Vulnerable age

PUBLIC

HEALTH

The Journal of the

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VULNERABLE

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THE papers we publish in this issue were read at the conference which was held jointly by the Welfare Group of the Society a n d the British Geriatric Association in April last. We welcome the enterprise which produced the joint conference and we present the papers to our readers with considerable pleasure. It is less than two years since we last devoted a special number to the welfare of the elderly. Then we considered mainly the social aspects of the subject, though one paper dealt with the experimental work of welfare clinics for the ageing. At that time the clinic for the elderly was a novel concept in the public health service and was being watched by the majority of M.Os H.. with a somewhat cautious interest. In a remarkably short space of time it has become something which the service is taking seriously and which promises to become a major feature of the personal health services in the fairly near future. For this a good deal of thanks is due to the pioneers who have experimented with such clinics against scepticism, lack of interest or even active discouragement. We consider it quite timely that the experience of the pioneers should be put at the service of those who are newly entering this particular field and whether it be in the administration and equipping of the clinic or in the forecasting of what the clinic may be called upon to do our authors offer some useful guidance. Stockport and Twickenham may not be typical of the country as a whole--there is, in fact, very good reason to believe that they are not-but the problems which arise in those particular places are characteristic ones. Variations in social and economic geography may alter the incidence and change the emphasis but they do not make any really fundamental difference in the nature of the troubles which have to be dealt with. 361

362

PUBLIC

HEALTH

VOL. L X X I V

NO.

10

We suspect that the comparative tardiness of the development of this sort of personal care of the aged is that in comparison with the care of the young child it brings a smaller immediately tangible return. The child welfare service ensures the supply of healthy, productive adults tbr the cotrununity's future ; not all the efforts of the geriatricians is going to turn the pensioner into a substantial wage-earner. In cold economic terms it is cheaper to let the aged die quickly than to keep them alive but unproductive for 10 or 15 years. We reject the economic argument. We do not even propose to press the point that to keep old people mobile and independent is cheaper than caring for them in hospitals, though it is not without substance. The principle we prefer to uphold is that of the human right to happiness. The man or woman who has borne the heat of the day has the right to relax in the cool of the evening. They and the younger generations who make up their families must be spared as much as possible of the strain and anxiety which is caused by preventible invalidism in the old and it is now becoming quite clear how much of the invalidism of old age can in fact be prevented.

SETTING UP A CLINIC FOR PREVENTIVE MEDICINE FOR OLDER PEOPLE By

J.

MADDISON,

M.D., B.S.,

D.P.H.

Medical Officer of Health, Twickenham Borough; Area Medical O.fficer, Area 10, Middlesex County Council. H o w FIT ARF Y O U ? IS your strength failing ? Are you short of breath ? Are you getting hard of hearing? Is your sight perfect? Is your memory failing? Do you think you are going to have a coronary thrombosis or a stroke ? Have you taken steps to institute the best preventive measure for all your disabilities? You will be a remarkable person if you have nothing wrong at all. In my clinic for older people everyone who comes has something wrong and in nearly every case ~mething can be done to effect improvement, PREVENTIVE

MEDICINE

FOR

OLDER

PEOPLE

For eight years I have been working on the idea of preventive medicine for older people. The first three years were devoted to a survey (Maddison, Smith and Olbrich, 1955). We show that tile majority of elderly people have something