The elderly in continuing-care units

Abstract

Elderly patient medicine had its origins some 50 years ago, when dedicated doctors, initially working independently in poor law infirmaries, in orthopaedic departments and in the community, took an interest in the medical care of the elderly. It was soon realized that much could be done to improve the quality of care by instituting medical treatment, by commencing rehabilitation procedures, and by vigorous up-grading of the ward environment. Dr Marjory Warren, for example, who was appointed to the West Middlesex Hospital in England, found that when elderly patients with strokes were admitted, they were often put straight to bed and kept there. This rapidly led to institutionalization. She developed a radical approach to their treatment, introducing remedial exercises to encourage remobilization. Together with the assistance of facilities provided by the social services departments, she found that she could discharge a high proportion of her patients. Thus it was that elderly patient medicine began, with a strong emphasis on rehabilitation. Later, elderly patient departments developed their expertise still further by combining a rehabilitation function with the admission, investigation and treatment of acutely ill elderly patients (Hodkinson and Jefferys, 1972; Bagnall et al., (1977).