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Associate Professor Michael Woodward reflects on his career in geriatric medicine

Associate Professor Michael Woodward is head of aged and residential care services at Austin Health, and a geriatrician in private practice at Donvale Rehabilitation Hospital. He is director of the Austin’s wound management clinic, editor of Wound Practice and Research and a past president of the Australian Wound Management Association. He is director of the memory clinic at the Austin and sits on numerous boards for dementia organisations.

“When I was a physician registrar at the Royal Melbourne Hospital in the early 80s, I was working in a ward that, like most wards, even back then, was full of older people. I asked my boss, Professor Ian Mackay, for advice on choosing a specialty. Straight away he said, ‘geriatric medicine’. Even though he is a well known immunologist, I think he was a bit of a frustrated geriatrician.

What I liked then and what I still like is that geriatric medicine involves treating the whole patient. You treat the patient’s physical symptoms as well as their psychological, cognitive and mental status, in the context of their social environment. It’s looking at whole systems of functions such as their mobility, their ability to look after their finances and their ability to eat.

As director of aged care at Austin Health I have a mix of inpatient and ambulatory responsibilities, as well as running a big department. The department has over 100 beds, a consultative service and a community service for people in their own homes. We also have specialty clinics such as memory, wound management, continence and falls. It’s one of the most comprehensive, hospital-based aged care services in Australia. I’ve been a consultant at the Austin since 1988.

Throughout my career, I’ve been very involved with professional organisations. I was chair of the Royal Australasian College of Physicians Committee for Physician Training for 6 years and deputy chair for 6 years before that. This group oversaw training for all physician specialties including the assessment process, accreditation, supervision of training, etc. At any one time we had about 1000 basic and advanced trainees so it was a big job. I’m proud of my work there.

Immunisation of older people is a major interest of mine. I sit on several global and national immunisation boards and recently revised the guidelines of the Australian and New Zealand Society for Geriatric Medicine for immunisation of older people. Older people need to be vaccinated against preventable diseases like pneumococcal disease, flu and shingles, but there’s not enough awareness about the importance of vaccinating this population. The kids have hijacked the agenda!

I also have a particular interest in cognitive disorders. I’m on the board of Alzheimer’s Australia Victoria, and am involved with several other professional associations. I’ve done a lot of research into developing drugs for Alzheimer disease, as part of international, multicentre trials. I’m also proud of some of the clinical dementia research I’m doing, including trying to gain a better understanding of what I call the ‘frontal variant’ of Alzheimer disease. This involves people with Alzheimer who present early on with frontal features such as behavioural problems. My MD research degree, which I completed last year, focused on this topic.

Wound management is also an area of interest. A key achievement of my presidency of the Australian Wound Management Association, from 2006 to 2010, was my involvement in developing guidelines for treating and preventing chronic venous leg ulcers, and similar guidelines for pressure injuries.

Although it’s increasingly being recognised as an important area to resource, geriatric services are often housed in second-rate facilities, in what some regard as second-rate hospitals. I think that’s ageism. Some people seem to believe that older people don’t mind being in the ward that’s been abandoned by, say, orthopaedics. It’s often a case of, ‘what can we do with this old, leftover ward? Hey, we’ll turn it into a nursing home’. It’s never the other way round, where a brand new building is filled with geriatric medical wards. The Austin is among the more enlightened hospitals but we are still pushing uphill nationally.

I think that ageism is changing. The so-called baby boomers are becoming old people, and they regard appropriate health care as a right. Also, the population explosion is not young babies in China, it’s people over age 80 in every country. If we don’t pay full attention to the ageing of society, it’s extremely likely it will be to our detriment. We need to fund more Alzheimer research, to develop drugs. We need to fund older persons’ vaccination. We need more appropriate residential care facilities and hospitals. We need to train hospital staff to deal better with confused older people and prevent falls and pressure injuries. All this has to happen soon or we’ll have millions of people with chronic wounds, including pressure ulcers, who are demented and living for years in second-rate facilities.

Any doctor who doesn’t do geriatric medicine is losing an opportunity to do an incredibly fulfilling job. You’re never going to run out of work, we need more geriatricians and it’s more conducive to the achievement of work–life balance than some specialties. Most importantly, it’s very satisfying to look after the whole of the patient in their social context, rather than being a super-specialist in one small part of the body.”