The Council of Europe includes 45 state members, while the European Community, limited until May 2004 to 15 countries, includes nowadays 27 different countries, with varying degrees of industrialization, economic benefits and employment. These initial remarks highlight that it is not possible to consider Europe as a homogeneous group of countries. The wide variation of demographic data is probably the best way of showing the 2008 disparity among the European countries:9

• Birth rate: the highest is in Iceland (2.2/woman) and the lowest in Slovakia (1.3/woman);
  
• Mortality rate during the first year of life: the highest is in Turkey (16.0/1000) and the lowest in Luxembourg (1.8/1000);
  
• Life expectancy at birth for men: the highest is in Liechtenstein (79.9 years) and the lowest in Lithuania (66.3 years);
  
• Life expectancy at birth for women: the highest is in Switzerland (84.6 years) and the lowest in the former Yugoslav Republic (76.5 years).

However, in more developed European countries, life expectancy at birth continues to increase: there is actually a 3-month ‘bonus’ of life for each year of life.10 In 2008, the European Union (EU) (27 countries) had a total population of 501 million inhabitants, of which 17% were over 65 years. Between 2010 and 2050, the EU (27 countries) dependency rate (ratio between people over the age of 65 and people between the ages of 15 to 64.9) is expected to increase from 25.9 to 59.4.

The number of nonagenarians, centenarians and supercentenarians (over 110 years) will continue to increase.11 While the healthy life expectancy is longer than ever in developed countries, still many older subjects spend the last years of their life suffering from chronic diseases and increasing disability, which explains why a large percentage of patients requiring healthcare belong to this age-group.

In this context, the promotion of training in geriatric medicine should be a priority in every European medical schools with the following aims: (1) to improve the understanding and integration of the ageing process within the life cycle, (2) to increase the basic and more specialized knowledge of chronic and disabling diseases, (3) to perform comprehensive assessment of the ageing and aged old persons in order to guarantee a better follow-up of the patient, and (4) to guarantee more suitable care, including the appropriate use of drugs in older subjects, neglecting neither ethical nor costs of care issues.12, 13

In the 1990s, a first European geriatric education survey was performed by a small group of professors of medical gerontology whose three goals were: (1) to establish the basis of a consensual undergraduate core curriculum, (2) to be politically active in order to obtain the creation of a chair of geriatric medicine in each European medical school, and (3) to set up a long-life training course to teach and train the future academics in geriatric medicine.14 Fifteen years later, an update was realized to evaluate the degree of achievement of these goals, the real situation at the beginning of a new millennium and the needs of professional academic specialists to better cope with the increasing care demand of the future older subjects.15 In this chapter a further update of the data of these two surveys will be provided.

Among the 31 European countries included in the 2008 survey, Geriatrics is:

• a medical speciality in 16 countries (Belgium, Bulgaria, Czech Republic, Denmark, Finland, France, Germany, Hungary, Italy, Lithuania, Macedonia, Malta, the Netherlands, Spain, Sweden and United Kingdom);
  
• a medical subspeciality in 9 other countries (Iceland, Ireland, Norway, Poland, Serbia and Montenegro, Slovakia, Switzerland, Turkey and Ukraine);
  
• not recognized as a specialty in 6 countries (Austria, Estonia, Greece, Luxembourg, Moldavia and Slovenia).

It is interesting to point out that the existence of geriatric nurses is recognized only in 13 European countries (mainly those in which geriatrics is considered as a medical speciality). However, recognition of the existence of a specialty does not imply that gerontology and geriatrics are included in the medical education curricula.

In seven European countries a chair of Geriatrics exists in all medical schools; the chair is most often filled but in a few cases the chairperson has not been nominated yet or is in the process of being appointed (Belgium, Finland, France, Iceland, Norway and Sweden). In several European countries, a chair of Geriatrics exists in some medical schools (80% Switzerland, 70% in Italy, 50% in the Netherlands and Serbia, 33% in Denmark and Austria, 36% in Spain and only 16% in Germany and Portugal). Moreover, no chair of Geriatric Medicine exists in Estonia, Greece, Luxembourg, Malta, Macedonia, Moldavia and Slovenia. It is interesting to notice that two countries (Macedonia and Malta) do not have a geriatric chair even if Geriatrics is recognized as a medical speciality.

Although the European Union of Medical Specialists—Geriatric Medicine Section (GMS-UEMS) has produced an undergraduate curriculum in geriatric medicine in 2003, which has been approved by a number of national geriatric societies, there is no evidence that this curriculum has been implemented in the majority of EU countries.16

Undergraduate teaching of geriatric medicine is organized in 25 countries, but it is mandatory in only 9, and nonexistent in 6 of the 31 surveyed European countries. The existing teaching activities are based on European/National core curriculum in only 2 countries, while in general, the content is independently determined by each medical school. Thus, variability is high both in teaching hours and curriculum. The mean number of teaching hours devoted to geriatrics varies considerably from one to another country, with a maximum of 100 hours in Norway, 60 hours in Serbia and Spain, 50 hours in Italy, Slovenia and Slovakia, 40 hours in Finland and Iceland, 30 hours in France, Hungary and Poland, 20 hours in Denmark and Germany, between 10 to 15 hours in Belgium, Czech Republic, Lithuania, Malta and Turkey and less than 10 hours in Ireland and Luxembourg. Within each country variability is also high. In 10 of these countries, geriatric teaching takes place at different times of the medical studies. Again, the differences are wide from one country to the other, but in most cases, geriatric teaching takes place in the second half of the medical studies, i.e. between the 4th and the 6th year. Moreover it is important to notice that the teaching methodology is ‘problem-based learning’ in nearly 50% of cases. Undergraduate teaching activities are organized in all medical schools of only 14 countries of the 31 surveyed, while clerkships are available in 16 of these countries (11 mandatory and 5 elective).

Postgraduate teaching activities are specifically organized by geriatricians in 16 European countries (Belgium, Czech Republic, Finland, France, Hungary, Ireland, Italy, Lithuania, Malta, the Netherlands, Norway, Poland, Slovak Republic, Spain, Sweden and United Kingdom) and in collaboration with internal medicine in 6 other countries (Germany, Iceland, Serbia, Switzerland, Turkey and Ukraine). Geriatric postgraduate teaching does not exist in 9 countries. In countries organizing postgraduate teaching activities, students are selected on a pre-requisite basis (N = 9) and the course is based on a pre-established core curriculum (N = 16). A final mandatory examination takes place at the end of the course in 13 countries and a mandatory re-validation is needed in only 8 countries.