Old people
?
must we shut them
Dr. Norman Capstick outlines a scheme which would save many old people from the isolation of an institution, but still enable them to receive the care and treatment that they need
The aim of keeping old people in the community is to avoid resignation to an institutional life, with its loss of independence, and also because a
partly
hospital
is
essentially
a
therapeutic institution, whose a disease, and not a place of
Purpose is the healing of residence.
Over
recent years, the numbers of old
ing hospital
and
people
enter-
residents has not only become a great strain on the resources of beds and nursing staff, but have resulted in many old People becoming institutionalised and losing contact with the community. The care of the elderly at home involves not only the co-operation of the general practitioner and psychiatric services but also the provision of clubs and day centres, and the friendly attitude of neighbours and Members of voluntary organisations. The core of preventing admission is knowing where to help. It cannot be assumed that old people will always seek help themselves; some do not know the services available or how to obtain such services as Meals on Wheels. Others will only consult their general practitioner if they are physically ill, and fail to realise that such symptoms as depression and anxiety are medical problems. If old age is accompanied by dementia, a hopeless domestic situation ^ay result, with squalor, loneliness and dietary deficiencies. Obviously, it is desirable that help be
becoming permanent
s?ught early.
Interference with liberty ?r
ideal preventive service, some form of would be needed. This would include an of the physical, social and financial conditions of old people. But registration might be conSldered an interference with personal liberties, and sheer weight of numbers might overwhelm the authorities. In some areas of the country, such as seaside resorts, the numbers might approach 40 per cent an
re?istration assessment
?f the population. ntil a preventive service is developed, efforts should ^ directed towards providing a community care
Service,
to
be available
as
early
as
possible
when
away?
there is need. The essential point is that the first perwho comes into the picture and who detects the need should know how to seek help. The 'first come' might be a member of the old person's family, a neighbour or a tradesman. The general practitioner is usually the best person to contact as a start. For his assessment will result either in immediate treatment, or, if the problem is a more involved one, in the decision to call in a psychiatric team. The psychiatric team will include a hospital social worker, mental welfare officer and psychiatrist. son
Treatable condition In these cases, physical, emotional and social factors must all be considered and each given attention. Disease in the elderly is often multiple and while many aspects may be due to degeneration, others are treatable. It has been estimated that over 50 per cent of old people entering a mental hospital do so with a treatable condition. Once the need for help has been established the essential feature is keeping contact. Organisation is needed to provide lines of communication between the services available. There must be regular meetings of the psychiatric team, to survey the needs and progress of patients being cared for at home. At such meetings, there should be attention to social measures, and the social worker can then contact the various services that are involved. A difficult problem is the diagnosis of depression in the elderly. Often, symptoms are thought to be due to the limitations of old age, and not recognised as symptoms of depression. If the possibility of depression is always kept in mind, this pitfall can be avoided.
Drug
treatment
The assessment at the beginning should result in a decision as to whether admission is needed, or whether treatment would be possible out of hospital. If admission is advised, early discharge and reintegration into the community must be borne in mind and a place kept in the home or lodgings.
Drug treatment, domiciliary visits, day hospital or out-patient appointments, chiropody, physiotherapy dental treatment may be needed. Provision must also be made for patients who are not attending a day hospital or day centre to make sure that their drugs are actually being taken. Many old people seem to be failing to respond to treatment, especially when living alone, and it is often found that the prescription has not been taken to the chemist or that the bottle of tablets remains untouched, though the patient insists that the drugs are being taken regularly. Visits to a day hospital, where the taking of drugs can be supervised, offer a solution to this problem. Daily visits by neighbours or members of voluntary organisations can fulfil the dual role of a social call and to make sure that drugs are being taken. Loneliness is a big factor in aggravating illness and steps to combat this should be taken as early as possible.
or
Ii
There is often difficulty in persuading old people to a club, and for this, an introduction by another member or social worker may be needed. Many retired couples are a self-contained unit and make few friends in a new retirement neighbourhood. Some may not be the club type and don't see any point in joining one, even in the isolation following a bereavement. When old people are advised to go to a geriatric day centre, only a minority become daily attenders. In these cases, there is no point in trying to use compulsion. It is better to extend an invitation to a weekly coffee morning, as this is usually greeted more favourably than joining a club, even though the coffee morning may be in a club. One such club, operated by the Worthing Division of the Red Cross, meets every Tuesday morning. Members are referred by the psychiatric service, who make the recommendation to the patient and tell the Red Cross to expect a new member. This makes sure that the hostess is able to tell each newcomer that they are expected and each is given a Red Cross badge. No Red Cross worker wears uniform when attending the club. The morning consists of conversation, coffee and such items as talent competitions, games and entertainments provided by the members. Social contacts are thus built up in a free and easy way. Members with cars are encouraged to collect other members, and this helps introductions. The great feature of such a club is the sense of belonging, enhanced by the badge, and for those leading an isolated life, it provides a point within the week to look forward to. The club has another advantage. A member of the psychiatric team is usually present and may then learn from the Red Cross workers that a particular member needs help. Also, the Red Cross workers are able to find out about members' difficulties among other advantages. For instance, one member was being overcharged for house repairs and expert
join
advice
Day
was
given to her. bring considerable relief family is at work it knows
centres
to the
family. old people
the cared for. The housewife with young children is without the additional burden of looking after an elderly relative. Out-patient clinics also break up the routine of the week and the excursion by hospital car service is
While the are
being
appreciated by many. Families often press for their old people to be admitted to hospital, on the grounds that they cannot cope. Often it is rather that the families do not know how to cope, and discussions often reduce demands for admission?and even result in enthusiasm for coping with the old people at home. A simple explanation of what is happening in a case of senile dementia assists understanding.
