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171
although undoubtedly present in some measure, appears not to be
extensive and, where it does exist, it would seem to arise in those
persons presenting with pathological conditions. Logically, identification
of these and other cases of sub-clinical malnutrition
would seem to fall within the purview of medical and nursing
activities and, ideally, responsibility for the initial assessments
should be a matter for the health services. In Greenwich, this has
always been a duty of our women public health officers for it had
long been realised that with malnutrition comes the more serious
problem of hypothermia.
Normally, the body has a highly efficient automatic system of
adjusting blood vessels to maintain a constant temperature of
98.4 °F. It achieves this by a combination of physical activity and
partaking of food and this is stimulated or depressed by the wearing
of suitable clothing. Danger arises when heat is being lost
faster than it can be replaced and a person then begins to exhibit
signs of "exposure" and, if treatment is not instituted to arrest
this fall in temperature, unconsciousness supervenes and the patient
dies. This is known as "hypothermia" and its association with the
elderly retired and sometimes home-bound person is manifest.
A diagnosis of hypothermia, in the earlier stages particularly,
demands some medical knowledge for it is made on the sum total
of a number of vague symptoms including unexpected and unreasonable
behaviour, physical and mental lethargy, abnormality
of vision, slurring of speech, shivering fits, sudden outbursts of
energy (perhaps physical resistance to help), falling episodes or
clumsiness, cramps, ashen colour, fainting and nausea accompanied
by complaints of coldness and tiredness.
In the elderly, the onset of this "accidental hypothermia" tends
to be insidious and often passes unnoticed by the individual concerned
or even by friends and relations. Living alone in a frail
condition is a common factor in hypothermia which may well be
exacerbated by such disorders as lowered thyroid function and by
the taking of tranquilising drugs.
Walkine the person, rubbing skin surfaces, heating with hot
water bottles and the giving of alcohol are clearly proscribed for
these all tend to bring blood to the surface and away from
vital internal organs.
When hypothermia is suspected and the doctor summoned, the
patient should be put to bed and given a warm, well-sugared
drink and the room temperature raised as quickly as possible to
the 65°/70°F. mark.
Fortunately, most elderly residents likely to be sub'ect to malnutrition
(and therefore hypothermia) are known to the geriatric