Milestones of care

the History Project of the Australian and New Zealand Society for Geriatric Medicine

Posted by Dr. Robert Prowse, Geriatrician, M.B, B.S. (Tas); FRCP (London) on October 31, 2022.

(An address presented at the Golden Jubilee ASM 2022)

The Australian and New Zealand Society for Geriatric Medicine (ANZSGM) is 50 years old, having been formed in 1972 as the Australian Geriatrics Society (AGS). The inaugural President was Dr Gary Andrews and the inaugural Secretary was Dr Colin Clowse, both working at Lidcombe Hospital.

In 1997, Len Gray, former Secretary and President, wrote a brief history, which says the AGS was formed at the time of an Australian Association of Gerontology (AAG) meeting in Canberra. In addition to the two office bearers, the other members present were D DeSouza (Vice-President), A. Collins, Dick Gibson, Kevin Grant, Keith Hirschfeld and H Robjohns, 8 people in all. Apart from this, there is no helpful detail available; no contemporaneous records have been found. Several years later other histories were written, especially by Dr Richard “Dick” Lefroy (WA) who became third President in 1975.

Although William Browne informed us at last year’s ASM that interest in the medicine of older people dates back at least to the Egyptians 5,000 years ago, modern geriatrics began in England from the late 1940s, inspired by Marjory Warren, and its introduction to Australia is considered to have been in Newcastle by Dr Richard Gibson from the 1950s, followed relatively quickly by services in all Australian mainland capital cities, notably at Lidcombe Hospital in Sydney. It is of interest that most of the developing services followed a similar model of starting in a sub-acute facility, such as rehabilitation, or in long term care, with the addition of developing a community service. In principle, these followed the experience of Marjory Warren. The development of acute geriatrics in general hospital faced more resistance.

The AAG was founded in 1964, as a multidisciplinary organisation of people interested in the care of older people; including nurses, social workers, sociologists and administrators. The first medical practitioners interested in geriatrics joined generally joined the AAG, as the only relevant organisation available. Although the AAG represented the multidisciplinary aspects of geriatrics well, there was increasing recognition of the need for a group of doctors who were particularly interested in the medical care of older people. To quote Dick Lefroy, doctors around Australia interested in developing geriatric services “struggled in a ‘non-committal’ administrative environment and the AGS would provide an association for individual members to use their collective strength”. After formation of the AGS, clinical meetings were initially held with the AAG and business meetings conjointly for convenience.

Why are there no records of early AGS?

Professor Tony Broe, the first interviewee for the History Project, explained:

"we weren’t concerned about our record, we were trying to establish Geriatric Medicine."

The administrative and secretarial support for the office bearers of the early AGS came for the clerical staff of the local geriatric department, which was one reason for the President and Secretary being in the same department or, at least, in the same city, as seen with Drs Andrews and Clowse. When the office bearers changed, most of the AGS records remained in the filing cabinet and were eventually lost when that Department’s offices moved. In the 1970s all records were in hard copy and the best one could do to confer with interstate members was by telephone to an individual. Full meetings of the Society required travelling interstate. Peter Landau, another interviewee, recalls, in his first year as a consultant, being told by the incoming AGS Secretary, who was in his Department in Sydney, that he was now Treasurer of the Society and being handed a shoe-box from the previous Secretary in Newcastle containing the financial records of the Society, which consisted of a bunch of uncashed cheques and a cheque book.

These informal arrangements for clerical support were sufficient for a society with a small number of members, but as the numbers grew and its activities increased in complexity, it was clear pro bono arrangements would be at risk from a question from senior management. In 1989, the Society adopted the RACP address as its mailing address, so the Society was not “lost” with each change of Honorary Secretary. Len Gray, Secretary 1987-91 and the first identified Editor of the Newsletter and who oversaw many administrative improvements in the AGS, in 1989-90 arranged to employ a secretary at Bundoora for 8 hours a week, the first person dedicated to working for the Society. Interestingly, Len said of this arrangement that it will not be viable in the long term and in 1991 the Society moved its office to the RACP, sharing a secretary for one day a week. In 1993 the first Secretary/Administrator was appointed, initially working 2 days a week, but with steadily increasing commitment of time. The Society now has 3 staff: an Executive Officer and Membership and Communications Officers.

