Cornel Sieber: “We live in a youth-obsessed world that leaves no room for old age”

Well, when I first began working in the field of geriatric health, geriatrics wasn’t even recognized as a distinct discipline! Over the years, we’ve succeeded in demonstrating the central and vital role of this field. As geriatricians, we typically work in interdisciplinary and interprofessional teams due to the prevalence of multimorbidity—around 80% of older individuals have multiple conditions at once. I believe modern hospital structures must increasingly adapt to demographic changes. However, in Germany, traditional ‘organ-oriented clinics’ dominate, meaning that specialists in pulmonology or cardiology, for instance, each have their own wards. This model doesn’t align with what we require in geriatrics. That said, this isn’t exclusively a German issue—established geriatric research is still lacking in many European countries.

Older people are, above all, often less flexible. Coming to a hospital means leaving their familiar environment. Many are extremely anxious—it’s somewhat comparable to the uncertainty children feel in such situations. However, for the elderly, the focus is not on feeling secure and comfortable; rather, their main concerns are safety and orientation. This is true regardless of whether someone is cognitively impaired or not. 

Good signage, high recognizability of spaces, and—in my opinion—an architecture that conveys calm and quiet are crucial. Our patients are typically very old persons, around 85 years old, and they live very differently at home. It’s vital that planners design hospitals not from the perspective of their own generation but with a clear focus on the people who will be patients there.

In planning, small but crucial details are often overlooked. For instance, what use is a single-sided handrail in a corridor? You cannot ‘choose’ which side of your body is paralyzed after a stroke, and if there’s no handrail on the patient’s functioning side, the space is not accessible.

Since older people often struggle with orientation, too many corners or poor lighting increase the risk of injury. Bathrooms also need to be spacious enough to accommodate assistive devices effectively. Ultimately, it can be said that, unfortunately, most hospitals are not truly designed for elderly people, even though they make up a very large share of patients.

The easiest solution is to involve the directly affected individuals early in the planning process. Medical and nursing staff are familiar with care needs and necessary workflows, and every location presents local factors that need to be considered. On a ward specializing in geriatric medicine, you need a lot more storage space for supplies like bandages, pads, wheelchairs, and walking aids than in general hospital departments. Since moving from one place to another is particularly exhausting for older adults, it’s also sensible to consult physiotherapy for insights.

However, we must also recognize that geriatrics still lacks broad appeal. We live in a youth-obsessed world—building a geriatrics hospital in this world is still a luxury. More often than not, existing structures are retrofitted for geriatrics, with varying success.

For older patients, therapy is usually the deciding factor in whether they can return to their home environment or have to move into a care facility. This should be the guiding principle when planning a geriatrics ward. We need spaces that accommodate diverse activities: wide corridors and sufficient therapy rooms for individual and group treatments. Physiotherapy and occupational therapy are needed, as are facilities to practice daily living skills. This also includes therapy kitchens where patients can practice or relearn simple tasks that they need at home. 

It’s true that we always have to save costs. That’s why it’s vital for planning teams to include individuals who can prioritize essential needs. Especially when it comes to technical equipment, there are some features that are more of a ‘nice to have’ and may not even be relevant to elderly patients. Many technical devices intended to assist them are overly complex to operate. Sometimes, elderly people would prefer fewer options or controls and instead value equipment with large buttons that are easy to use. However, it is important to note that it has been shown time and again that everything crucial should be built from the outset! Any retrofitting of components or equipment is many times more expensive than if it had been included in the planning from the very beginning. 

It’s true that our staff walk just as much as those in other medical fields, and they understandably become frustrated when corridors are long, or storage rooms are poorly located. That’s why, as I mentioned earlier, it’s crucial to plan workflows with the input of the people involved. In geriatrics, nursing staff are in frequent contact with primary care physicians, so they need quiet and private workspaces for phone calls and personal exchange. Open-plan offices are entirely unsuitable for this.

Moreover, geriatrics and nursing involve numerous conversations with caregivers and family members. Planning a discharge is a completely different process for elderly patients. And, of course, people also die in geriatric wards. For these conversations with families, we also need spaces where they can be conducted in a dignified manner.

Overall, the situation has improved significantly. It’s noticeable that geriatrics has become more interesting for hospital structures. When I began working in Germany in 2003, there wasn’t even a separate geriatrics department. The introduction of the DRG system (Diagnosis-Related Groups) didn’t cater well to geriatric care needs. For example, a lung infection in an elderly patient often involves complications that require early comprehensive geriatric treatment. To provide this care, we need geriatricians, a specialization that was rare for a long time. Today, however, many young professionals are entering the field, and the area is disproportionately female. In my experience, women are on average better equipped for this field, have a holistic approach, and simply do a better job. 

That said, student education remains at risk due to turnover in teaching positions. There are too few geriatricians, so professorships are out of necessity sometimes filled by other specialists who are less suited to the field. Geriatrics is not a subspecialty like gastroenterology or cardiology—it’s more of a ‘superspecialty.’ The broad approach that we need for geriatric medicine, just as we need it for pediatric medicine, is also reflected in the treatment. However, while treatments in pediatrics are usually linear, care for older adults often involves deviations and unexpected developments. No other patient group is as diverse as the elderly. There is no such thing as ‘the typical elderly patient.’ Hospital structures must adapt to this reality.