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efficiency and working capacity of our older population. If a few million older people
were in productive employment the benefit to everyone would be immense. The extra
money they would earn would provide them with better food, and the extra activity
would help to keep them fit. All this could be done if we could keep the old people
healthy; it is not being done at present. The reason is that although our National
Health Service makes provision for infants and children, nursing and expectant mothers,
it makes no provision for a preventive health service for older people.
Clinics.
We need prevention clinics for older people which can discover the early clinical
signs of deterioration; their aim should be to prevent or delay the onset of deterioration
and to retard its progress. These clinics can be of various kinds: they can be held in
local authority clinics; they can be part of a hospital out-patient department; they can
be part of a hospital day treatment centre; they can be provided in the premises of
practitioners. They can be staffed by hospital doctors, by medical officers of local
authorities, or by practitioners, all of whom need special training.
In whatever way this service is provided, the person attending needs the benefit of
a high-class diagnostic and preventive service obtainable at one time and in one place.
Older people will not be bothered with trailing round hospital departments on different
days for examination of eyes, of ears, for electrocardiograph, photograph, X-rays, chiropody,
haematology, or physiotherapy. If the full examination and all the ancillary
investigations can be carried out scientifically and accurately in one place at the first
attendance and without undue waiting or delay, then subsequent appointments are most
likely to be kept; this has been our experience in our clinic.
If the medical examination is to fulfil the proper and practical translation of the
word "prevention", then the doctor must be as fully equipped with diagnostic apparatus
as a consultant would be, and must be as clinically sound in the field of prevention as
the consultant is in ward work. This service would be the first line of defence in the
maintenance of the health of the elderly. The provision of quasi-socio-medical "chat
and hope" centres for informal discussions with a doctor, where both hope for the best,
is merely scratching at the surface of the problem. The limited equipment and facilities
of the existing infant welfare clinics will not be sufficient.
Middle life is the stage of active life for everybody; it is from this stage onwards
that the defects begin. If we offered people the chance of preventive medical examinations
there is no doubt great numbers would come to accept as quite normal their
periodic appointments for their routine medical investigations. The preventive public
health service may well become the most important medical service in the country.
If an older person has his glasses put right, his diet improved and supplemented
as necessary, his mineral, vitamin and hormone deficiences corrected, and his way of life
suitably adjusted, there will soon be a marked improvement in health. There is improvement
in appearance, muscle tone, physical activity and mental vigour. In his greater
freedom of movement, and in the reassurance he gets from the clinical estimate of his
powers, a greater mental stability develops. The psychological benefit is marked, and
the whole pattern of life seems to change. One quite intelligent woman who came to
the clinic saying 'I feel so miserable and wretched and ashamed of my appearance that
I would like to die" improved so much that two years later, at the age of 83, she went
abroad alone and enjoyed herself so much that she repeated the trip the following
summer. Another woman undertook a successful journey to Canada years after she
had abandoned all hope of ever being well enough to go. But although the early
improvements can be quite spectacular, still more encouraging is the fact that in a good
many cases the improvement remains steady and even increases.
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