The History of Geriatric Medicine in North Dublin
The modern specialty of Geriatric Medicine was first established in the United Kingdom in the late 1940s. Due to the pioneering work of Dr. Marjorie Warren, a physician who worked in a London Workhouse Infirmary from 1926 onwards, the importance of accurate clinical diagnosis and rehabilitation for older people became widely accepted. Her work, and in particular her ability to restore older patients to independent living outside of a workhouse setting, inspired other British physicians leading to the formation of the British Geriatric society in 1948. Its’ Irish counterpart, The Irish Gerontological Society, is the second oldest Geriatric Medicine society in the world and was founded in 1955 by a Dublin General Practitioner Dr. John Fleetwood.
However Geriatric Medicine’s development as a mainstream medical specialty only began in Ireland with the appointment of a number of Consultant Geriatricians in the late 1960s and early 1970s. The first appointment in Dublin was that of Dr. Jack Flanagan in 1969. He developed the first geriatric unit in Dublin at St. Mary’s Hospital, Phoenix Park before opening the first geriatric medicine unit in a large teaching hospital at St. James Hospital (then known as St. Kevin’s Hospital) in 1972.
North Dublin’s geriatric medicine service began in 1973 at Blanchardstown Hospital when a service for all of North Dublin was introduced. This was the first dedicated service offering comprehensive geriatric assessment through geriatric medicine out-patient clinics, geriatric medicine day hospital, and through in-patient rehabilitation beds. Specialist decision making for older adults requiring long term residential care in North Dublin was also introduced with this service in order to ensure that long term care beds were used only for those older adults who were unable to live at home after comprehensive assessment. This service was run by Dr. Jacques Noel and Dr. Denis Keating and admission to this service took place upon referral from a patient’s general practitioner.
Dr. John Lavan replaced Dr. Denis Keating in 1975. In the same year a move was made to begin the process of moving specialist geriatric medicine services into the acute hospitals of North Dublin (Mater Hospital, Richmond Hospital and Jervis Street Hospital). As part of this process a 30-bedded assessment and rehabilitation unit for older adult patients was opened at St. Laurence’s Hospital ( also known as the Richmond Hospital) in 1975. This service allowed General Practitioners and hospital specialists to refer older patients with geriatric medical needs to a unit where a dedicated group of nursing, therapy and medical staff could optimize their condition.
In 1987 St. Laurence’s Hospital and The Charitable Infirmary (Jervis Street) moved to the then newly built Beaumont Hospital. A geriatric medicine day hospital service began in 1988. The geriatric medicine service for Beaumont, The Mater Hospital and St. Mary’s Hospital continued to be run as one service across three sites by Dr. Jacques Noel and Dr. John Lavan until 1988. At this point, because of the increasing work load at each site it was decided to develop individual Geriatric Medicine departments in each hospital to cater for the increasingly large older population of North Dublin.
Despite many contemporary developments the cornerstone of modern geriatric medicine remains the comprehensive geriatric assessment process, as pioneered in North Dublin by nursing, therapy and medical staff from 1973 onwards. The 2012 HSE National Clinical Programme for Older People (NCPOP) has by implication acknowledged the work carried out by these professionals as it emphasizes as its’ core guiding principle that older adult patients do better when admitted to a specialist geriatric medicine ward with specialist healthcare staff.
The details in this short history of Geriatric Medicine in north Dublin have been compiled by Dr. John Lavan with the assistance of Dr. Jacques Noel.
Drs. Alan Moore & Ciaran Donegan. March 2013.