National Geriatric Service Suggested

Press, Volume C, Issue 29498, 27 April 1961, Page 8

National Geriatric Service Suggested

Few things would do as much to reduce hospital costs, accelerate other admissions, and promote the happiness of the elderly sick, as a national geriatic service, said Dr. J. L. Newman, superintendent of Green Lane Hospital. Auckland, in an adress to the British Medical Association. The address, delivered at the asAuckland in February, has just been released in the form of a report in the British Medical Journal. Dr. Newman said that, on the best figures he had available, nearly one-third of all hospital bed usage was for the over-«’s.

A national geriatric service must be dedicated to the Ideals of the relief of suffering, the promotion of happiness, and the restoration to independence. The mental infirmities of old age presented "a terrible problem,” perhaps the biggest problem of all because of reluctance to recognise its existence, he made. He hoped for an early amendment of the Mental Hygiene Act to get rid of the necessity for certification of those who could not speak for themselves. The care of long-term sickness in old folk should be recognised as a special branch of medicine. The lack of accommodation for the frail ambulant and for the mildet cases of mental confusion had led to the growth of what were called “Rest Homes" which accepted elderly boarders for fees. Annex Ideal The ideal arrangement for the elderly sick was a geriatric annex to a general hospital. A hundred such beds would be enough to keep a house-physician and a geriatrician and a medicalsocial worker fully occupied. The geriatrician’s activities should extend outside the annex to the homes of prospective patients, and be could select the cases for admis. sion. The annex Should admit direct as well as from acute wards, and should have its own rehabilitation department staffed in rotation by physiotherapists and occupational therapists from the main hospital- Any place doing justice to old patients should have on easy call a urologists, an oculist, an aural surgeon, and an orthopaedic surgeon as a minimum.

Dr. Newman thought a geriatic annex preferable either to a ward or to a special geriatric hospital. A ward was "usually left in the care of doctors with heavy commitments on the acute side, and the geriatric Inevitably suffered.” Where shortage of numbers made it uneconomic to have a special annex it was “absolutely essential” that the medical staffing, at any rate at senior level, should be by a doctor who was not in charge of other beds, A special geriatric hospital tended to remain Isolated, with- a detrimental effect on the training it should give to nurses: end it was "only too likely" to be remote, whereas easy aeeess . was essential if the Interest of the relatives was to be maintained.

Local Comment "A geriatric service may better be organised on a regional rather than a national basis.” the North Canterbury Hospital Board’s director of out-patient services (Dr. W. I. Paterson) said when asked to comment on Dr. Newman’s suggestion. ”We have to

work together within the local community if we wish to provide the best possible services for our old folk. A national system is useful for consultation, but I would not like, to see all our geriatric serviced controlled as one unit”

On the question of the accommodation of geriatric patients. Dr. Paterson said that the idea of an annex was "an interesting one which should be given full consideration.” Nevertheless, he was inclinded to think that an annex, as opposed to a ward, could “tend to lead to that separation of geriatric patients from the others which Dr. Newman was so anxious to avoid.’* He (Dr. Paterson) had up to now favoured a geriatric ward attached to a general hospital as the best means of caring for the sick aged. He agreed with Dr. Newman that a senior specialist staff should be appointed fulltime to the geriatric unit, whether an annex or a ward.

Dr. Newman's suggestion for the establishment in general hospitals of geriatric services as distinct from the acute medical wards, under the control of a geriatrician of senior status, with their own staff of physiotherapy and rehabilitation, were identical with those recently put forward by physicians of the Christchurch Public Hospital, said Dr. H. R. Donald, chairman of the Aged People's Welfare Council.

The number of old people who occupied hospital beds represented only a small percentage of those who were in need of similar accommodation or assistance and the simple measures suggested would scarcely justify the title "National Geriatric Service.” Dr. Donald said.