a

chronological record of the events that have marked the development of the same
and to have a tool where the data of the medical specialty are stored where the data
of that medical specialty And that will also serve as a consultation for students
interested in that subject.
Geriatrics in Mxico

The aging process that the population is experiencing at the global level is
responsible for the emergence of new health problems and social and economic
needs that the countries of Latin America, within which Mexico is included, are not
prepared to solve.

The increase in the population of older adults will be responsible for the diseases
that hit humanity also change; this epidemiological1 transition will be characterized
by an increase in the prevalence of chronic diseases and their complications, as well
as by a decrease in infectious and nutritional diseases. In Latin America and the
Caribbean we are at a stage where high fat diets, high tobacco consumption and
sedentary lifestyles generate an increase in cardiovascular diseases - such as
ischemic heart disease and cerebrovascular disease - Primarily affecting
populations under 50 years of age. Following the development and implementation
of programs for the detection and management of diseases such as diabetes mellitus
and systemic arterial hypertension, these complications will occur more frequently in
the elderly.2

Situation in Mexico

The National Population Council (CONAPO) developed estimates of the aging of the
Mexican population by 2050.3 The increase in older people will be a consequence
of the increase in life expectancy, which is expected to reach 80 years in men and
almost 85 years in the women. The population pyramid allows us to compare the
age distribution in Mexico in 2005 and see that older adults will represent almost a
third of the population by 2050.
One of the major problems of the aging population in Mexico is that 69.3% of the
population aged 65 and over lives in low- or very low-level municipalities, with little
access to basic health services despite the existence of social support programs.4
That is why programs designed to provide social, economic and medical services to
this vulnerable population are required - and are in development. However,
interventions should not be limited to the population of older adults, but rather should
establish national programs of successful aging that allow healthy lifestyles to be
established for the population of young people who by 2050 will be older adults.

In Mexico, chronic non-communicable diseases are among the first 10 causes of

post-productive mortality reported in 2005 by the Ministry of Health, with diabetes
mellitus being the first of them since 3 years ago. The challenge of health systems
in Mexico is the training of medical and paramedical personnel in the care of the
elderly, as well as the inclusion of geriatrics in undergraduate and postgraduate
academic programs.

History and emergence of geriatrics

A relevant antecedent on the aging in our country rests with Dr. Manuel Payn in
1957, who promotes and represents the Government of Mexico in the first Pan
American Congress of Gerontology in Mexico City5, however, it was not until the
1970s When the issue of aging becomes increasingly important when perceiving the
transition of the population, as a result of the increase in life expectancy, a decline
in infant mortality and a reduction in the birth rate.

At that same time the emergence of different institutions related to Geriatrics like the
Geriatrics and Gerontology Society of Mexico AC (GEMAC) in 1977, the National
Institute of Senectud (INSEN) on August 22, 1979 and in 1984 by Initiative of Dr.
Lozano Cardoso begins its activities the Mexican Association of Gerontology and
Geriatrics (AMGG). Until the 1980s, care for the elderly continued to be limited to
public and private residences known as nursing homes, most of which provided only
basic food and shelter services without the infrastructure, programs and professional
human resources for real geriatric- Geriatric. The medical attention was provided by
doctors who exercised the most diverse specialties, the internist doctor, as to date,
was the one that rendered a more integral attention especially in social security
institutions or of the health sector since in the private medicine even today more is
used to other specialists.

Geriatrics as a specialty in Mexico

Geriatrics, like other specialties in our country, arises from the interest of doctors
from other disciplines who, motivated by entering Geriatrics, learn in a self-taught
way the care of the elderly and those who wanted to formalize their studies had to
travel abroad to specialize, Which gives rise to the development of different schools
in the practice and teaching of Geriatrics in our country.

In 1985 the first master's degree in sciences with orientation in Geriatrics in the
National School of Medicine and Homeopathy of the National Polytechnical Institute.
Geriatrics began in the medical school of the UNAM in 1989 and in 2002 in the
University of Guadalajara being now obligatory in most of the country's medical
schools and only recently the specialized programs in internal medicine included
subjects In Geriatrics. However, the professors who teach Geriatrics are, for the
most part, specialists outside the field of Geriatrics or Gerontology.

In other countries, Geriatrics can be practiced by doctors of any specialty, especially

internists and family doctors, but the need for previous training in internal medicine
is required, given the characteristics of the geriatric patient. This requirement has
been maintained since the beginning of the first university programs in our country.

