Rethinking care for the sick elderly

Abstract

It is well established that Geriatrics and Gerontology are specialties in their own right meriting separate tertiary and primary care training.1 Health Care for the elderly also forms a newly added subject to the field of biomedical ethics.2 Demographic studies are consistently predicting the increasing proportion of "aged" members in our global population.3 Positive conceptions of 'healthy aging' are rightly displacing negative ageist perceptions that indiscriminately cast the elderly as weak, vulnerable, or incapable of self-determination.4 When, through the natural course of aging or due to illness or injury, body or mind begin to fail, a legitimate need for intervention - and care - will arise. In this article we discuss what is morally justified for the elderly population and recommend changes necessary in Malta especially in view of the established postwar rise in the elderly population. 5 to which Malta has been no exception. The President of the Malta College of Family Doctors is of the opinion that, "As medical technology continues to develop and new treatments and health care costs escalate, governments all over the world must devise more morally explicit principles whereby health care resources are allocated". He also points out that there exist dilemmas at sectorial levels where different groups of people, with different special needs, may feel disadvantaged. The elderly, for example, he says have less priority than the young in getting `life-saving cardiac treatment', whilst benefiting from other services helping them to remain active members of society.6 No one doubts that the institutions that were available in Malta for the elderly until a few years ago left much to be desired. The phrase "Tax-Xjuh" for the elderly was associated with either "tal-Frankuni" (Mount Carmel Hospital) for the psychiatrically ill or with "L-Imgieret" (St. Vincent De Paul Residence) and many were the elderly who shied away from wanting to spend the last few years of their life in such institutions. Although changes have been recently implemented to improve the quality of care and the quality of the environment in these institutions, much still needs to be done.