When Dr. Richard W. Besdine decided to leave a career in basic science research so he could study the health problems of elderly people, he faced two obstacles: he could not find a single U.S. medical training program in the field, and his colleagues thought he had lost his mind.

That was 1972, when fading old doctors — not hotshot young researchers — were the ones who took care of the old people.

Besdine was not deterred. He went to Scotland to train and came home to help establish at Harvard America’s first medical training program in geriatrics — the branch of medicine concerned with the diseases and problems of old age.

Now, Besdine is director of the division of geriatrics at the Warren Alpert Medical School of Brown University. The medical school just won a $450,000 grant from the John A. Hartford Foundation to enhance education in geriatrics. With the grant comes the foundation’s designation of Brown as a Center of Excellence in Geriatric Medicine and Training, awarded to only 3 of the 27 medical schools that applied.

Geriatric medicine has come a long way since 1972. Today there are 5,000 board-certified geriatricians and Besdine calls the field “vibrant and exciting.” But most geriatricians are busy treating patients, not training the next generation of doctors.

That’s where the Alpert Medical School and Hartford Foundation grant come in. The Hartford grant will help pay for part of the salaries of junior faculty, so they’ll have protected time when they don’t need to be making money by seeing patients. They’ll use that time, Besdine says, to research aging issues and acquire the skills and knowledge to teach about aging.

“You need effective teachers who will consume the knowledge created and translate it and disseminate it to the clinicians who are going to keep you and me out of the nursing home,” Besdine says.

Additionally, the grant will help open up a dozen additional positions in a fellowship program in aging, in which internists who have completed their residency spend an additional year or two studying aging issues. The “very best” of those fellows, says Besdine, will stay on as Brown faculty.

The Hartford grant, to be spent over three years, works especially well in combination with a four-year $2-million grant received last year from the Donald W. Reynolds Foundation, Besdine says. The Reynolds money is being used to incorporate aging-related information into every course for every year of medical school.

It’s not a moment too soon. There are 75 million people in the baby boom generation, and nearly all will live to age 65. There will never be enough geriatricians to care for them all, Besdine says. Instead, all doctors need to know how medical needs differ in old age. Certain illnesses are much more common in elderly people, and diseases that affect all ages often behave differently in the old.

“The more generalist physicians who are adequately educated in the care of the elderly, the fewer geriatricians we need,” Besdine says. “Everything we’re doing at Brown is aimed at equipping the generalist to do it right.” Specialists and surgeons also need to understand that elderly people respond differently to medications and anesthesia, among other things.

For example, Besdine explains, even in a healthy person, the heart muscle becomes thicker and stiffer as it ages. As a result, the left ventricle, the big pumping chamber, fills with blood more slowly and needs longer to pump out the blood to the rest of the organs. That means that a rapid heart rate in an elderly person can be dangerous. “We are taught as physicians that the heart tolerates rates of 120, 130, even 140 pretty well,” Besdine says. But that’s not true for older people. When an infection, fever or other physiological stress in an old person causes the heart rate to accelerate, “getting that heart rate down is absolutely a high priority,” he said. “If you don’t know that, every older person you take care of is going to be a catastrophe.”

Besdine decided to go into geriatric medicine because he had found the greatest satisfaction when caring for older people; they were the ones “who pushed me to the very limits of my ability.”

His enthusiasm has proven infectious, says Dr. Edward Wing, chairman of the department of medicine at Rhode Island Hospital and at the Alpert Medical School. “He’s made medical students at Brown excited about geriatrics,” Wing says. “It’s not a popular field. Not many people go into it. He’s gotten residents excited about it.”

Geriatrics remains a comparatively low-paying field. Doctors get paid per patient visit, but with an old person each visit tends to take longer, because the person moves more slowly and is more likely to have multifaceted medical issues, Wing explains.

But doctors who choose the field love it, says Wing. “They get a lot of satisfaction. They have long-term relationships with fascinating people. … They’re wonderful to talk to.”

ffreyer@projo.com