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The physical assessment would be made by the patient's own Doctor supplemented in
some cases by investigations carried out in the hospital. The social assessment would be
based on information given by relatives to the Lady Almoners of the hospital and reports
of visits made by the Council' s Lady Public Health Inspector or workers from the Hospital
Personal Aid Service for the Elderly run by the King Edward Hospital Fund for London,
Such reports would take into account the kind of rooms the patient lives in, the toilet
facilities, whether much nursing or medical attention is required and what kind of help
is available from relatives and neighbours. It may be that little is required beyond
arrangement for meals and cleaning. The "Meals on Wheels" Service and the Invalid Kitchen
of London Meals Service and Home Helps are valuable in overcoming these difficulties.
Some old people do require a minimum of nursing. Much may be done by District
Nurses, and the Borough Council run a valuable laundry service for incontinent persons,
With such help many people may be looked after satisfactorily in their own homes,
Nevertheless when all these factors have been taken into account, a certain number of
patients obviously need admission to hospital, and are too difficult to be cared for at home.
It should be emphasised here than an old person ill is not necessarily"chronic sick"
aand may be acutely ill with pneumonia, heart failure, etc and treated in no way different
from a young person with these illnesses in the ordinary acute wards of the hospital
In hospital every endeavour is made to get patients up and ambulant. The patient
confined to bed runs a greater risk of bed sores, trouble with the bowels and bladder,
stiffness of the joints and other mishaps. For this reason every encouragement is given to
increase the activity of patients as much as possible. Physiotherapy helps to re-educate
people in walking and using their hands. Chiropody and Occupational therapy are valuable
adjuncts. We are sometimes pleasantly surprised to find patients who have been bedridden
and apathetic in their own home, become ambulant and alert when encouraged to get up.
Incontinence too may improve. On the other hand, occasionally, the transfer to unfamiliar
surroundings exerts a harmful effect and a patient may succumb very shortly after removal
to hospital. Even though walking may be severely restricted, many aged people enjoy a
chair existence knitting reading, looking at television and talking to their neighbours.
The chronic sick wards differ in their requirements from ordinary wards. There
should be less discipline and a freer more home-like atmosphere with day rooms, gardens
and all forms of amenities for patients who will spend months or years there, many till
the end of their days. While attempts have been made to improve old and out-of-date
buildings by redecoration, reflooring and so on, they still fall far short of the ideal.
Nevertheless, patients are usually very happy in this sheltered atmosphere and are well
cared for by a devoted staff.
Vacancies occur infrequently in the chronic wards. To cope with the demand for the
few available beds, it is important that patients who can be looked after outside should
not be retained in hospital longer than necessary. Patients are constantly reviewed to
see whether sufficient improvement has taken place for them to return to their own home
or be looked after in Homes for Old People. The latter are usually full and vacancies
rare, so that circulation is very slow. Private Nursing Homes can accommodate some
elderly people who can afford the necessary fees.
The lack of facilities and the difficulties in helping many of the chronic sick for
whom application is made is a source of great concern, but the problem is too large to be
regarded as a medical one alone. When it is realised that in 20 years time one in 5 of
the population will be 65 years of age or over, it is obvious that difficulties will
increase rather than diminish and that the problem is a social one that needs a greater
integration of all social services to solve it than exists at present
The last decade has witnessed a greater understanding of and interest in the needs
and difficulties of the older members of the community, but a lot remains to be done to
bring our chronic sick hospitals and departments up-to-date and more in accord with the
hopes and aspirations of the present day.