Introduction
Geriatric medicine has been a recognized speciality since 1969 in Sweden. In December 2005 it was decided that geriatrics could remain as a specialty of its own and not, as had been suggested at that time, to become a subspecialty of Internal Medicine.
In 2007 there were 664 persons with specialist certificates in geriatrics in Sweden making it the 10th largest medical specialty. At the same time there were 110 physicians undergoing training in Geriatric Medicine, and thus every year there will be 30–40 new specialists, but at the same time the same number or even more will retire (at age 65).
It is estimated that about 450 specialists are working within Geriatric Medicine while the rest mainly work in primary care and Internal Medicine. Most geriatricians (80 %) are members of the Swedish Geriatric Society.
Delivery of geriatric services
Geriatric Medicine in Sweden is a hospital specialty. In the 70 hospitals in Sweden (pop. 9 130 000) there were at the end of 2006, of a total of 26 255 hospital beds of which 2 037 beds were in geriatric settings. Today there are 42 independent geriatric clinics as well as divisions in Internal Medicine clinics in Sweden. Many of these have acute care wards for an initial investigation of elderly usually with further planning of care, and also wards for the rehabilitation of stroke and osteoporosis related fractures and for the palliative care. The six university hospitals are well equipped with Geriatric medicine services compared to the rest of the country. In smaller hospitals there might be only a unit or a ward of geriatric service organized as part of an Internal Medicine clinic. Current studies of health care show a growing demand for geriatricians and there is a shortage in relation to available positions.
Many geriatric clinics have an out-patient unit which is often specialized for i.e. osteoporosis, dementia (memory clinics), stroke or general geriatrics. Patients can be referred from primary care. However, there are no specific geriatric services in primary care but there is a discussion about developing certain “units for the elderly”.
Long term care in nursing homes and homes for the elderly is the responsibility of primary care and the family physicians. Due to lack of GP:s and in some cases lack of interest in that kind of care geriatricians from geriatric clinics are in many instances delivering medical and geriatric care to nursing homes.
Only in the capital of Sweden, Stockholm, there are private Geriatric Medicine clinics, but almost all medical care and especially geriatric care in the country is financed publicly.
Pregraduate training in geriatric medicine
The medical faculties have a certain freedom to choose the curriculum for the medical students. Thus the pregraduate training in Geriatric Medicine range from one to three weeks and is generally given between the seventh to tenth terms of a total of 11 terms. The education is a combination of lectures, patient demonstrations and clinical attendance with a final exam.
Postgraduate training
After basal medical training (21 months of internship usually without Geriatric Medicine) most trainees in Geriatric Medicine start a programme that last for at least five years. The different parts of this program are usually the same for all trainees in the country. The fulfillment of the curriculum requirements is assessed during the programme and when the head tutor determines that the trainee has acquired sufficient knowledge and skills according to preset goals the trainee becomes a certified specialist after a central screening procedure.
The curriculum is in concordance with the UEMS – Geriatric Medicine Section training programme. A final specialty examination is today voluntary. A system for accreditation visits at all the training institutions has been in function for some years.
Research in Geriatric Medicine
There are six chairs in Geriatric Medicine located in Stockholm, Gothenburg, Malmoe, Linkoping, Uppsala, and Umea. All the Departments of Geriatric Medicine are active in research and in Malmo and Gothenburg the research is mainly epidemiology in geriatrics and gerontology, in Umea clinical geriatrics (i.e. falls, delirium) and in Stockholm, Uppsala and Linkoping dementia research.
Organization
President of Swedish Geriatric Association (SGF) for the next two years will be Anne Ekdahl, medical director of an outpatient Geriatric Clinic of Norrkoping. The board consists of seven members and the president.
The SGF representative at the EUGMS full board is ass. professor Ake Rundgren, Gothenburg.
The journal of SGF is Nordisk Geriatrik (Nordic Geriatrics) with six issues per year. Important information and geriatric research of national interest can also be published in Journal of The Swedish Medical Association.
Information and guidelines are also regularly placed on the website of SGF.
Scientific Meetings
From 2005 a yearly meeting “Geriatriskt Forum” is held.
- Anne Ekdahl, Geriatriska Enheten, Vrinnevisjukhuset SE601 82 Norrköping, Sweden. Phone +46 11 22 38 17; mobile +4673 848 42 50; anne.ekdahl@lio.se or
- Åke Rundgren, Geriatric Clinic, Östra Hospital, SE416 85 Göteborg, Sweden. Phone +46 31 343 40 81, mobile +4670 778 71 00; fax +4631 343 40 38.
ake.rundgren@vgregion.se