Rehabilitation for older peopleBMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7138.1108 (Published 11 April 1998) Cite this as: BMJ 1998;316:1108
At risk in the new NHS
- John Young, Consultant physician,
- Janice Robinson, Director,
- Edward Dickinson, Director
- Department of Elderly Care, St Luke's Hospital, Bradford BD5 0NA
- Community Care Programme, King's Fund, Cavendish Square, London W1M 0AN
- Research Unit, Royal College of Physicians, St Andrews Place, London NW1 4LE
Fifty years ago, in a brief but powerful paper, Marjorie Warren laid down the guiding principles of what was to become the specialty of geriatric medicine.1 She emphasised the process of rehabilitation—to help elderly people regain their best possible functional independence. How is the rehabilitation of older people faring in the reformed NHS?
Elderly care medicine, like many other acute specialties, has come under considerable pressure. An established pattern of rising admissions, disproportionate to demographic changes, has been compounded by a steady reduction in acute hospital beds. The solution to these conflicting trends has been to press for shorter lengths of stay, making rehabilitation especially vulnerable. Two index conditions which provide an insight into contemporary rehabilitation for older people are stroke and fractured neck of femur.
The Department of Health's targets listed in the Health of the Nation drew particular attention to stroke, and we now know, from research, how a comprehensive stroke service should work. There is particular confidence that properly organised hospital care of stroke …