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limitation proved of little consequence in Greenwich for, over a
number of years, its comprehensive geriatric services evolved on
empirical lines, viz. ascertainment of needs and the production of
practical solutions, all with a view to creating for our residents, an
old age of which we ourselves would be unashamed. It has always
been, and still is, our endeavour to understand the problems and
state of mind of the aged and/or the solitary person for whom these
services exist, to impress upon them that they are not forgotten, to
lend assurance in their fears and to help them realise some of the
few hopes still remaining to them.
Naturally everyone is different but as people grow older,
generally their bodily alertness wanes, their emotions cool and they
begin to accustom themselves to life on a lower key at a slower rate.
Impetus may be given to this decline by illness, 'stroke' or perhaps
the loss of a close relative. As a result of poorer muscular co-ordination
old people, generally, are subject to a certain amount of unsteadiness
which, on occasions, is inclined to precipitate falls
involving fracture of thighbones which could spell disaster. Accidents
of this nature are likely to occur on rising quickly in the morning
before the circulation has a chance to adjust or after a hot bath
or a heavy meal when the heart is undertaking a little extra work.
Nutritional problems among the aged are common and, due perhaps
to a reluctance to take exercise or sheer forgetfulness, costiveness or
incontinence may become established to prove a continuing difficulty.
Loneliness, which often impels an elderly person to a bedridden
existence long before this really becomes a necessity, is sometimes
responsible for mental deterioration. This may present as a serious
arteriosclerotic dementia or merely as insomnia, irrascibility, forgetfulness,
wandering, mislaying personal possessions and an inability
to dress properly, etc. In a recent survey at Newcastle, it was
found that about 12% of a random sample of old people of 65 years
and over suffered from psychiatric disturbance of at least moderate
severity and, of these, only a small proportion were in hospitals or
residential homes.
It has been suggested by the Minister of Health that an allocation
of 10 hospital beds per 1,000 persons over the age of 65 years
could be considered reasonable but that this figure was only for
guidance and would vary when regard was had to the local population
structure. However, on a national level there would certainly
appear to be a general shortage of geriatric beds. This has been
supported by recent investigations which have revealed that numbers
of acute hospital beds are 'blocked' by geriatric patients who do not
require nursing skills and who, rightly, should be at home with
supportive services or in local authority welfare homes. Predicaments
of this nature could largely be avoided by careful assessments prior
and subsequent to admission aided by full co-ordination of hospital