The history of the geriatrics and gerontology in Hungary – the HAGG

The importance of health issues related to aging and older people was recognized as science in Hungary in the early 20th century. Four scientists did efficient pioneering work for the development of gerontology and geriatrics in the country: prof. Sándor Korányi (physician and nephrologist), Frigyes Verzár (physiology), and professors László Haranghy and Edit Beregi on the field of pathology. The first Congress on Gerontology was organized in 1937. Coordination and support for research on gerontology started when the Committee of Gerontology of the Hungarian Academy of Sciences was set up, with prof. Haranghy in the chair. The Committee regularly organized scientific meetings and CME courses on gerontology. In 1958 the Gerontological Section of the Hungarian Biological Association was founded. It was led by László Haranghy. In 1956 Hungary became a member of IAG and one decade later the Hungarian Association of Gerontology (HAG) was established. From the late sixties the scientific activity on the medical, clinical and sociological fields of gerontology gradually increased. The team of the contemporary Hungarian Research Institute on Gerontology played important role in this development.  

The significant international activity of the Hungarian Association of Gerontology and mainly that of prof. Edit Beregi was recognized by the fact, that the XVth World Congress on Gerontology was held in Budapest, in 1993. This really successful congress was attended by nearly 5000 participants.

The National College of Geriatrics/Gerontology as a periodically renewed advisory board of the Minister of Health has been operating since 1988. Geriatric medicine as a primary medical speciality has been recognized since 2000. The minimum criteria for geriatric departments have been defined in the early years of this century by the health authorities.  

Membership of HAGG (paying members): 70. It has decreased in the last years. The majority of members is geriatrician working in hospital or university departments, or in Nursing Homes but there are also nurses and physiotherapists in the HAGG. There is only one special section in the society, the “Nursing Homes Section”. Information to the members: mainly by e-mails and attachments. The technical background for videoconferences is available via the geriatric/gerontological departments of the four universities. The chair of geriatrics at the Semmelweis University has an up-to-date technical basis also for high-level international videoconferences.

Organization of the health care system including geriatric care 

Dominant part of the Hungarian health care system is organized and supervised by the government and funded by the National Health Fund. The geriatric departments also operate in this framework. The real private sector has a small segment of health care system, the majority of them are outpatient clinics. In the case of elderly people, a significant part of nursing homes are private institutions. However, even these private nursing homes can get some partial financial support from the National Health Fund because solution of the domestic problems of elder patients and their long-term care by government-funded institutions is relatively insufficient and only few patients have additional insurances. In 2011 the National College of Geriatrics and Chronic Care together with the HAGG initiated at the health authorities that „active” geriatric departments should be established (in the universities and in every major regions of the country) in addition to the already existing departments for chronic care and rehabilitation. The proposals supported also by the Council of Aging and the Parliament’s Health Committee (mediated efficiently by former HAGG president dr. Laszlo Ivan MP) has been accepted by the health authorities and this process has started in 2012, first in the universities.  

Undergraduate and postgraduate tuition
Undergraduates learn 6 years at the medical schools of our four major universities (Budapest, Szeged, Debrecen, Pécs) before getting a diploma. To be a geriatrician a postgraduate doctor has to have standardised training in hospitals or university departments for further 5 years (first an internal medicine and emergency based common trunk for 24 months and then a second more special block of 36 months including internal medicine, geriatrics, geronto-psychiatry, neurology, rheumatology, oncology, immunology). The practical teaching program is carried out by local tutors, but the whole training process of a given geriatrician-candidate is being supervised by an appointed university mentor. A practical and theoretical exam at a state exam committee (professors) finalizes this specialization-process. The title of “geriatrician” must be re-validated in every 5 years with CME credit points and finally by a complex test-based exam. 

The first Hungarian university textbook of Geriatrics (ed. Székács B., 485 pages, 18 sections, 75 chapters) was published in 2005. In 2011 professors B. Székács and I. Kiss from the Semmelweis University initiated a case-based online interactive geriatric teaching and self assessing program (with case presentations and basic knowledge blocks), targeting first of all the geriatric residents. This e-program has been successfully completed and finalized by the leading experts of the four geriatric (gerontological) university departments in 2012.

Research, publications
In Hungary there are 3 chairs of Geriatric Medicine (Semmelweis University, Budapest; Albert Szentgyörgyi University, Szeged; and Debrecen) and 1 chair of Gerontology (University of Pécs). 12 PhD trainees are at this time in geriatrical or gerontological topics.

