Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-26T00:52:19.820Z Has data issue: false hasContentIssue false
  • English
  • Français

Continuing care of Old People—A Medical Viewpoint

Published online by Cambridge University Press:  14 November 2008

Richard Lewis  and
John Wattis
Richard Lewis
Affiliation:
Consultant in Psychiatry of Old Age Pen-Y-Fal Hospital, Abervagenny, Gwent, Wales.
John Wattis
Affiliation:
Senior Lecturer/Consultant, Department of Psychiatry of Old Age. St. James' University Hospital, Leeds, England.
Get access Rights & Permissions [Opens in a new window]

Abstract

Provision for old people who are in need of continuing care requires close co-operation between informal carers and different agencies and disciplines providing health and social care. In the United Kingdom, the present system of care has evolved from earlier patterns of care centred on the asylums and the poor law with its workhouse institutions. It lacks cohesion. Despite the designation of old people as a priority group, resources are still inadequate to provide a good quality of care. Organisational differences between health and social services can lead to inefficient use of existing resources. More specialised medical, psychiatric and social services for old people enhance the possibilities for co-operation even though they may appear to lead to greater fragmentation. The history of the development of these services in the UK, including the recent expansion of private sector care, is reviewed, with special attention from the medical perspective to the phenomenon of ‘bed blocking’. The recently published Griffiths Report on community care is briefly considered, and some principles for future developments are laid down.

Type
Review Article
Information
Ageing & Society , Volume 8 , Issue 2 , June 1988 , pp. 189 - 209
Copyright
Copyright © Cambridge University Press 1988

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

NOTES

1 Griffiths, Sir Roy. Community Care: Agenda for Action. London, HMSO, 1988.Google Scholar

2 Thomson, D.Workhouse to nursing home: residential care of elderly people in England since 1840. Ageing and Society, 3 (1983), 43–69.CrossRefGoogle Scholar

3 Godber, G.Correspondence. British Medical Journal, 284 (1982), 1040.CrossRefGoogle Scholar

4 Maguire, P. A., Taylor, I. C. and Stout, R. W.Elderly patients in acute medical wards: factors predicting length of stay in hospital. British Medical Journal, 292 (1986), 1251–1253.CrossRefGoogle ScholarPubMed

5 Bagnall, W. E., Datta, S. R., Knox, J. and Horrocks, P.Geriatrie medicine in Hull: a comprehensive service. British Medical Journal, ii (1977), 102–104.CrossRefGoogle Scholar

6 Evans, J. G.Integration of geriatric with general medical services in Newcastle. Lancet, i (1983), 1430–1433.CrossRefGoogle Scholar

7 Brocklehurst, J. C. and Andrews, K.Geriatric medicine – the style of practice. Age and Ageing, 14 (1985), 1–7.CrossRefGoogle Scholar

8 Burley, L. E., Currie, C. T., Smith, R. G. and Williamson, J.Contribution from geriatric medicine within acute medical wards. British Medical Journal, ii (1979), 90–92.CrossRefGoogle Scholar

9 Pawlson, L. G.Hospital length of stay of frail elderly patients. Journal of The American Geriatrics Society, 36 (1988), 202–208.CrossRefGoogle ScholarPubMed

10 Mitchell, J., Kafetz, K. and Rossiter, B.Benefits of effective hospital services for elderly people. British Medical Journal, 295 (1987), 980–983.CrossRefGoogle ScholarPubMed

11 Wattis, J., Wattis, L. and Arie, T.Psychogeriatrics: a national survey of a new branch of psychiatry. British Medical Journal, 282 (1981), 1529–1533.CrossRefGoogle ScholarPubMed

12 Wattis, J. and Arie, T.Further developments in psychogeriatrics in Britain. British Medical Journal, 289 (1984), 778.CrossRefGoogle ScholarPubMed

13 Wattis, J. P.Geographical variations in the provision of psychiatric services for old people. Age and Ageing, 17 (1988) 171–180.CrossRefGoogle ScholarPubMed

14 Eagles, J. M. and Gilleard, C. J.Factors affecting admission and discharge placements of demented elderly patients. British Journal of Clinical and Social Psychiatry, 3 (1985), 29–33.Google Scholar

15 Bergmann, K., Foster, E. M., Justice, A. W. and Matthews, V.Management of the demented elderly patient in the community. British Journal of Psychiatry, 132 (1978), 441–449.CrossRefGoogle Scholar

