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Hospital 125th: Ageing and the changing nature of care

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Life expectancy is increasing by five hours a day, or almost three months a year.

This has been the case for the past 170 years.
The 85-years-and-over segment of the population is the fastest growing. It’s becoming a case of ‘live long and prosper’.
The continuing trend towards longer lives and recognition of the potential for older people to benefit from modern healthcare led to a whole new branch of medicine in the 1950s – geriatrics.
The branch is provided by multi-disciplinary teams with assessment, treatment and rehabilitation, and is no longer regarded by many as the ‘Cinderella’ of medical specialties. The potential to make big differences in the quality of life of elderly people is becoming evident and provides a more fulfilling environment for those dedicated to improving lives.
Palmerston North Hospital geriatrician, Dr John Bourke, says that ageing can be graceful and that in general, people are living not only longer, but better.
“It is a cliché, but 70 is definitely the new 60, and so on. We have better food and better medical treatment these days. Social class is also proven to be a big factor in health, extending through to ageing.
“In general, morbidity is being compressed, so instead of more years of ill-health with loss of independence at the end of life, people tend to have shorter illnesses – and to put it bluntly, a faster death.
“I am generally optimistic about people living longer and more easily. We have far better diagnostic tools and better treatments available than 125 years ago to make lives more comfortable.  Nursing care is better – no-one should die of bedsores associated with immobility these days. And we work in multi-disciplinary teams, which is far more effective for patients,” he said.
There has certainly been progress in the care of the elderly since the Awapuni Old Men’s Home was opened by the Palmerston North Hospital Board in 1914. Attitudes have also changed towards older people, even in the naming of units for their care - the Awapuni Home was soon renamed the Old People’s Home, and eventually Awapuni Hospital, before it was demolished as an earthquake risk in 1989. At that stage there were 120 to 150 inpatients there.
As the district’s population continued to age, there was pressure to find a new facility to replace Awapuni as early as the 1970s, and in 1978 the Hospital Board purchased 120 acres of land at Summerhill, Aokautere, for a hospital for geriatric, psychiatric and young patients with disability*.
Dr Dick Presland, general physician, was appointed in 1977 to care for geriatric patients and Ward 2, in the old Military Block, which was established in 1978.
Geriatrician Dr Fred Hirst was appointed in 1982 before the new hospital site was developed.
He said: “The planned Aokautere Hospital at Summerhill would have been 'a modern asylum' where old people were put out of sight. It reminded me of England where geriatric facilities historically were in unwanted buildings and old workhouses, geographically isolated from the base hospitals and with poor access to the investigation and treatment resources of base hospitals as enjoyed by younger patients.  Until the mid-1950s elderly patients were usually kept in bed all day, not mobilised or dressed in day clothes and without recognition of their rehabilitation potential.
“A Service Development Group** was formed to review the hospital’s geriatric service provision and the Aokautere Hospital, in particular. This group agreed with my concerns and recommended to the Board that it abandon the hospital proposal and instead develop modern facilities within the Palmerston North Hospital site that focused on assessment and rehabilitation with prompt access to laboratory and imaging resources.
“In 1982, many frail elderly inpatients within the acute service wards had a prolonged length of stay due to lack of recognition of rehabilitation potential or prompt access to therapy resources.  The waiting list for the only geriatric ward, Ward 2, had spiralled out to 60 with a waiting time of a year. At Horowhenua Hospital in Levin, there were fewer than 12 admissions a year to the 80 geriatric beds.  In both hospitals, multi-disciplinary teams were established and all inpatients in the geriatric beds or on the waiting lists were re-assessed and re-prioritised for rehabilitation potential and discharge planning.
“In 1982, Ward 2 became an assessment and rehabilitation unit and Ward 1, a 'geriatric day hospital' unit. In 1983, at Horowhenua Hospital, similar developments occurred. By 1984 waiting lists had been cleared and in 1985 the first patient transfers began from Awapuni Hospital and from Clevely in Feilding. The whole nature of ‘hospital care' for elderly patients was changing and those requiring long-stay continuing care were now being transferred to the private sector.
"By the late-1980s the geriatric medicine service at Palmerston Hospital was highly regarded by our peers nationally and we were seen to be offering 'best practice' care by the Department of Health. As a result, our service was awarded additional funding to appoint one of five advanced training registrar positions in geriatric medicine allocated around the country.
“Progressively we developed an integrated psychogeriatric service, geriatric day hospitals, flexible admission intermittent care programmes and home care services at Palmerston North and Levin.  In 1990, when we became additionally responsible for the service in Whanganui, similar development of these components of a comprehensive geriatric service occurred. Denise Udy, our geriatric service manager, was a leader in the home care scheme nationally. We pioneered the scheme in Levin in the early 1990s and, following its success, extended it across the Manawatū- Wanganui Area Health Board.”
Hirst puts extended life for the elderly down to the advent of beta blockers in the 1960s, which allowed effective, tolerable treatment of hypertension together with a decrease in smoking. Quality of life has been aided by oral diuretics, lower limb prosthetics, cataract surgery and early multi-disciplinary assessment and rehabilitation with the recognition that 'bed is bad'.
“The major issues now for longevity are for women to stop smoking; men are heeding the call but women haven’t, particularly in Māori and Pacific Island communities.  Air pollution is a major global environmental issue as a contributor to early death and climate change needs to be fully recognised for the threat it poses.”
Today, Palmerston North Hospital offers assessment and rehabilitation services for those over 65. There are 24 beds in STAR 2, plus another 20 beds in STAR 4 in Horowhenua. Hospital stays are generally short although those suffering severe strokes could be in hospital for up to six weeks.
The Community Elder Health team of 20 are involved in outpatient clinics, ward and ED consultations and also home visiting treating the person in their own home.
As the baby boomers of today reach their dotage they can thank their lucky stars and some pioneering doctors, for the probability that they will enjoy a far more rewarding old age than was generally the case 125 years ago.
*Aokautere Hospital was to provide medium and long-stay care beds for 112 Geriatric, 50 Psychiatric, 50 Psychogeriatric and beds for adolescent patients with physical disabilities or mental illness.
** This group included:Dr Tony Poynter, Medical Superintendent in Chief; Dr Don Urquhart, Radiotherapist; Prof Nan Kinross, Professor of Nursing Massey University; and external advisor, Prof John Campbell, Professor of Geriatric Medicine Dunedin University
- Written by Paula McCool

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