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164
It was only after the establishment of the National Health
Service in the latter 1940s that serious attention began to be paid
to geriatrics and its associated problems by local authorities and,
for that matter, by the medical profession as a whole. Fortunately,
at long last, stimulation of medical interest has resulted in greater
emphasis being placed upon the preventive aspects of illness in
old age.
Prevention of disease at any age is usually long term but this is
especially true regarding many of those disabilities associated with
the ageing processes. For instance, health education in the field of
dietetics is a necessity if obesity with its accompanying sequelae of
arthritis, diabetes and hypertension are to be avoided and, appropriate
financial arrangements need to be made to prevent the debility
and hypovitaminosis arising from malnutrition born of persistent
straitened circumstances so common in elderly households.
Patently old age modifies most diseases and, in geriatric cases,
the classic symptoms are usually not so pronounced. Because of
diminished response in the senium, breakdown in physiological
mechanisms controlling blood pressure, temperature and water
balance is often insidious and painless. Lack of response of the
heat-regulating centre of the brain brought about by cerebrovascular
disease, perhaps presenting as "confusion" in the elderly, could
lead to ailments such as pneumonia, tuberculosis, genito-urinary
and other infections escaping detection and perhaps to cases of
irreversible hypothermia. Again, because of the absence of pain,
loss of movement in an old person can sometimes be mistakenly
attributed to a "stroke" when it may well be due to an undiagnosed
fracture and the onset of deafness or defective sight, failings
frequently met with in the elderly, are often so imperceptible that
only chance examination reveals their existence. Immobility
arising from bad feet or arthritis of the knee or hip joint can lead
to progressive dependency which, although not in itself lethal,
could result in many unhappy years being spent expensively in an
institution until a final illness terminates the misery.
Despite the fact that in old age multiple pathology is the rule
rather than the exception, much of this illness is non-lethal and,
far from being degenerative and untreatable, many disabilities such
as anaemia, thyroid disease (both hypo and hyper functioning),
congestive cardiac failure, urinary tract infection, depression, etc.,
are manifestly treatable conditions.
Leaving aside the humane elements of the problem there are
sound economic reasons for even further emphasis on the prevention
of disability in old age and, advantages gained by early
recognition and treatment of many of these ailments can be