Scientific meetings (ASM)

Although most meetings of the early AGS were held with AAG meetings, the Society made a contribution to a Royal Australasian College of Physicians meeting in 1973 (its 1st year). One of the presenters was Dick Lefroy on “Is geriatric medicine a specialty”, a topic much in contention at the time. The New Zealand Geriatrics Society was formed in 1976 and members of the AGS presented at the inaugural meeting, which was also held with the RACP. There was a further symposium at an RACP meeting in Hobart in 1977. After this, AGS meetings were held with the AAG, until 1984, when on a Saturday morning following the RACP meeting in Adelaide, it held a separate meeting which has come to be regarded as the first ASM in the current format. Meetings continued with the RACP in nearly every year until 2000, since when the Society has held its ASM independently.

The quality of the ASMs was greatly enhanced when the Returned Services League (RSL), which was interested to improve the care of an increasing cohort of ageing veterans, offered to sponsor an international expert in geriatric medicine to visit Australia, to speak at the ASM but also to visit other sites in Australia, to maximise the benefit of the sponsorship, by including those unable to attend the ASM. The first of these RSL Professors was Professor John Grimley Evans (Oxford), who presented at the joint meeting with the RACP in Hobart in 1986. In all, there had been 12 RSL Professors by the time the RSL withdrew its sponsorship in 1997. However, the concept had proved successful for the Society and model was maintained with sponsorship from pharmaceutical industry, providing another 12 International Professors. Increasing concerns about the ethics of industry sponsorship led to the Society taking over funding the International Professorship in 2010.

At the 1984 meeting, Michael Woodward counted the attendees; there were 37 at the start and 42 by 11:30. The highest attendance so far was 775 at the Sydney ASM in 2018. There was no charge to attend the 1984 ASM; it was $100 for the 1988 meeting and $1,200 for the 2018 meeting, both in Sydney.

The most significant prize awarded by the Society is the R M Gibson prize, named in honour of Dick Gibson, the pioneer geriatrician in Newcastle, for the best presentation by an Advanced Trainee in Geriatric Medicine at the Annual Scientific Meeting. Terry Finnegan, another History Project interviewee, says that he was the first recipient in 1979, for a presentation at an AGS session in Perth within an AAG Meeting. No record of this meeting has yet been found and subsequently there is no record at all of meetings in 1980, 1981 or 1983. In this period the prize was awarded on the basis of essays or reports submitted to the SAC. The next winner of the prize was in 1989, again awarded for presentation at a meeting, interestingly not at the AGS ASM but a meeting in Christchurch conjointly with the New Zealand Geriatrics Society (and RACP). David Conforti was the winner. There were no submissions from trainees to the 1990 ASM in Melbourne, but subsequently the prize has been awarded at every ASM.

In 1994, the Career Investigator award was instituted, with sponsorship from a pharmaceutical company. Acknowledging the clinical demands on specialist Geriatricians soon after achieving FRACP, the award was designed to encourage members within 5 years of Fellowship with research interests to continue to develop this aspect of their careers. The Society took over the sponsorship of this award in 2010, the same year as funding the International Professor. There have so far been 27 awardees. The third prize awarded at the ASM is the Poster Prize, also initiated with industry sponsorship, but only for 2 years before being taken over by the Society. Unlike the other prizes, it is open to any poster presenter. There have been 20 winners.

Society Structure and Membership

The Society has undergone two major constitutional changes, both associated with new titles; in 1993 to the Australian Society for Geriatric Medicine and in 2006, following amalgamation with the New Zealand Geriatrics Society, the current title was adopted.

