Progressive patient care in the geriatric unit.

IT is not many years since the old-fashioned chronic wards of a hospital' were thought to have an entirely custodial function. They existed to provide care and attention for elderly patients when nothing further could usefully be done. With a rapidly ageing population this custodial approach proved inadequate, and since it was not possible to provide and staff an ever increasing number of chronic sick beds a new approach became necessary. and others who demonstrated that given proper treatment in a proper setting old people were capable of rehabilitation. They found that the majority of their patients could return to the community and thus escape the human scrap heap of the old-fashioned chronic sick ward. These pioneers and their successors have in a few years transformed geriatrics from the cinderella of the hospital service into a most active and exciting branch of medicine which has seen the development of many new ideas concerning the function of the hospital and the management of patients. One of these new ideas is progressive patient care. The Concept of Progressive Patient Care The idea behind progressive patient care is the classification of patients according to their medical and nursing needs. It is also a recognition of the fact that these needs change during the course of a patient's stay in hospital. In one sense the idea goes back as far as Florence Nightingale, whose practice it was to nurse the most ill patients near the entrance to the ward close to the sister's office, and to move the convalescent or least ill patients to the further end of the ward. In geriatrics the idea really began 20 years ago when Marjory Warren (I943) made a plea that no patient should be admitted to a chronic sick ward without prior investigation in a general hospital. Following this the British Medical Association (1947) recommended the establishment of geriatric units in general hospitals. These were to be wards under consultant physicians where elderly patients could receive investigation, treatment, and rehabilitation, so that in due course they might return to the community. If they failed to respond to treatment they could be transferred later to long-stay nursing annexes. Thus was born the idea of a patient moving from one type of ward to another at the appropriate point in his illness. Later the pattern was enlarged to include the conception of a recovery home or halfway house to …