DEMENTIA IN THE ELDERLY?A COMMUNITY PROBLEM By David Wild Deputy County Medical Officer of Health, West Sussex conference was held on October 8th and 9th, 1964. It was organised by the Association for National Mental Health for staff concerned with the care and treatment of old people with mental deterioration, to consider com-
in welfare homes in South Shields showed the facilities which can be available under the welfare service. Dr. Wollner spoke of the association between psychiatric and physical ill" ness. He advocated a special unit where geriatric patients could be admitted immediately, and where full assessment could be made by a geriatrician in consultation with all who knew the patient and his circumstances. The conference also showed how points of view can differ, according to the section of the population which each person sees. The comments of workers involved in the day-to-day care of old people in homes and hospitals contrasted strikingly with those of participants working outside, and coping with patients in their homesFrom the inside looking out, the pressures seemed to relate to inadequate accommodation and staffing. From the outside looking in, they related to changes in society, where families have become more mobile and so in' volved with their own internal problems that they have little time for the
valuable THISFriends House at
mon
problems
basis. The
on an
inter-disciplinary
speakers were Dr. Felix Post (Physician to Bethlem Royal Hospital),
Thomas Wilson Dr. (Consultant Geriatrician from Redruth), Mr. Peter Hunter (Psychiatric Social Worker from Devon), Mr. J. Hanson (Director of Welfare Services for South Shields), Mrs. N. Wolfe (a health visitor from Brackley), Dr. C. P. Hindley (a London general practitioner) and Dr. L. Wollner (Geriatric Physician from Oxford). Miss Geraldine Aves, formerly Chief Welfare Officer of the Ministry of Health, was in the Chair. They presented a great variety of material, both about practical services and on the general characteristics of elderly patients?for instance, Dr. Post's findings that senile dementia affects only about 12% of the over-
aged.
eighties. Among
Genuine
assessment Dr. Wilson's description of the success of placement, following assessment in a psycho-geriatric unit in Cornwall, showed how much time can be saved in the long run by thorough assessment at the beginning. Since this is a long-term problem, effort spent on early diagnosis is never wasted. Mr. Hanson's description of quite severely handicapped patients being cared for
In the discussion groups, there was genuine concern with what each person could do, rather than with who was to be in charge. The inter-relationship ?f the whole community in this problem became apparent, since a shortage ot staff in one field was likely to have effects on other services. Various pr?' posals for social measures were canvassed, notably that for setting up a register of old people. Nearly all the principal speakers were attracted by this idea, but others pointed out the difficulty of deciding who to includethe problem of keeping it up to dateand the danger of extending services to people who did not need them. MrsWolfe and Dr. Hindley showed ho^> given adequate time, a field worke1"
the delegates were reprefrom geriatric hospitals, psychiatric hospitals and welfare homes, as well as health visitors, psychiatric social workers, mental welfare officers, local authority medical officers, members of voluntary organisations, and at least one trade unionist.
sentatives
Thorough
266
concern
to fouldinget an
'ems
probsuccessfully
know the old-age
area, and could
co-ordinate services directed to where
so
that they
they
were
were
most
deeded. The key role of the general practitioner was dealt with by several speakers, particularly by Dr. Hindley, a G.P. himself. He emphasised first ' lhat an early return to the community I Places a very heavy burden on G.P.s, and
financial incentive must be to encourage them to look the aged. Secondly, that G.P.s have a personal relationship with their I | Patients, which is of the patients' own can make personal I' choosing. G.P.s decisions in the interests of their Patients, while remaining aware of how 5pch decisions affect the community. They know their patients in sickness and health, and can become expert in Preventing the onset of disease by some
considered
jtfter
detecting early changes. The
meeting
discussed
at
some
the question of extending the retirement age, so that people who were still fit and able to make a contribution should be able to stay on at work. Although great interest was expressed in this scheme, there was considerable doubt about its wisdom, since it would involve great changes in the present social structure. It was also felt that training for retirement would almost certainly be much extended. In closing, Miss Aves emphasised again that the problems could not be solved in isolation, and called on each service to plan together with all interested parties. Society is not unsympathetic, and needs only the lead of
length
some
forward-looking body
to
put
out
its best effort. As a participant at this conference, I think that the N.A.M.H. should be congratulated on giving such a lead, and that a meeting as instructive, relaxed and friendly as this will be both a stimulus to new effort and an education in the deployment of services.