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165
stantial. Independence, that essential ingredient of a contented
retirement, would be prolonged, local authority residential accommodation
would be more suitably filled and many hospital places
released for more urgent and less "bed-blocking" cases. Indeed, it
has been estimated that today, because of high morbidity rates in
the older age groups, two-thirds of all hospital beds (other than
those for paediatric, maternity and mental cases) are occupied by
persons over the age of 65. With the anticipated increase during
the next 10 to 20 years in the elderly population, especially those
over 75 the majority of whom will be women, some alleviation of
the strain on hospital resources is essential if a breakdown is to be
averted.
It seems that an effective geriatric service must be based upon
the following propositions :—
(a) Preventive action—nutritional, prophylactic and educational.
(b) Ascertainment of disability.
(c) Provision of all necessary supportive services or prompt
hospitalisation, as appropriate, to prevent, reverse or
decelerate dependency.
(d) Adequate and suitable residential accommodation when
required.
How can such services be organised and how ought they to be
implemented?
It has been estimated that some 95% of all old people live and
die at home. Logically, therefore, the first lines of defence must
be established in the home by preventive-orientated medical and
nursing agencies.
Despite very strong support for a hospital-based geriatric service
it is clear that, without a re-orientation of its functions or a substantial
increase in nursing and ancillary staff, the existing hospital
services would be unable to sustain the imposition of a further
heavy and growing burden. Moreover, at present, hospitals can
deal only with such cases as are referred to them, namely, those
with overt disease or persons in whom doctors have suspected some
disability. Even this situation pre-supposes that elderly people, as
a whole, regularly attend their own doctors who are aware not only
of the medical condition of their patients but also of their social
and environmental circumstances. There is ample evidence that
this is not so and that more than half of all disabling conditions
occurring in elderly persons are unknown to their general practitioners.
This probably arises from the fact that it is traditional in
this country for medical treatment to be based upon the