jags and the geriatrics renaissance

SPECIAL EDITORIALS

JAGS 50:5–6, 2002© 2002 by the American Geriatrics Society 0002-8614/02/$15.00

JAGS

and the Geriatrics Renaissance

F

rom its founding, the

Journal of the American Geriat-rics Society (JAGS)

has been inseparable from theAmerican Geriatrics Society (AGS), which spawned it.This has not been true of all specialty journals and theirsponsoring societies. Perhaps the marriage in geriatrics ismore binding because the name of the

Journal

guaranteesit. I have been particularly interested in cataloguing the re-naissance in geriatrics that began in 1975 or so, and it isclear that the

Journal

mirrored, fostered, and recordedthat renaissance.

JAGS mirrored

the geriatrics renaissance by undergo-ing a renaissance of its own. In a masterful stroke, the So-ciety was able to induce Paul Beeson to assume the editor-ship in 1978. He performed remarkable alchemy, turningit from a truly backwater journal of anecdotes and case re-ports to the beginnings of a modern clinical science jour-nal. The rest of us editors have simply followed his lead,perhaps introducing some progressive changes every fewyears when the editorship moved but basically allowingthe rising tide of excellent scientific papers to sweep the

Journal

along. A journal is no better than the quality ofthe manuscripts submitted to it, so the fact that

JAGS

mir-rored the renaissance should not surprise anyone.

JAGS fostered

the renaissance by setting high stan-dards for acceptance of papers, arousing the interest ofoutstanding people to write invited articles, and formingnew sections of the

Journal.

An excellent example was theintroduction of a section on Medical Ethics and Humani-ties by Eugene Stollerman, editor, and David Thomasma,section editor. There have been many others, and now the

Journal

has eight section editors.In many ways, the

Journal

and the AGS have fed oneach other, combining to make geriatrics the widely re-spected specialty it is today. I can attest to the stature of theAGS from personal experience. John Burton and I have been

codirecting the AGS-run, Hartford-financed project,

Increas-ing Geriatrics Expertise in Surgical and Related MedicalSpecialties.

In pursuing this endeavor, we are in constantcommunication with leaders in the fields of anesthesiology,emergency medicine, general surgery, gynecology, ophthal-mology, orthopedics, otolaryngology, physical medicine andrehabilitation, thoracic surgery, and urology. When we pro-posed that the leadership group for the project expandinto a professional society, the leaders chose to make it aSection in the AGS, rejecting many other possible alli-ances. When the same leadership group developed a State-ment of Principles for geriatric care in the specialties, it chose

JAGS

for the primary publication site. We can concludethat, even in far-flung fields not previously attentive to ge-

riatrics, the Society, the

Journal

, and the field are now heldin high esteem.

JAGS

recorded

the renaissance. It became the major,although not exclusive, site for the publication of the re-search reports that led the way to accelerated progress inthe field of geriatrics. To follow the progress in the diagno-sis and management of geriatric syndromes, one only needreview the volumes of

JAGS

, where everything important iseither published or, in the case of the breakthrough articlespublished in the major general journals, cited.

Let us trace the renaissance briefly. In 1975, three re-markable events heralded a revolution in the care of olderpeople. Robert Butler published the Pulitzer Prize–winningbook,

Why Survive? Being Old in America

and catapultedthe plight of older people into the national spotlight.

1

TheNational Institute on Aging was created by law in 1974and was launched in 1975 with a paltry budget of $19million but with Bob Butler as the first Director (anothermasterful stroke). The then Veterans Administration (nowDepartment of Veterans Affairs) funded the first eight Ge-riatric Research, Education and Clinical Centers.

By 1980, the renaissance was unstoppable. Fellowshipssprang up, and medical students and residents began to hearabout the principles of good geriatric care. Syndromes suchas incontinence, falling, dementia, and late-life depression—

largely ignored by previous generations of physicians—beganto receive attention. Geriatrics divisions were created in manymedical schools with a diverse cadre of faculty made up ofyoung graduates of geriatrics fellowships and generally ledby more-senior physicians, some of them geriatriciansemerging from behind a curtain of ageism that had beenerected by the medical profession, while others were con-verts from other specialties and subspecialties. In the early1980s, foundations, principally the John A. Hartford Foun-dation, began to provide financial support for teaching, re-search, and patient care in geriatrics.

At first, geriatrics entered into an era of descriptive re-search directed at outlining the clinical features, evalua-tions, courses, and outcomes of illnesses and syndromescharacteristic of older patients. This phase was based onmany cross-sectional observations or epidemiological analy-ses of large data sets and the rare cohort study with longi-tudinal data. Some observational studies were prospectivebut most were retrospective.

So compelling was the “demographic imperative”

2

that the aims of research rapidly transformed into risk-fac-tor identification and intervention trials. The former wasan easily available by-product of multivariate analyses ofcross-sectional and cohort studies, as well as of the base-

6

SOLOMON

JANUARY 2002–VOL. 50, NO. 1 JAGS

line data on study groups in intervention trials. The inter-vention trials, alternatively, required a higher order oftime, energy, and courage and a fixation on rigorous ex-perimental design and execution.

By recording the results of the wave of research thataccompanied, indeed epitomized, the geriatrics renaissance,the

Journal

has established itself as one of the leading spe-cialty journals in the nation. How could one have madethat statement 25 years ago? Now it is nearly 50 years oldand heading for 100. Long live

JAGS!

David H. Solomon, MDProfessor Emeritus of Medicine/Geriatrics

UCLA School of MedicineLos Angeles, CA

REFERENCES

1. Butler RN. Why Survive? Being Old in America. New York, NY: Harper andRow, 1975.

2. Somers AR, Fabian DR. The Geriatric Imperative: An Introduction to Gerontol-ogy and Clinical Geriatrics. New York, NY: Appleton-Century-Crofts, 1981.