The medicalisation of old age

摘要

The Oxford English Dictionary describes medicalisation as pejorative, initially applied to the over-investigation and treatment of sexually active teenage girls. Since Ivan Illch's popularisation of the term, its use has spread to conditions such as pregnancy and childbirth, sexual orientation, mental illness, and the menopause. There is legitimate concern about the medicalisation of dying, and because old people die, it is tempting to extend such concern to old age. In the 1930s, Marjory Warren showed that old people in workhouse wards had treatable diseases and could be rehabilitated and discharged. Apparent social problems were in fact a result of patients being poorly served by health services. With the realisation that something could be done for elderly patients and that such care would make hospitals run more efficiendy, geriatric medicine has grown dramatically in the United Kingdom, but less so elsewhere. However, in the past decade the problems of elderly people have been "de-medicalised" by the movement of patients from hospitals into nursing homes, where their health care has been substituted by social care. The warehousing of frail elderly people in nursing homes is a result of medical disinterest and of political ideology, and has led to a social model of care in which medicine is denied a role. At a less extreme level, evidence of benefit from social interventions in the form of aids and appliances for mobility problems in old age has been reported. But how many of these people would benefit from medical treatment?