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the home cleared, decorated and prepared to enable the old person to go back in the
community.
There is a need for geriatric health visitors to assess, advise, and mobilise neighbours
and trades'people and put the old person in touch with social services. (See page 24
—Health Visiting). A trained social worker with a special interest in the elderly would
be invaluable in case work with the elderly, depressed and lonely, and in giving
supportive therapy to the families of senile difficult patients. It is envisaged that these
two types of officers would work in partnership forming part of the community care
team.
The aim is to keep the old person in the community as long as possible; group
dwellings with warden and old persons flatlets would go a long way to meet the need
of a steadily rising elderly population in the Borough.
My thanks to Dr. J. S. Finn, M.B., B.Ch., B.A.O., and Dr. J. D. B. Andrews,
M.D., B.S., M.R.C.S., L.R.C.P., D.P.H., Consultant Geriatricians is acknowledged.
The following contribution by Dr. John Maddison, M.D., B.S., D.P.H., appeared
in PUBLIC HEALTH, November, 1965 —
MAINTAINING THE HEALTH OF OLDER PEOPLE
Much disability
There exists amongst the elderly population a vast amount of ill-health and
disability, much of which is preventable and remediable. This is the fundamental issue
which needs to be emphasized again and again. You can observe the deteriorated elderly
man or woman in your own family, on the streets, in welfare associations, at their
Christmas parties, in your old peoples' homes, and in the hospitals.
The multiple deficiency syndrome
We have examined over 1500 people in our experimental clinic at Teddington,
where we have available a wide range of diagnostic equipment, and we have observed
that almost all elderly people have disabilities — some few, some many. Nearly onethird
have nutritional deficiences and anaemia; sooner or later almost everyone suffers
from deficiency of endocrines, especially of androgen or anabolic hormone, oestrogen,
progestogen, or thyroxine; we all get artery disease; women get foot defects; we wear
incorrect spectacles and we gradually go deaf.
The disabilities of later life are multiple. From middle life onwards people begin
to show signs of deterioation in their health; the disabilities increase in number and
severity. They creep on insidiously without the person realizing there is anything
wrong or the extent of it; they do not seek treatment. If these disabilities exist, as they
do, and are preventable, as they are, then we should be vigorous in our endeavours to
prevent them.
Saving
If we could prevent this enormous mass of disability in older people and keep
every one of them healthy and happy in his own home, with full functional activity,
able to work, in harmony with those around him — then the saving on the endurance
and generosity of relatives and friends, on national assistance, on hospitals, on medical
and welfare services would be enormous; and the increase in productive capacity for the
nation would be very great. For if we prevented deterioration we would raise the
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