The creation of patient careers in geriatric wards: Aspects of policy and practice

Official policy, professional ideology and manifestos concerning geriatric care reflect Activity Theory assumptions about what constitutes ‘successful’ ageing. Three prescriptions for hospital geriatric care can be synthesised from these sources. Research data suggests there is often a reasonable ‘fit’ between these prescriptions and the careers of acutely ill geriatric patients who do not die. But for long stay patients, there is a wide discrepancy. Two distinct sub-types of long stay career can be identified, one of which is less discrepant from the care prescriptions than the other. It can be argued that contrasts in the structure of social relationships amongst doctor, nurse and patient are the key to understanding how the two types of long stay career are created. Moving on from this analysis, it is possible to suggest an alternative organizational arrangement for delivery of long stay geriatric care, within which the nursing profession or other non-medical carers, are explicitly accorded prime authority and responsibility. Potential problems, and the requirement for safeguards to prevent deterioration of standards must be considered, but there exist real possibilities for future development of positive alternatives.