Memorandum by the British Geriatrics Society
(WP 13)
The British Geriatrics Society (BGS) is the
only professional association, in the United Kingdom, for doctors
practising geriatric medicine. The 2,200 members worldwide are
consultants in geriatric medicine, the psychiatry of old age,
public health medicine, general practitioners and scientists engaged
in research of age-related disease.
Geriatric Medicine is that branch of general
medicine concerned with the clinical, preventive, remedial and
social aspects of illness of older people. Their high morbidity
rates, different patterns of disease presentation, slower response
to treatment and requirements for social support, call for special
medical skills. The purpose is to restore an ill and disabled
person to a level of maximum ability and, wherever possible, return
the person to an independent life at home.
The BGS welcomes the opportunity to respond
to the White Paper and makes the following points:
1. The BGS welcomes the aspiration of the
White Paper to move towards health promotion as a complimentary
strategy to disease management, but is disappointed by the focus
on children and the working population, with a lack of reference
to older people, particularly those approaching retirement. Older
people stand to gain as much from a health promotion approach
as younger people and their relative absence from this paper will
prevent the government achieving its public health goals.
2. The BGS would hope that increased expenditure
on health promotion where evidence of cost effectiveness is weak,
would not be at the expense of proven interventions for health
problems of older people including comprehensive geriatric assessment
and rehabilitation which are evidence based.
3. The Society believes cessation of smoking
to be an important health promotion measure to reduce the incidence
of chronic chest disease, ischaemic heart disease, cardiovascular
and peripheral vascular diseases and would urge that the proposed
ban on smoking in public places is implemented without exceptions
in line with other countries including Scotland and Ireland.
4. The Society welcomes measures to tackle
the problems of obesity and poor nutrition. However, there is
evidence that increased exercise is beneficial at all ages and
not just an issue for the young, which should be highlighted.
In addition, older people may suffer from problems of under nutrition
and poor dietary balance emphasising the need for greater awareness
and education surrounding nutritional issues in older people.
The issues may be exacerbated by concurrent disease, low incomes
and social isolation.
5. The Society also welcomes measures to
moderate the consumption of alcohol in society. Again, this is
not purely an issue for the young. In many areas, high alcohol
intake throughout life has been a cultural feature leading to
increasing evidence of liver disease and mental health problems
among older people, exacerbated in the post retirement period.
6. The Society is concerned that mental health
is insufficiently represented in the White Paper. There is an
emphasis on work related stress, but levels of stress, depression
and anxiety among spouses and carers of people with chronic disease
are very high and often under-recognised. Vulnerable older people
living alone suffer from the same issues.
7. The Society welcomes the recognition of
the impact of inequalities in the White Paper. There is a lack
of equity in health care resourcing which is particularly evident
in services for vulnerable and older people, but also inequity
of access due to disability or disengagement. Current concerns
over the value of pensions and financial security may exacerbate
these issues and the Society would urge that attention be paid
to these areas.
8. The Society acknowledges the important
role of community matrons (advanced nurse practitioners) in health
promotion and chronic disease management. However, the role of
these professionals seems to be disease specific and may not address
the multiple co-morbidities special to older people. The role
of health trainers appears unevaluated at this point.
January 2005
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