Brocklehurst. The Ciba Foundation maintained its interest in old age by establishing a series of special colloquia in London, which were attended by many international experts on ageing, and supported the British Society for the Research in Ageing, which was founded by Korenchevsky.
As the new‐style treatment methods were applied to the previously neglected chronic sick, clear evidence emerged of its effectiveness, particularly in hospitals. Official health data sources, such as Hospital In Patient Enquiry (HIPE) data collection, the Office of Health Economics and Health and Personal Social Services Statistics for England, showed that the number of deaths and discharges of elderly people and patient turnover from geriatric wards steadily increased while the average and median lengths of stay decreased. In 1980, the Chief Medical Officer for England and Wales was able to report ‘the average length of stay for patients in hospital departments of geriatric medicine is steadily diminishing – more so than in any other hospital specialty. Only 10% remain in hospital for more than 6 months; the median length of stay is only 21.7 days’.27 Progress was such that in 1984, the Nuffield Provincial Hospital Trust was able to comment, ‘It [geriatric medicine] has established its expertise and has had notable success in developing and raising the standards of services for the old’.28 Concomitant with these developments, individual geriatricians began to create differing styles of practice: whereas some did not take emergency admissions, others took increasing numbers of acutely ill patients, and still others reintegrated with general medicine, taking part in unselected acute medical intake and joint ward rounds with their general physician colleagues.
Problem areas
The birth of geriatric medicine in the UK was hampered by the indifference of the medical profession to elderly patients for many reasons. The care of the aged and infirm lacked the dramatic appeal of acute illness in the young. Physicians questioned why elderly people should be put through extensive rehabilitation when they had only a few years to live. Complete recovery was rarely possible, and the result was often disproportionate to the effort required. Chronic sick patients were often accommodated in poorly equipped and staffed hospitals. General physicians feared ‘bed blocking’ if they admitted elderly patients, appeared uninterested in deciding what was normal or abnormal in this age group and in learning what treatment could achieve, were displeased at the diversion of resources from general medicine to geriatric medicine, and were unenthusiastic about the considerable social/nonmedical components of geriatric medicine. Geriatricians were viewed as ‘second‐rate’ physicians.
Another concern was the quality of care given to older people in hospitals. This culminated in the publication in 1967 of Sans Everything: a Case to Answer, which alleged inappropriate care in hospitals for the elderly and mentally ill. Official investigations found that the complaints were inaccurate, vague, lacking in substance, misinterpretations, or over‐emotional.29 Following yet another allegation of improper care in a unit for the mentally subnormal in 1967, the Secretary of State for Health created the Hospital Advisory Service (HAS) in 1969, which was to act as his ‘eyes and ears’. It was to be responsible only to him and was to be independent of the Department of Health. Visits to hospitals for the elderly and mentally ill started in 1970 and were carried out by teams of ‘in‐post’ professionals: consultant geriatricians or psychiatrists, senior nurses, paramedical staff, administrators, and later social workers. It is best considered as a form of ‘peer review’. Later its remit was extended to cover community services, at which time it was renamed the Health Advisory Service.
The development of specialist service for the elderly mentally ill lagged behind that of the physically ill. Not infrequently, these patients were inappropriately admitted to geriatric wards, where staff had limited experience in managing them. Sometimes they were admitted to large general mental hospitals where the general psychiatrists did not welcome them. The Ministry was aware of the problems presented by these patients and published advisory documents.30,31 Eventually, guidelines were introduced to ensure admission to an appropriate ward: assessment by a multidisciplinary team was recommended. Joint assessment units with input from the local authority, psychiatrists, and the geriatrician were set up, although they tended to silt up owing to the failure to move the patients on to suitable wards or accommodation. Psychogeriatric day hospitals were opened, which provided a useful community function. Local authority residential homes were encouraged to take more mentally ill patients. However, it was not until the 1970s that consultant psychogeriatricians were appointed.
Another source of debate was the term geriatrics and allied words. The word gerocomy, attributed to Galen, was used for the medical care of the elderly and was adapted to geroncology for their sociological aspects. In 1903, Metchnikoff invented the word gerontology for the biological study of the ageing process. Nascher is generally credited with coining the word geriatrics.32 ‘The term was … derived from the Greek, geron, old man and iatrikos, medical treatment. The etymological construction is faulty but euphony and mnemonic expediency were considered of more importance than correct grammatical construction’. Howell pointed out at least one author who had confused gerontology (the science of old age) and geriatrics (the care of the aged). The word gerontology has been attacked as a barbarous misspelling, and the word geratology, the study of old age, has been suggested instead. The founders of the Medical Society for the Care of the Elderly did not use the word geriatrics since it was, in the 1940s, almost unknown. Many UK hospital geriatric units, aware of the public’s perception of geriatrics as being apparently synonymous with senility, now call themselves ‘Department for the Medical Care of the Elderly’ or ‘Care of the Elderly Department’.
Key points
In spite of interest in old age, enlightened medical treatment of the elderly sick patient did not start until the twentieth century.
Classification of patients and better treatment methods showed that the majority of those admitted to elderly care wards could be discharged.
Community studies found unreported minor illness in older people, which could have a major impact on the quality of life if left untreated.
University authorities were slow to implement the education of medical students about the medical and social aspects of illness in the older person.
Powerful charitable foundations supported research into the causes of ageing.
References
1 1. Abel‐Smith B. The Hospitals 1800–1948. Heinemann; 1964.
2 2. Anonymous. The Lancet Sanitary Commission. Lancet; 1869.
3 3. Webster C. Caring for Health: History and Diversity. Open University, Milton Keynes, 1993.
4 4. Warren MW. Care of chronic sick. Br Med J 1943;ii:822–3.
5 5. Jones AT, Nixon JA, Picken RMF. Welsh Board of Health: Hospital Surveys – the Hospital Services of South Wales and Monmouthshire. HMSO; 1945.
6 6. Bevers EC, Gask GE, Parry RH. Ministry of Health: Hospital Survey – the Hospital Services of Berkshire, Buckinghamshire, and Oxfordshire. HMSO; 1945.
7 7. Gray AMH, Topping A. Ministry of Health: Hospital Survey – the Hospital Services of London and the Surrounding Area. HMSO; 1945.
8 8. Amulree L, Sturdee EL. Care of the chronic sick and of the aged. Br Med J 1946;i:617–8.
9 9. Boucher CA. Survey of Services Available to the Chronic Sick and Elderly 1954–1955. Reports on Public Health and Medical Subjects No. 98. Ministry of Health; 1957.
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