In 1986, Dr. Rosala Rodrguez started the first program in medical gerontology at
the Adolfo Lpez Mateos Regional Hospital of ISSSTE in the Federal District, along
with Dr. Salinas at the University of Nuevo Len. In 1993 Dr. Luis Miguel Gutierrez
Robledo, internist Geriatra of the National Institute of Medical Sciences and Nutrition
"Salvador Zubirn" (INCMNSZ) created the first university program in the UNAM of
the geriatrics specialty for internists. With Dr. Gutirrez Robledo formally began in
Geriatrics Mexico as a specialty with headquarters in INCMNSZ in 1994.

In 1995 Dr. David Leal Mora Internist graduated from Geriatrics at the Johns Hopkins
Geriatrics Center in Baltimore U.S.A. Begins the first university program outside the
city of Mexico endorsed by the University of Guadalajara.

Geriatrics services in Mexico City

The activities related to the care of the elderly begin at the General Hospital of
Mexico on the initiative of Dr. Arturo Lozano Cardoso in 1978, an effort added to Dr.
Armando Pichardo Fuster and Dr. Leonor Pedrero Nieto, all specialty cardiologists.

Dr. Luis Miguel Gutierrez, like all those who sought to perform the specialty of
geriatrics, found himself in need of traveling abroad, where appropriate, to the
University of Grenoble, France, where he specializes in Geriatrics and Gerontology
and upon his return The geriatric assessment clinic at the INCMNSZ 1989 attached
to the Gastroenterology Service and in 1992 found the geriatrics section as an
independent service.
Most Geriatrics hospitals are concentrated in the capital of the country, in the health
sector, the National Institute of Medical Sciences and Nutrition "Salvador Zubirn",
the General Hospital of Mexico, the Hospital of Petrleos Mexicanos, The Gustavo
Baz Prada General Hospital, the Fray Bernardino Alvarez Hospital (area for
psychiatric elders) and the Adolfo Lpez Mateos Hospital of ISSSTE6. In the private
sector, the ABC Hospital and the Hospital de la Beneficencia Espaola.

Of the health sector institutions with national coverage, only the ISSSTE has given
a great boost to geriatric care, thanks to the work that has been developed by Dr.
Rosala Rodrguez. On the contrary, the IMSS has lagged behind as it does not yet
incorporate Geriatrics into its specialties despite the fact that the attention of the
older adult is one of its main priority programs. In this institution, the La Raza National
Medical Center, the Magdalena de las Salinas Hospital and the General and
Regional Hospital Gabriel Mancera have specialized geriatric care highlighting the
one carried out by Dr. Zoila Trujillo.

The geriatrics institute of Ministry of Health

On December 13, 2007, the National Academy of Medicine of Mexico and the
Coordinating Commission of the National Institutes of Health and High Specialty
Hospitals held the International Seminar "Research on Aging and Health: A National
Imperative". Presented the Technical Report of the Ad Hoc Group for the analysis of
the feasibility of creating the National Institute of Geriatrics.

The document presented generated consensus in the sense of creating a National

Institute of Geriatrics, in order that those who are dedicated to research and teaching
in this area should have the support to develop the necessary knowledge for the
elderly adult population.
The work developed by the Ad Hoc Group culminated on July 28, 2008, with the
signing of the decree creating the Institute of Geriatrics. In the ceremony presided
by Felipe Caldern Hinojosa, president of the Republic, also were Jose Angel
Cordova Villalobos, Secretary of Health; Jess Kumate, former secretary of Health,
and Juan Molinar Horcasitas, then director of the Mexican Institute of Social Security.
Said decree was published in the Official Gazette of the Federation on July 29 of the
same year.