as the turning off of gas at the mains at night, information about laundry services for incontinent people, and the provision of 'sitters-in' for shopping excursions give tremendous relief to the
Hints such
14
Herald' Photo: Photo: Courtesy Courtesy 'Worthing 'Worthing Herald' Clubs can make a a substantial contribution to the wellbeing of old people. One such club, run by Worthing Worthing Division of the Red Cross, meets every Tuesday morning. Oldest member is Mrs. M. Robinson (.right) pictured in March celebrating her 100th birthday with Mrs. E. Lidbetter (.centre), then then club leader, and (left) the club's transport officer, Mr. G. R. Oliver.
family. In this way, people come to feel that the old person is not simply a family problem, but a problem shared between family, social workers and the community.
When old people live at home alone, pressure for admission may be an attempt to relieve family anxiety. If the children live at a distance, they naturally worry about how the aged mother or father is managing. Putting in a telephone for a daily call, the knowledge that a visitor checks things occasionally, or that meals are provided either through the W.V.S., in an old people's club or day centre may be all that is needed. In many parts of the country, there is an alternating programme of six weeks in hospital, followed by six weeks at home. This not only enables the family to have respites from a difficult situation, but also allows the patient to be assessed physically in hospital. It provides an opportunity to discover the appropriate drug which will quieten needless agitation and provide adequate sleep, thus ensuring a quiet night for the entire family. Where there are financial difficulties, National Assistance or Supplementary Pensions may be essential. At all times, care must be taken to balance help with the independence that old people wish to maintain. Many old people resist a change from independence to care, but, with tact, the problem can be presented in such a way as to avoid distress. It is a matter of offering help rather than insisting upon it. And the best way to do this is to talk to the old person and show how a particular service would help him or her.
?
must we shut them
Dr. Norman Capstick outlines a scheme which would save many old people from the isolation of an institution, but still enable them to receive the care and treatment that they need
The aim of keeping old people in the community is to avoid resignation to an institutional life, with its loss of independence, and also because a
partly
hospital
is
essentially
a
therapeutic institution, whose a disease, and not a place of
Purpose is the healing of residence.
Over
recent years, the numbers of old
ing hospital
and
people
enter-
residents has not only become a great strain on the resources of beds and nursing staff, but have resulted in many old People becoming institutionalised and losing contact with the community. The care of the elderly at home involves not only the co-operation of the general practitioner and psychiatric services but also the provision of clubs and day centres, and the friendly attitude of neighbours and Members of voluntary organisations. The core of preventing admission is knowing where to help. It cannot be assumed that old people will always seek help themselves; some do not know the services available or how to obtain such services as Meals on Wheels. Others will only consult their general practitioner if they are physically ill, and fail to realise that such symptoms as depression and anxiety are medical problems. If old age is accompanied by dementia, a hopeless domestic situation ^ay result, with squalor, loneliness and dietary deficiencies. Obviously, it is desirable that help be
becoming permanent
s?ught early.
Interference with liberty ?r
ideal preventive service, some form of would be needed. This would include an of the physical, social and financial conditions of old people. But registration might be conSldered an interference with personal liberties, and sheer weight of numbers might overwhelm the authorities. In some areas of the country, such as seaside resorts, the numbers might approach 40 per cent an
re?istration assessment
?f the population. ntil a preventive service is developed, efforts should ^ directed towards providing a community care
Service,
to
be available
as
early
as
possible
when
away?
there is need. The essential point is that the first perwho comes into the picture and who detects the need should know how to seek help. The 'first come' might be a member of the old person's family, a neighbour or a tradesman. The general practitioner is usually the best person to contact as a start. For his assessment will result either in immediate treatment, or, if the problem is a more involved one, in the decision to call in a psychiatric team. The psychiatric team will include a hospital social worker, mental welfare officer and psychiatrist. son
Treatable condition In these cases, physical, emotional and social factors must all be considered and each given attention. Disease in the elderly is often multiple and while many aspects may be due to degeneration, others are treatable. It has been estimated that over 50 per cent of old people entering a mental hospital do so with a treatable condition. Once the need for help has been established the essential feature is keeping contact. Organisation is needed to provide lines of communication between the services available. There must be regular meetings of the psychiatric team, to survey the needs and progress of patients being cared for at home. At such meetings, there should be attention to social measures, and the social worker can then contact the various services that are involved. A difficult problem is the diagnosis of depression in the elderly. Often, symptoms are thought to be due to the limitations of old age, and not recognised as symptoms of depression. If the possibility of depression is always kept in mind, this pitfall can be avoided.