16 Blumenthal, M. D.Psychosocial factors in reversible and irreversible brain failure. Journal of Clinical and Experimental Gerontology, 1 (1979), 39–55.Google Scholar

17 Royal College of Psychiatrists/British Geriatrics Society: guidelines for collaboration between geriatric physicians and psychiatrists in the care of the elderly. Bulletin of the Royal College of Psychiatrists, Vol. 4, 11 (1979), 168–169.Google Scholar

18 Townsend, P.The Last Refuge: a Survey of Residential Institutions and Homes for the Aged in England and Wales. Routledge and Kegan Paul, London, 1962.Google Scholar

19 DHSS. Report of a Study on Community Care. London, DHSS, 1981.Google Scholar

20 Grundy, E.Demography and old age. Journal of The American Geriatrics Society, 31 (1982), 325–332.CrossRefGoogle Scholar

21 Grundy, E. and Arie, T.Falling rate of provision of residential care for the elderly. British Medical Journal, 284 (1982), 799–802.CrossRefGoogle ScholarPubMed

22 Wilkin, D., Mashiah, T. and Jolley, D. J.Changes in behavioural characteristics of elderly populations of local authority homes and long-stay hospital wards 1976–77. British Medical Journal, 2 (1978), 1274–1276.CrossRefGoogle Scholar

23 Clarke, M. G., Williams, A. J. and Jones, P. A.A psychogeriatric survey of old peoples' homes. British Medical Journal, 283 (1981), 1307–1310.CrossRefGoogle Scholar

24 De Zoysa, A. S. R. and Blessed, G.The place of the specialist home for the elderly mentally infirm in the care of mentally disturbed old people. Age and Ageing, 13 (1984), 218–223.CrossRefGoogle ScholarPubMed

25 Wilkin, D., Hughes, B. and Jolley, D.The implications of managing confused and disabled people in non-specialist homes for the elderly. Health Trends, 14 (1982), 98–100.Google ScholarPubMed

26 Mann, A. H., Graham, N. and Ashby, D.Psychiatric illness in residential homes for the elderly: a survey in one London Borough. Age and Ageing, 13 (1984), 257–265.CrossRefGoogle ScholarPubMed

27 Finlay, O. E., Bayles, T. D., Rosen, C. and Milling, J.Effects of chair design, age and cognitive status on mobility. Age and Ageing, 12 (1983), 329–331.CrossRefGoogle ScholarPubMed

28 Donaldson, L. J.Characteristics of elderly people misplaced in hospitals and homes. Public Health, 97 (1983), 257–263.CrossRefGoogle ScholarPubMed

29 Masterton, G., Holloway, E. M. and Timbury, G. C.Role of Local Authority homes in the care of the dependent elderly: a prospective study. British Medical Journal, 283 (1981). 523–524.CrossRefGoogle ScholarPubMed

30 Winbow, A. and Farquharson, A.The Joint Assessment Panel of the Elderly. British Journal of Clinical and Social Psychiatry Vol. 2, 4 (1984), 108–111.Google Scholar

31 Meacher, M.Taken for a Ride. Longman, London, 1972.Google Scholar

32 Wilkin, D. and Hughes, B.Residential care of elderly people: the consumers' views. Ageing and Society, 7 (1987), 175–201.CrossRefGoogle Scholar

33 Norman, A.Severe dementia: The Provision of Long-stay Care. Centre for Policy on Ageing. Policy Studies in Ageing no. 7, 1987.Google Scholar

34 DHSS. Regulation 9, Supplementary Benefit Requirement. Resource and Single Payment Amendment Regulation. London, DHSS, 1983, Circular 7/143.Google Scholar

35 Murphy, E.Community Care – I. Problems; II. Possible solutions. British Medical Journal, 295 (1987), 1505–1508CrossRefGoogle Scholar and 296 (1988), 6–8.

36 Yorkshire Television: First Tuesday series (6 October 1987).

37 Andrews, K.Private rest homes in the care of the elderly. British Medical Journal, 288 (1984), 1518–1520.CrossRefGoogle ScholarPubMed

38 Godber, C.Private rest homes: answers needed. British Medical Journal, 288 (1984), 1473–1474.CrossRefGoogle ScholarPubMed

39 Audit Commission. Making a Reality of Community Care. London, HMSO, 1986.Google Scholar

40 Grundy, E.Community care for the elderly 1976–1984. British Medical Journal, 294 (1987), 626–629.CrossRefGoogle Scholar