The National Health Program provides the frame of reference for the academic and
research work developed by the Institute of Geriatrics, as it fulfills its mandate:

Strengthen and integrate actions to promote health and prevent and control
diseases. Strengthen research and teaching in health for the development of
knowledge and human resources. It also takes up the strategies outlined in
the Action Plan on Health in the Elderly.
The health of older people in public policies.
Adapt health systems to the challenges of aging.
Training of human resources.
Generation of information to execute and evaluate actions that improve the
health of the elderly. The Institute of Geriatrics maintains as a guide the
following objectives:
To contribute to the development of the highest academic standards for the
study and practice of geriatrics and gerontology.
Conduct and promote research that supports the evidence for decision
making about the biology of aging; The social and economic determinants of
health in old age; The causes, prevention and treatment of diseases
associated with aging; The promotion of health to promote an active and
healthy aging; The creation or modification of models of care, programs and
policies; And the development of new technologies to improve the quality of
life of the elderly.
 Participate in the definition of policies and programs for the training of
specialized human resources.
Develop standards for the provision of social support services and long-term
care that serve as a reference for the care of the elderly and as support to
families and social support networks.
Generate and disseminate knowledge about aging in all its aspects aimed at
health professionals, society and the elderly and their families.
Promote the incorporation of new scientific knowledge in the formulation of
public policies related to aging.
Contribute to the definition of public policies to promote the healthy aging of
the population in Mexico.

The Geriatrics Institute is conceived as the beginning of a great project that seeks,
within the National Health System, to generate plans and programs of great impact
in the care of the elderly and in the process of aging of the population. This impact
is reflected in the horizontal link with other components of the National Health
System, in the improvement of quality standards of services and in the training of
specialized personnel. The projection of the Institute of Geriatrics is directed
towards:

1. Cross-sectoral linkage: a horizontal link has been established with all sectors
involved in the care and study of the country's elderly population, both at the
public and private levels, promoting that, through a health care network, it can
be applied at the national level .
2. Linkage with Universities and Institutions of Higher Education: The Institute
of Geriatrics should participate jointly with Universities and Associations of
Medicine Faculties in the formation of educational programs of
undergraduate, postgraduate and continuous medical education to ensure
the training of physicians and staff Affinity of the country in the branches of
 geriatrics and gerontology, favoring the creation of new specialists and
allowing to improve the quality of the medical care of the elderly.
3. Linkage with the National Institutes of Health and Hospitals of High Specialty:
Together with these institutions, we will seek the creation of autonomous
spaces specialized in the care of elderly people who do not have a social
security service and where services are provided Quality according to the
needs of the older adult patient.
4. Promotion of innovative models of care: beyond strengthening existing
services and disseminating current models of care, the role of the Geriatrics
Institute will be fundamentally of innovation in the generation of new
healthcare modalities, in particular those designed to become alternatives to
Hospitalization and those that promote the maintenance at home of the
chronically ill and dependent elderly. Among the options that are already
envisaged is the development of a telemedicine program.
5. Attention standards: a primary role will be played in generating standards of
care for the elderly, favoring selective primary care that allows the
establishment of individual treatments that seek independence and social
integration, as well as development and validation Of clinical guidelines for
the diagnosis and treatment of the elderly's own pathology.
6. Institutional and home care of patients with long-term care: worldwide
experience has shown that strict regulations are essential for the
establishment and functioning of institutions dedicated to the care of patients,
regardless of the degree of disability they present. The Institute of Geriatrics
can propose the minimum requirements for these institutions and disseminate
clinical guidelines for the diagnosis and management of geriatric syndromes,
adapted to the context of long-term care institutions, use of bras and
guidelines for the rehabilitation of patients.
7. International projection: the Institute of Geriatrics will develop an influential
position at the international level, particularly in Latin America, by contributing
to a better understanding of the phenomenon of aging and through the
dissemination of locally generated information and collaboration in studies
Multinationals. The international linkage will allow the Institute to access the
advances in countries that already have a culture developed in the field of
aging research and the policies formulated based on the results of the
research.
Conclusion:

Given the importance of providing quality care to the elderly and with a view to
promoting the learning of geriatrics in undergraduate medical students and other
related careers, we approach the essential concepts of geriatric evolution in a
practical and concise manner , Providing with this precise definitions of this specialty
and its objectives as a branch of medicine, specifying what is an elder, what levels
or models of care exist for this population and the importance of a multidisciplinary
team for its management.

Knowing the above mentioned will allow the identification of the importance of
providing medical care to the elderly based on the principles of autonomy, justice,
beneficence and non-maleficence. In addition, it will address some of the ethical
dilemmas observed in daily practice.

Knowing the history and evolution of geriatrics in Mexico will help to focus on the
biological, psychological and social aspects, in addition to making possible the
systematic observation of the therapeutic process and the result of medical-social
actions, with the aim of preventing or at least delaying, the appearance of
incapacities and makes it possible to program the care plan at any level of health,
even in the patient's own home.
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