Drug
treatment
The assessment at the beginning should result in a decision as to whether admission is needed, or whether treatment would be possible out of hospital. If admission is advised, early discharge and reintegration into the community must be borne in mind and a place kept in the home or lodgings.
Drug treatment, domiciliary visits, day hospital or out-patient appointments, chiropody, physiotherapy dental treatment may be needed. Provision must also be made for patients who are not attending a day hospital or day centre to make sure that their drugs are actually being taken. Many old people seem to be failing to respond to treatment, especially when living alone, and it is often found that the prescription has not been taken to the chemist or that the bottle of tablets remains untouched, though the patient insists that the drugs are being taken regularly. Visits to a day hospital, where the taking of drugs can be supervised, offer a solution to this problem. Daily visits by neighbours or members of voluntary organisations can fulfil the dual role of a social call and to make sure that drugs are being taken. Loneliness is a big factor in aggravating illness and steps to combat this should be taken as early as possible.
or
Ii
There is often difficulty in persuading old people to a club, and for this, an introduction by another member or social worker may be needed. Many retired couples are a self-contained unit and make few friends in a new retirement neighbourhood. Some may not be the club type and don't see any point in joining one, even in the isolation following a bereavement. When old people are advised to go to a geriatric day centre, only a minority become daily attenders. In these cases, there is no point in trying to use compulsion. It is better to extend an invitation to a weekly coffee morning, as this is usually greeted more favourably than joining a club, even though the coffee morning may be in a club. One such club, operated by the Worthing Division of the Red Cross, meets every Tuesday morning. Members are referred by the psychiatric service, who make the recommendation to the patient and tell the Red Cross to expect a new member. This makes sure that the hostess is able to tell each newcomer that they are expected and each is given a Red Cross badge. No Red Cross worker wears uniform when attending the club. The morning consists of conversation, coffee and such items as talent competitions, games and entertainments provided by the members. Social contacts are thus built up in a free and easy way. Members with cars are encouraged to collect other members, and this helps introductions. The great feature of such a club is the sense of belonging, enhanced by the badge, and for those leading an isolated life, it provides a point within the week to look forward to. The club has another advantage. A member of the psychiatric team is usually present and may then learn from the Red Cross workers that a particular member needs help. Also, the Red Cross workers are able to find out about members' difficulties among other advantages. For instance, one member was being overcharged for house repairs and expert
join
advice
Day
was
given to her. bring considerable relief family is at work it knows
centres
to the
family. old people
the cared for. The housewife with young children is without the additional burden of looking after an elderly relative. Out-patient clinics also break up the routine of the week and the excursion by hospital car service is
While the are
being
appreciated by many. Families often press for their old people to be admitted to hospital, on the grounds that they cannot cope. Often it is rather that the families do not know how to cope, and discussions often reduce demands for admission?and even result in enthusiasm for coping with the old people at home. A simple explanation of what is happening in a case of senile dementia assists understanding.
as the turning off of gas at the mains at night, information about laundry services for incontinent people, and the provision of 'sitters-in' for shopping excursions give tremendous relief to the
Hints such
14
Herald' Photo: Photo: Courtesy Courtesy 'Worthing 'Worthing Herald' Clubs can make a a substantial contribution to the wellbeing of old people. One such club, run by Worthing Worthing Division of the Red Cross, meets every Tuesday morning. Oldest member is Mrs. M. Robinson (.right) pictured in March celebrating her 100th birthday with Mrs. E. Lidbetter (.centre), then then club leader, and (left) the club's transport officer, Mr. G. R. Oliver.
family. In this way, people come to feel that the old person is not simply a family problem, but a problem shared between family, social workers and the community.
When old people live at home alone, pressure for admission may be an attempt to relieve family anxiety. If the children live at a distance, they naturally worry about how the aged mother or father is managing. Putting in a telephone for a daily call, the knowledge that a visitor checks things occasionally, or that meals are provided either through the W.V.S., in an old people's club or day centre may be all that is needed. In many parts of the country, there is an alternating programme of six weeks in hospital, followed by six weeks at home. This not only enables the family to have respites from a difficult situation, but also allows the patient to be assessed physically in hospital. It provides an opportunity to discover the appropriate drug which will quieten needless agitation and provide adequate sleep, thus ensuring a quiet night for the entire family. Where there are financial difficulties, National Assistance or Supplementary Pensions may be essential. At all times, care must be taken to balance help with the independence that old people wish to maintain. Many old people resist a change from independence to care, but, with tact, the problem can be presented in such a way as to avoid distress. It is a matter of offering help rather than insisting upon it. And the best way to do this is to talk to the old person and show how a particular service would help him or her.
