These ‘giants’ have changed over the past 50 years. The understanding of ‘modern geriatric giants’ has evolved to encompass the four new syndromes of frailty, sarcopenia, the anorexia of ageing, and cognitive impairment.2 These syndromes are the harbingers of falls, hip fractures, affective disorders and delirium with their associated increase in morbidity and mortality.2

All medical specialties need to be able to succinctly explain what they do, and in geriatric medicine this can be particularly difficult as there is a degree of breadth in the management of complexity, frailty and health in old age.3 Clarity in what a specialty does is vital when it comes to communicating roles within a health system.

Geriatricians at times have been guilty of being over complicated in their descriptions of their roles, in an well meaning attempt to describe the complexity of a fascinating discipline. In 2013, Heckman et al commented that rather than broad all-inclusive definitions, what geriatric medicine required was a short description of core competencies within the discipline of geriatrics.4 This could be packaged in a way to communicate with colleagues in other medical specialties, policy-makers and the general public.4 Indeed, such an approach is the very nature of marketing in many other sectors.

 

What are the 5Ms?

Mary Tinnetti delivered a keynote address in April 2017 at the Canadian Geriatric Society Conference. During that address she outlined the concept of the Geriatric 5Ms—a simple construct which defines the core competencies of geriatric medicine in a manner which is memorable for those inside and outside of the specialty.5

The 5Ms include mind, mobility, medications, multi-complexity and matters most (and can be counted on the fingers of one hand!). In a recent British Geriatrics Society newsletter, an article reports how well received it was by trainees and consultants alike.3 Indeed, they have been referred to as the ‘geriatricians salute’ and the ‘high five to geriatrics’!

 

Patient-centred definition

Chronically ill older adults often see multiple specialist physicians—all working within their own disease silo—with no one physician responsible for overall patient care.6 If physicians follow single disease based guidelines for older patients with multi-morbidity, they could drive polypharmacy as they don’t provide guidance on how best to prioritise recommendations for individuals in whom treatment burden will sometimes be overwhelming.7

However, taking this responsibility for patient-centric medicine and patient-centred decision making is one of the cornerstones of geriatric medical practice. Therefore, one of the important components of the Geriatric 5Ms is ‘matters most,’ recognising the importance of the patient at the centre of geriatric care delivery.

The Geriatric 5Ms provides an approach that allows geriatricians and those with an interest in geriatric medicine to communicate what they do. Furthermore, the 5Ms place the patient at the centre of what we do in ‘matters most,’ recognising the importance and salience of patient-centred care in geriatrics where pragmatic medicine is often delivered.

 

Dr Lloyd D Hughes, GP Registrar, Pediatric Medicine, NHS Fife

 


References

1. A giant of geriatric medicine – Professor Bernard Isaacs (1924 – 1995). British Geriatrics Society. Available from: http://www.bgs.org.uk/geriatricmedicinearchive/bgsarchive/biographies/a-giant-of-geriatric-medicine-professor-bernard-isaacs-1924-1995 (Accessed 26th July 2018)

2. Morley JE. The New Geriatric Giants. Clinics in Geriatric Medicine 2017; 33(3): xi-xii

3. Adams J,Molnar F. The GERIATRIC 5Ms – Giants for the Next Generation. BGS Newsletter 2018; 65(5): 8

4. Heckman GA, Molnar FJ, Lee L. Geriatric medicine leadership of health care transformation: To be or not to be? Can Geriatr J 2013; 6: 192–95

5. Tinetti M, Huang A, Molnar F. The Geriatrics 5M’s: A New Way of Communicating What We Do. J Am Geriatr Soc 2017; 65(9): 2115

6. Fleming MO, Haney TT. An Imperative: Patient-Centered Care for Our Aging Population. Ochsner J 2013 Summer; 13(2): 190–193

7. Hughes LD, McMurdo MET, Guthrie B. Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to older people with multiple co-morbidities. Age Ageing 2013; 42(1): 62–69