Report of the Commissioner of Public Health / Western Australia.

  • Western Australia. Public Health Department.
Date:
[1961]
Catalogue details

Licence: Public Domain Mark

Credit: Report of the Commissioner of Public Health / Western Australia. Source: Wellcome Collection.

    14/94 (page 12)
    In these observations, the picture of the State as a whole has been outlined. The Deputy Commis¬ sioner of Public Health, Dr. W. S. Davidson, has made a closer study and accurate assessment of metro¬ politan needs and has prepared a report which follows immediately. Note should be made of his comments concerning “ multiple pathology ” in the elderly and of the need, in every case, for a complete clinical assessment of the patient’s condition before treatment and rehabilitation are planned. GERIATRICS : METROPOLITAN AREA The social, economic and medical problem of dealing with old age has arisen from improvements in the last 100 years in social welfare, preventive medicine, clinical medicine, and therapeutics and the resulting increase in the number of people who live to old age. Removing the problem of premature death from disease produces the problem of old age and as it is no solution to a problem to solve it merely by creating another problem, a responsibility still rests with Society and Medicine to alleviate the suffering of the aged and the strain they place on the general economy. Much has been said and written on this subject but in order to understand fully the action taken in other countries and the possible application of their methods to our own problem, it is necessary to under¬ stand fully what the problem is. In other words, instead of relating philosphical answers to philosophical questions, we must determine the extent of our own problem and select the answer best suited to it. Our figures make it abundantly clear that the real problem lies in the age group 70 years and over. This age group, although only 5 • 7 per cent, of the total population, occupies over 30 per cent, of the beds in our Public General Hospitals. In addition, this age group overflows into the “ C ” class or convalescent hospitals occupying therein 1,300 beds or a number equivalent to our total Public General Hospital beds. Further than this, aged persons occupy homes for the aged to the extent of another 1,300 beds excluding homes built for pensioners by the State Housing Commission. Table 1 shows the metropolitan male and female populations aged 70 years and over and the number of beds in various categories occupied by them per thousand aged males or aged females. The numbers per thousand cannot be compared directly with similar figures from other countries because metropolitan institutions have a role to play in covering the rural population. The extent to which this rural commit¬ ment increases metropolitan figures has not been accurately determined. The main objective in displaying the figures is to show differences between male and female requirements and draw conclusions therefrom. A factor which plays a big part in the discrepancy between male and female demand for beds in the metropolitan area is the difference in distribution of the sexes in the old age groups throughout the State. Although total figures for the State are 19-7 thousand old women and 15-1 thousand old men, in the metro¬ politan area these populations are 14-8 thousand and 8-8 thousand respectively. There is therefore a very distinct gravitation of elderly females to the metropolitan area, making their number 60 per cent, higher than that for males, whereas in the country there are more elderly males than females. In the metropolitan area it will be seen that the elderly male makes a higher demand in proportion to his numbers on acute hospital beds than the elderly female—12-8 beds per thousand elderly males com¬ pared to 8-9 beds per thousand elderly females. Wilson et alia in discussing Multiple Pathology in the Elderly, indicated that in their series of 200 unselected cases presenting as sick there was an average of 6-4 diseases per elderly male and 5-4 per elderly female. It would therefore appear that the higher pro¬ portion of acute beds for males is required partly to meet a higher proportionate demand from country areas and partly because the elderly male is more subject to acute disease. There is little significant difference in the demand for residential accommodation between male and female. In the males it is 61 beds per thousand and in the females 57 beds per thousand. When, however, we come to the “ C ” Class hospital, which is classified as a convalescent hospital but, in fact, specialises in long stay geriatric cases, we find that the elderly female demand on such beds is out of all proportion to that of the elderly male, namely 64 per thousand against 39 per thousand in respective populations 70 years and over. An analysis of the cases in “ C ” Class hospitals showed that in males 49 per cent, and in females 43 per cent, were ambulatory. In both sexes 30 per cent, required skilled nursing, and only 46 per cent, were mentally normal. Of the mentally obnormal, most were merely confused, but the females showed a higher percentage of disturbed or troublesome cases, 15 per cent, as against 2 per cent, in the males. Thirty-seven per cent, of the males were incontitent and 28 per cent, of the females. As so many of the patients are ambulatory and so few require skilled nursing, the question arises as to whether or not a number of such cases could not be treated equally well at home if some real attempt was made to rehabilitate them and some assistance given in the home. The high figures for mental con¬ fusion and incontinence suggests that these may often be determining factors in the breakdown of family responsibility for home care. This family responsibility for home care breaks down more readily in the case of the elderly female and accounts for the much higher demand she makes than her male counterpart on “ C ” Class hospital accommodation. Her tendency to be more disturbed, troublesome and interfering probably accounts for this. If more careful assessment of the patient’s condition is initially made, more intensive treatment and rehabilitation measures instituted and more support given in the home, it should be possible to decrease greatly our present usage of 3 • 3 beds per thousand population for long stay geriatric cases, so that our requirements more closely approximate to 1 to 2 per thousand of total population, the figure considered adequate in the United Kingdom, even although the problem is much greater there because of the higher proportion of old people.