The natural history of the elderly in Britian

First of all, I would say this is not a research paper. Moreover, I won't guarantee it is 100% true facts covering all social classes in Britain. But I write this blog post based on my knowledge and work experience.

We do enjoy the life by studying and working , going holidays and being off sick, arguing and agreeing, marrying and divorcing, attending weddings and funerals, and so on. When we reach 65 and above, we will be in the group of old age in the countries like UK and USA. The alternative nomenclature of the elderly is senior or senior citizen. The definition of old age varies from society to society, from department to department.

At work, I mean, at hospital where I work , we consider those with 75 and above (some hospital 78, some 79) as the elderly people. They are put in the list of the elderly care consultant, who will lead the team for his patient's medical and social issues to be sorted out. Once patient is medically fit or nearly fit, we start the discharge plan. That means we decide to where patient is going. To his own home? to rehab hospital, to residential home or nursing home.

The majority of elderly people lives alone or with their spouse if they are still alive. It is common that their children live nearby, helping with shopping and cleaning. Some elderly people have no own children, but they have been looking after well by step-daughter or son as next of kin. I still remember one old man was admitted to hospital for some reason. His son had been in Australia for many years. Almost everyday, the anxious son rang us, asking about his father's updates, saying "thank you" during most of the calls. He also had threatened to make complaint against us for a couple of times. Yes, that is our life. Anyway, that old man got better and he went home after sometime.

Basically we cannot discharge our patients without making sure that they will be safe at home. During the discharge plan, the phyisotherapist does mobility assessment, providing walking assistance if required while the occupational therapist's function is to assess if patient can do his or her daily activities safely, such as kitchen, stairs and bathroom. Some needs stair lift to go to upstairs bathroom. Other need wheel chair for shopping.

Some people require rehabilitation before going home. So they go to a local community hospital to build up their mobility.

While they are in acute hospital or rehab hospital, we consider if patient will need care package at home. For example, some people needs once a day carer in the morning for cleaning, dressing and making breakfast, etc. Some need twice a day. At this point, social worker plays a role to organize carer package, including funding issue. Maximum home carer is 4 times a day in my area. Generally "more help" means "less independent and more frail".

What will happen if someone needs more than 4 times a day? Commonly, such people are with advancing dementia or with multiple health problems and no longer able to cope at home alone. Answer is residential home. Next question is who will pay. Patient himself or local authority?

What would be the next step after Residential home (RH)? From RH, they might come back to hospital with water infection, chest infection or fall and collapse. Some died at hospital due to current illness or new problems. Other died of natural cause at RH.

A small percentage of people need 24 hours nursing care due to some conditions, such as dense stroke, advanced Parkinson's disease. They are transferred to nursing home as RH usually has no nursing support. (Apparently, 24 hour care at own home is around £2400 a month)

I am thinking myself what would be my final place before death if I have a chance to live long.