41 Bennett, J.Private nursing homes: contribution to long-stay care of the elderly in the Brighton Health District. British Medical Journal, 293 (1986), 867–870.CrossRefGoogle ScholarPubMed

42 Capewell, A. E., Primrose, W. R. and MacIntyre, C.Nursing dependency in registered nursing homes and long term care geriatric wards in Edinburgh. British Medical Journal, 292 (1986), 1719–1721.CrossRefGoogle ScholarPubMed

43 Smith, T.Denmark: the elderly living in style. British Medical Journal, 287 (1983), 1053–1055.CrossRefGoogle ScholarPubMed

44 Smith, T.Old age in the sun. British Medical Journal, 288 (1984), 1515–1517.CrossRefGoogle ScholarPubMed

45 Laurence, M.Geriatric cuckoo. World Medicine, 25 08 (1979), 19–20.Google Scholar

46 Coid, J. and Crome, P.Bed blocking in Bromley. British Medical Journal, 292 (1986), 1253–1256.CrossRefGoogle ScholarPubMed

47 Roudot-Thoraval, F., Boubert, M., Fourestie, V. and Lejonc, J. L.Social future of elderly admitted to acute care hospital: opinion of patient or family as predictive factor of subsequent transfer to long term care. British Medical Journal, 294 (1987), 608.CrossRefGoogle ScholarPubMed

48 Lamont, J. T. et al. The outcome of hospitalisation for acute illness in the elderly. Journal of The American Geriatric Society, 31 (1983), 282–288.CrossRefGoogle ScholarPubMed

49 Andrews, K. and Brocklehurst, J. C.The implications of demographic changes on resource allocation. Journal of the Royal College of Physicians, 19 (1985), 109–111.Google ScholarPubMed

50 Rubin, S. G. and Davies, G. H.Bed blocking by elderly patients in general hospital wards. Age and Ageing, 4 (1975), 142–147.CrossRefGoogle ScholarPubMed

51 Farag, R. R. and Tinker, G. M.Delay in discharge of patients from an acute geriatric unit. Health Trends, 17 (1985), 41.Google ScholarPubMed

52 Lowry, S. and Briggs, R.Boom in private rest homes in Southampton: impact on the elderly in residential care. British Medical Journal, 296 (1988), 541–543.CrossRefGoogle Scholar

53 Rodgers, J. S. and Muir-Gray, J. A.Long-stay care for elderly people: its continuing evolution. British Medical Journal, 285 (1982), 707–709.CrossRefGoogle ScholarPubMed

54 DHSS (1957), HM (57), 86.Google Scholar

55 DHSS. Priorities for Health and Social Services in London. HMSO, 1976.Google Scholar

56 Challis, D. and Davies, B.A new approach to community care for the elderly. British Journal of Social Work, 10 (1980), 1–18.Google Scholar

57 Challis, D. and Davies, N.Case Management in Community Care. Gower, Aldershot, 1986.Google Scholar

58 International Association of Mental Health Workers. A proposal to the Griffiths Enquiry into community care from the I.A.N.H.W. Bulletin of the Royal College of Psychiatrists, 12 (1988), 77.CrossRefGoogle Scholar

59 Cumberlege Report. Neighbourhood Nursing: a Focus for Care. HMSO, 1986.Google Scholar

60 Anderson, R.The unremitting burden on carers. British Medical Journal, 294 (1987), 73–74.CrossRefGoogle ScholarPubMed

61 Alzheimer's Disease Society. Caring for the person with dementia: a guide for families and other carers. Alzheimer's Disease Society, 1984.

62 Toner, H. L.Effectiveness of a written guide for carers of dementia sufferers. British Journal of Clinical and Social Psychiatry, 5 (1987), 24–27.Google Scholar

63 Gilleard, C. J., Belford, H., Gilleard, E., Whittick, J. E. and Gledhill, K.Emotional distress amongst the supporters of the elderly mentally infirm. British Journal of Psychiatry, 145 (1984), 172–177.CrossRefGoogle ScholarPubMed

64 Greene, J. G., Smith, R., Gardiner, M. and Timbury, G. C.Measuring behavioural disturbance of elderly demented patients in the community and its effect on relatives. Age and Ageing, 11 (1982), 121–126.CrossRefGoogle ScholarPubMed

65 King's Fund. Living Well into Old Age. Project Paper no. 63. King Edward's Hospital Fund for London, 1986.Google Scholar

66 Murphy, E.Griffiths on community care: potentially disastrous. British Medical Journal, 296 (1988), 876–877.CrossRefGoogle ScholarPubMed