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Continuing care of Old People—A Medical Viewpoint

  • Richard Lewis (a1) and John Wattis (a2)


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.



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

2 Thomson, D.Workhouse to nursing home: residential care of elderly people in England since 1840. Ageing and Society, 3 (1983), 4369.

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

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), 12511253.

5 Bagnall, W. E., Datta, S. R., Knox, J. and Horrocks, P.Geriatrie medicine in Hull: a comprehensive service. British Medical Journal, ii (1977), 102104.

6 Evans, J. G.Integration of geriatric with general medical services in Newcastle. Lancet, i (1983), 14301433.

7 Brocklehurst, J. C. and Andrews, K.Geriatric medicine – the style of practice. Age and Ageing, 14 (1985), 17.

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), 9092.

9 Pawlson, L. G.Hospital length of stay of frail elderly patients. Journal of The American Geriatrics Society, 36 (1988), 202208.

10 Mitchell, J., Kafetz, K. and Rossiter, B.Benefits of effective hospital services for elderly people. British Medical Journal, 295 (1987), 980983.

11 Wattis, J., Wattis, L. and Arie, T.Psychogeriatrics: a national survey of a new branch of psychiatry. British Medical Journal, 282 (1981), 15291533.

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

13 Wattis, J. P.Geographical variations in the provision of psychiatric services for old people. Age and Ageing, 17 (1988) 171180.

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), 2933.

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), 441449.

16 Blumenthal, M. D.Psychosocial factors in reversible and irreversible brain failure. Journal of Clinical and Experimental Gerontology, 1 (1979), 3955.

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), 168169.

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.

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

20 Grundy, E.Demography and old age. Journal of The American Geriatrics Society, 31 (1982), 325332.

21 Grundy, E. and Arie, T.Falling rate of provision of residential care for the elderly. British Medical Journal, 284 (1982), 799802.

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), 12741276.

23 Clarke, M. G., Williams, A. J. and Jones, P. A.A psychogeriatric survey of old peoples' homes. British Medical Journal, 283 (1981), 13071310.

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), 218223.

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), 98100.

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), 257265.

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), 329331.

28 Donaldson, L. J.Characteristics of elderly people misplaced in hospitals and homes. Public Health, 97 (1983), 257263.

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). 523524.

30 Winbow, A. and Farquharson, A.The Joint Assessment Panel of the Elderly. British Journal of Clinical and Social Psychiatry Vol. 2, 4 (1984), 108111.

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

32 Wilkin, D. and Hughes, B.Residential care of elderly people: the consumers' views. Ageing and Society, 7 (1987), 175201.

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

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

35 Murphy, E.Community Care – I. Problems; II. Possible solutions. British Medical Journal, 295 (1987), 15051508 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), 15181520.

38 Godber, C.Private rest homes: answers needed. British Medical Journal, 288 (1984), 14731474.

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

40 Grundy, E.Community care for the elderly 1976–1984. British Medical Journal, 294 (1987), 626629.

41 Bennett, J.Private nursing homes: contribution to long-stay care of the elderly in the Brighton Health District. British Medical Journal, 293 (1986), 867870.

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), 17191721.

43 Smith, T.Denmark: the elderly living in style. British Medical Journal, 287 (1983), 10531055.

44 Smith, T.Old age in the sun. British Medical Journal, 288 (1984), 15151517.

45 Laurence, M.Geriatric cuckoo. World Medicine, 25 08 (1979), 1920.

46 Coid, J. and Crome, P.Bed blocking in Bromley. British Medical Journal, 292 (1986), 12531256.

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.

48 Lamont, J. T. et al. The outcome of hospitalisation for acute illness in the elderly. Journal of The American Geriatric Society, 31 (1983), 282288.

49 Andrews, K. and Brocklehurst, J. C.The implications of demographic changes on resource allocation. Journal of the Royal College of Physicians, 19 (1985), 109111.

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

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

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), 541543.

53 Rodgers, J. S. and Muir-Gray, J. A.Long-stay care for elderly people: its continuing evolution. British Medical Journal, 285 (1982), 707709.

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

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

56 Challis, D. and Davies, B.A new approach to community care for the elderly. British Journal of Social Work, 10 (1980), 118.

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

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.

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

60 Anderson, R.The unremitting burden on carers. British Medical Journal, 294 (1987), 7374.

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), 2427.

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), 172177.

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), 121126.

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

66 Murphy, E.Griffiths on community care: potentially disastrous. British Medical Journal, 296 (1988), 876877.

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Continuing care of Old People—A Medical Viewpoint

  • Richard Lewis (a1) and John Wattis (a2)


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