THE PLIGHT OF THE AGED
By LORD AMULREE
DURING the past forty years any increase in the population of this country has been due to an increased expectation of life rather than to a rise in the birth-rate. For example, in 1900i he expectation of life was 46 years, whereas in 1944 it was 64. The increase has therefore been considerable, and is attributable to advances in public health and in preventive and curative medicine. The result has been that whereas in 1900 there were 2,400,000 in the country aged 60 and over, in 1944 this number had increased to 6,300,000. This change in age of the population has brought with it many problems, but, although certain of these have been referred to from time to time, it was not until 1943 that an official body ventured to examine them scientifically. In that year the Nuffield Foundation appointed a Survey Committee to undertake an extensive and comprehensive enquiry into the position of the aged in our modern world and to advise on measures which could be 'taken to improve their lot.
The report of this Committee, which has been issued this week, is disturbing ; while it reveals a state of affairs rather less serious than that of the Curtis Report it nevertheless discloses that the conditions under which many old people live are not only far from ideal but are a long way below what could with a little care and thought be achieved. The provision for old age and contributory pensions, coupled with the good work of the Assistance Board, have for many old people abolished the fear of any -actual destitution ; but this fear has been replaced by a new one—the realisation that modern life has become so complex that aged and feeble persolts are hardly able to cope with it. The report deals in some detail with the houses in which old people live. These are not differe.nt from those which the rest of the population inhabit, but there are drawbacks and inconveniences which affect the aged more adversely than the younger members of the community; for example, absence of running water, or anything but a cold tap, and the doubtful pleasure
of an external, often shared, earth or water-closet. A house too large for their needs (and this applies to old people of all incomes) also imposes a burden that may become intolerable. The report suggests that Local Authorities should include in their housing
schemes a number of one- and two-bedroom houses for old people. Examples are quoted where the new houses conform fully ta up-to-date standards of comfort, and where old people have been only too willing to move out of their three- or four-bedroom houses, which have therefore become available to younger persons with growing families. Because the elderly find it a burden to walk long distances, any such houses should be placed near to shops, cinemas, churches and public-houses. Houses or flats (these should be on the ground floor) of this kind are valuable assets in any housing estate ; the old enjoy the company of the young and the young have much to learn from their elders. Besides, old people can equally help the young by taking care of children while the parents go out. If the wife has always to remain at home to take care of the children while the husband is free, trouble will not be far away.
It is eminently desirable that old people should be able to remain in their homes as long as possible, but the experience of any body, voluntary or municipal, that establishes homes or hostels for old people is that the demand for admission is always greatly in excess of the vacancies. At one series of homes in North Lond6n, pro- viding accommodation for 140 old persons able to pay from 30s. to 405. a week, the yearly requests for admission exceed 700. The experience of those few enlightened Local Authorities who have made like provision is similar ; it is clear, therefore, that there are a large number of old people who desire some kind of communal or semi- communal life, for which they are prepared to pay, because they are unable to carry on their everyday life without help. Hitherto, this was often provided by some member of the family or by some &voted servant or " help " ; nowadays most members of any family have to work, while servants or companions are practically unobtainable.
We would do well to consider foP.owing the example of other countries. In France the State, and in Switzerland the Canton, provide accommodation for the aged of all classes ; those who can afford to pay a small weekly sum are housed in single bed-sitting rooms with their own furniture, while those who can contribute nothing are received in institutions, which are usually small, where they are allowed a refreshing degree of freedom and are, moreover, not debarred from earning a little money by working either inside or outside the institution. The buildings may not be ideal, but the right of the individual to exist is respected ; he is not deprived of his self-respect as a citizen. In Great Britain a few far-seeing Local Authorities have had the good sense to realise the wisdom of such an approach ; in particular I would instance (without disrespect to other equally intelligent authorities) the Crookson Cottage Homes in Glasgow or the hospital at Farnham, which is administered by the Surrey County Council.
One of the chief worries of old age, as the report emphasises, is loneliness. This can be greatly mitigated by establishing old people's clubs where the elderly can meet, make friends and gossip with old ones and enjoy games and obtain simple meals at small cost. On the same principle homes for old people should not be estab-
lished in large mansions in the country, as is often suggested. old
people need the surroundings to which they have been accustomed. A large part of our population is urban and needs to be able to visit families and friends ; more important still they 'expect visits from them. Everything should be done to enable the young to carry out their -filial obligations, and a long, tiresome and expensive journey is a frequent deterrent.
The report draws attention to the fact that in an ageing com- munity it is important, from an economic point of view, to en- courage people of pensionable age to remain at work as long as they can make a worth-while contribution to the creation of wealth. The report also states that, as a result of enquiries made of a large number of employers, many persons who in times of peace would have retired were found during the late war still capable of good productive work. This is an important observation, for it will be necessary in the future to retain in work—work that is suitable to their physical condition—many who would otherwise retire. This is the only way in which to avoid the situation, economically impossible, in which a small young section of the population is forced to work to support a larger ageing section. This principle, if adopted, would remove from any old persons the harrowing sense of hopeless uselessness which so many of them now feel. The report, however, lays down the essential proviso that no pensionable Person shou!d be called on to work except voluntarily and that no employer should be compelled to continue to employ a person of pensionable age whom he does not consider fit for employment.
The report does no more than touch upon the medical side of old age, and it is when this is considered that one of the most hopeful and constructive ways of helping emerges. At the present time a large number of old persons are condemned to a life of permanent invalidism, leading often to a long, hopeless period when they remain bedfast, because it has never been fully realised that old persons with their chronic or long-term ailments are as susceptible to active medical treatment as younger persons suffering from acute or short- term ailments. In many Public Assistance Institutions, as well as in expensive nursing homes, or, indeed, in their own homes, there are an uncounted number of elderly persons whose ailments could be remedied, if not cured, to such an extent that they could be restored to a considerable degree of activity and so be able to return, some to their own homes and some to homes for old people, where they could lead lives little removed from normal. The recognition of the value of active medical treatment—and in the few institutions where this has been undertaken its success proves the truth of this state- ment—would free a large number of beds and nurses for their proper function of aiding in the rehabilitation of the sick, whereas they are now being wasted on giving no more than devoted care and attention to patients who need a more active and intelligent approach. It is to be hoped that when the National Health Act comes into force all the specialist resources of medicine will become available, with no administrative difficulty or barrier, to all old persons, no matter where they are housed. This will contribute greatly to their welfare and to their happiness, and will enable this country to be as proud of its welfare service for the aged whose work is done as it is for the young whose work is yet to come.
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