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1ll
authorities for their plans in this respect for the next ten years
and time is getting short for such a far-reaching decision.
Inevitably, the question of in-patient treatment for some of
our older citizens will arise. So frequently do the aged look upon
the hospital as the end of a "one-way" street that it should be
our earnest endeavour to get them to regard it, rightly, as no more
than a necessary interruption of limited duration in their home
life. Over and above that, however, we must be convinced that
hospital admission is necessary. We must be sure that the senile
dementia for which treatment is considered essential is not mental
depression brought about by financial worry, inadequate fuel or
lack of food. Sir John Charles, in his final report as Chief
Medical Officer to the Ministry of Health, stated that "the response
(of the elderly) to a proper diet is often dramatic" and many an
old person with mental infirmity has made a remarkable recovery
when regular, balanced meals have been forthcoming. Again, we
must be satisfied that the swollen ankles are really symptomatic
of heart failure, vein thrombosis, rheumatoid arthritis, chronic
bronchitis or emphysema and not merely immobility resulting
from inactivity. To say that hospital admission, for the elderly,
has certain inherent hazards is not to denigrate the hospital services
but simply to state the obvious. There is the ever-present danger
of cross-infection, gastric and respiratory, which old people tolerate
rather badly. Over-investigation by a zealous staff for such
disabilities as coronary disease, hypertension, diabetes and
respiratory troubles is not only a dreaded possibility but can
sometimes lead, inadvertently, to over-medication despite the fact
that the lowered safety margin for drugs in old people is well
known. Conversely, in overcrowded geriatric wards, a position
unfortunately all too common these days, there is a risk of
under-nursing due to staff shortages thus giving rise to understimulation,
both physical and mental, with an enforced disregard
of personality. This cannot be in the best interests of our old
folk. Many things may go awry but only after every environmental
aid has been invoked should in-patient treatment be
considered.
If hospital treatment becomes essential, what then? At the
start, we would do well to remind ourselves that restoration to
health is really a function of the entire community because all
healing depends upon total needs—medical and physical needs,
psychological needs and social and specific needs with perhaps the
greatest emphasis on the psychological aspects. Keeping this in
mind and aiming to reduce chronicity to a minimum, our precept
must surely be, quickly into hospital, effective treatment and
quickly out again. Nothing short of dire necessity should divert