The History Project has a copy of an undated AGS constitution. There were 3 Membership Categories: Full Membership, largely as it is today but specifying their being ‘at a senior level’; Associate Membership, for medical practitioners interested in Geriatric Medicine but not eligible for Full Membership and Honorary Life Membership, with simpler and more open criteria than were adopted by the Society in 2008. There was no category for Advanced Trainees; in 1990 an amendment specified they were eligible for Associate Membership.

The Constitutional review in 1993 added a Trainee category as well as one for retired Members, in the 21st year of the Society this seems to have been appropriate. Interestingly, the Associate Membership category was abolished. It was re-established in 2000, as a category specific to General Practitioners. The final significant addition to Membership categories was made in 1999, when Overseas Membership was added. This meant that the Constitution of the amalgamated Society provides for 6 categories of Membership.

In 1980 there were 56 Members; 44 Full and 12 Associate. Growth of the membership through the 1980s was quite rapid, by 1990 there were 318 Members, 1999 415, 2010 781, 2020 1,232 and this year 1,325, made up of:

  • 983 Full members
  • 272 Trainee members
  • 15 Associate members
  • 31 Retired members
  • 8 Overseas members
  • 16 Honorary Life members
  • In 1989, membership subscriptions were $30 for Full Membership and $15 for Associates. By 1997, they were: Full $148, Trainee $88 and Retired $20; 2003, Full $253, Trainee and Associate $165, Overseas $157, Retired $22. The Full subscription in 2021 was $455.

    Honorary Life Members

    One reason for concern to accurately document Honorary Life members is that these are those who have been considered by their peers to have met the criteria of “having made an outstanding contribution to the Society or to geriatric medicine”. These are individuals who are likely to have contributed to the history of the Society, which is not to exclude others who have not been so honoured. Recommendations originate in the divisions.

    Altogether, 28 Honorary Life Memberships have been awarded, of whom 12 have died. The first known awardee, but the most recent addition to the list of HLMs, was Dr William John (Bill) Stevenson, in 1984. Apart from the April 1984 Newsletter reporting the award, little is known about him and no-one in the Victorian division is aware of him. In particular, how he relates to Geriatric Medicine is unclear; he was an epidemiologist who became Chief Health Officer for Victoria and it is possible that he was recognised for supporting the development of Geriatric Medicine in Victoria.

    The discovery of this HLM may disappoint some in the Western Australian Division who, when they proposed Dick Lefroy for the award in 1991, undoubtedly appropriately, claimed Dr Lefroy would be the first HLM of the AGS. Nominations for Honorary Life Membership increased dramatically in the 21st century. There were 8 HLMs in 1999; 20 added from 2003-2021. Most HLMs have come from the Victorian Division (8), most of the other divisions 4-5, including New Zealand, which has had 4 since amalgamation. There have only been 2 from Western Australia.

    Geriatric Medicine training

    The earliest geriatricians in Australia were, perforce, trained in other specialties. The first 2 presidents both spent considerable time in the developing geriatric service at Lidcombe Hospital and both did a year’s training in geriatrics in Glasgow in 1969-70; effective advanced geriatrics training but without the later formal structure. One of Dick Lefroy’s accounts states that the first advanced trainee in Geriatrics was recommended for Fellowship in 1977. Tony Broe was the inaugural Chair of the Specialist Advisory Committee in Geriatric Medicine in 1975 through to 1982. The History Project has details of the SAC meetings from 1979-1989. In 1980 there were 7 Advanced Trainees; 2 in final year of training and 5 continuing in 1981. By 1989 there were 15 ATs, 8 completing that year.

    In this address, I have concentrated on early years, as these are likely to be less well known to this audience (and hence perhaps of more interest). Please contact me if anyone has:

  • Any documents from this period, even a single page
  • Any corrections to this report
  • In particular:
  • if you won an R M Gibson Prize between 1980 and 1988 inclusive
  • or if you know of someone who did
  • If you know the name of that first AT in 1977