The Challenge of Chronic Disease in Old Age

A RECENT leading article in the British Medical Journal (1961) has stated that 'old age will provide the hospital service with its principal challenge in the next 20 years'. There is good reason for believing that this challenge is already in existence and furthermore that it concerns not only the hospital service, but the health and welfare services in the whole country. Much has been said and written on this subject so that familiarity has given rise to an attitude of 'laissez faire'. Despite the work of Sheldon (1948) the amount of need among old people is still insufficiently appreciated by clinicians, administrators and politicians. Accommodation of hospital or residential home type remains inadequate in quantity and sometimes in quality, while the deficiencies increase progressively with the rising proportion of old people in the population. We are, in other words, being outstripped by population changes. The effect of this on individual lives of old people and their families, on the administration of the National Health Service, and the work of the Local Government Authorities, is grave. As a result Geriatric Hospital wards and Residential Homes have developed long waiting lists so that the patient's condition deteriorates before he can be admitted; meanwhile, wards of all types are blocked by aged people who no longer require a hospital bed. In the home, many nursing and welfare resources