Geriatric care in general practice

Abstract

The community care team must become more orientated towards the needs of the elderly and retired, and must aim above all to preserve the dignity of this group. These needs must be interpreted as the elderly see them and not a 'catalogue of professional assessment.' In this way the physical degeneration, the psychological and social problem which are increasingly a part of the medical needs of an aging society, can be most effectively accommodated. The organization of the community care team must be sufficiently adequate to seek out the problems involved, and not wait until these are thrust upon them. Appointment systems are not necessarily the best way of organizing consultations, especially if these necessitate the use of the telephone or answering services. Travelling long distances at awkward or busy times, or being asked to see doctors unknown to them, adds to the poblems of patients. There are 3 main reasons why the general practitioner, supported by the hospital and local authority, is the best person to undertake this role: There is no clear dividing line between health and disease. Many elderly people fall between the two, and to judge whether they progress towards or regress from disease requires surveillance over a long period, and this can be done only by the general practitioner team. The general practitioner is the best person to arrange any further investigation of a disease process or offer the reassurance that may be required after the initial screening. The practice age/sex register makes a good basis on which to organize systematic care. There are 3 aims of a geriatric clinic: Assessment and resolution of the reported medical, social, and psychological needs. Seeking out the unreported medical, social, and psychological needs, and coordinating the preventive care of the elderly. The followup of patients so that their progress and treatment effectiveness can be assessed. The help of the health visitor is vital. She is an integral part of the team, and can do much of the spadework. After a review of 1,146 patients aged 65 and over, 6 major areas in which problems exist can be identified. Judging by this review 50% of the elderly are ill or disabled, having day to day problems with ill health. 30% have difficulty with house work; 30% are unable to cut their own toe nails; 17% cannot do their own laundry; 11% cannot bath themselves; many have no inside toilet and no hot water on tap; 50% have not had a holiday for 5 yr or more; 18% have no usable radio; 17% have no usable television; 42% live alone and are not visited regularly by relatives; 88% would welcome someone to talk to; 50% have an effective weekly income after payment of rent, rates and mortgage of less than £8.50.