In the last decade a great number of scientific and educational papers related to the gerontology and geriatrics has been published in Hungarian or international scientific journals mainly on the following topics:

A small selection of publications on topics above from HAGG-related Hungarian scientists over the last 15 years:  

  • Szekacs B, Vajo Z, Acs N, Hada P, Csuzi L, Bezeredi J, Magyar Z, Brinton EA.: Hormone replacement therapy reduces mean 24-hour blood pressure and its variability in postmenopausal women with treated hypertension. Menopause. 2000 Jan-Feb;7(1):31-5.
  • Szekacs B, Vajo Z, Varbiro S, Kakucs R, Vaslaki L, Acs N, Mucsi I, Brinton EA. Postmenopausal hormone replacement improves proteinuria and impaired creatinine clearance in type 2 diabetes mellitus and hypertension. BJOG. 2000 Aug;107(8):1017-21. 
  • Semsei I. On the nature of aging. Mech Ageing Dev. 2000 Aug 15;117(1-3):93-108.
  • Békési G, Kakucs R, Sándor J, Sárváry E, Kocsis I, Sprintz D, Várbíró S, Magyar Z, Hrabák A, Fehér J, Székács B. Plasma concentration of myeloperoxidase enzyme in pre- and post-climacterial people: related superoxide anion generation. Exp Gerontol. 2001 Dec;37(1):137-48.
  • Kovács A, Szikszai Z, Várady E, Imre S.  Study on the hemorheological parameters of oldest-old residents in the East-Hungarian city, Debrecen. Clin Hemorheol Microcirc. 2006;35(1-2):83-8
  • Zs-Nagy I. Fritz Verzár was born 120 years ago: a personal account. Arch Gerontol Geriatr. 2006 Jul-Aug;43(1):1-11. 
  • Zs-Nagy I. Is consensus in anti-aging medical intervention an elusive expectation or a realistic goal? Arch Gerontol Geriatr. 2009 May-Jun;48(3):271-5.
  • Simkó GI, Gyurkó D, Veres DV, Nánási T,CsermelyP. Network strategies to understand theagingprocess and help age-related drug design. Genome Med. 2009 Sep 28;1(9):90.
  • Vellai T, Takács-Vellai K, Sass M, Klionsky DJ.The regulation of aging: does autophagy underlie longevity? Trends Cell Biol. 2009 Oct;19(10):487-94.
  • Szekanecz Z, Szekanecz E, Bakó G, Shoenfeld Y. Malignancies in autoimmune rheumatic diseases - a mini-review. Gerontology. 2011;57(1):3-10.
  • Magyar Z, Bekesi G, Racz K, Feher J, Schaff Z, Lengyel G, Blazovics A, Illyes G, Szombath D, Hrabak A, Szekacs B, Gergics P, Marczell I, Dinya E, Rigo J Jr, Tulassay Z . Increased total scavenger capacity and decreased liver fat content in rats fed dehydroepiandrosterone and its sulphate on a high-fat diet.  Gerontology 2011;57(4):343-9.
  • Barna J, Princz A, Kosztelnik M, Hargitai B, Takács-Vellai K, Vellai T. Heat shock factor-1 intertwines insulin/IGF-1, TGF-? and cGMP signaling to control development and aging. BMC Dev Biol. 2012 Nov 1;12:32.
  • Balaskó M, Soós S, Párniczky A, Koncsecskó-Gáspár M, Székely M, Pétervári E. Anorexic effect of peripheral cholecystokinin (CCK) varies with age and body composition (short communication). Acta Physiol Hung. 2012 Jun;99(2):166-72.
  • Szekacs B: Hypertension in the elderly - Critical review of diagnostic-therapeutic guidelines and their background. LAM 2012 (8-9): 505-515) (extended English abstract).
  • Bori Z, Zhao Z, Koltai E, Fatouros IG, Jamurtas AZ, Douroudos II, Terzis G, Chatzinikolaou A, Sovatzidis A, Draganidis D, Boldogh I,Radak Z The effects of aging, physical training, and a single bout of exercise on mitochondrial protein expression in human skeletal muscle. Exp Gerontol. 2012 Jun;47(6):417-24.

Network remodeling of intramural coronary resistance arteries in the aged rat: a statistical analysis of geometry. Mech Ageing Dev. 2013 Jul-Aug;134(7-8):307-13.

                                                                                                                                                                                   (B. Székács)