Survival of the Unfittest
A Study of Geriatric Patients in Glasgow
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Originally published in 1972, this book is an analytical account of the socio-medical tribulations suffered by Glasgow’s east-end elderly leading to referral to geriatric wards. It examines why so many old people suffer from physical, mental and social deprivation in the final years of their lives. It shows by statistical studies and illustrative case histories that the basic cause is the survival into old age of people who are unfit to care for themselves, in such numbers that help from families, neighbours, the social services and the NHS is insufficient. From this study the expression the "geriatric giants" or the four I’s was coined: impairment of intellect (cerebral dysfunction), incontinence, immobility and instability (falls). The term ‘giant’ is seen to refer both to statistical frequency and to the huge personal burden of sufferers, escalating the need for socio-medical intervention. Prophetic in its predictions that the huge and complex social care problem would grow in the future much of this book remains relevant today.
Table of Contents
Part 1: The Fall of Mrs McGoldrick 2. The East End of Glasgow 3. The Evolution of the Geriatric Service 4. The Hard Core 5. The Co-ordinates of Care 6. Insufficient Basic Care 7. The Anatomy of Neglect: Preoccupation 8. The Anatomy of Neglect: Dilemma, Refusal 9. The Anatomy of Neglect: Rejection 10. The Bonds of Strain 11. The Sources of Strain 12. The Victims of Strain 13. The Triangles of Dependency 14. Incontinence 15. Community Care 16. ‘Something Must Be Done’ Part 2: Materials and Methods; Definitions. Appendices. Tables. Bibliography.
Bernard Isaacs was Consultant Physician in the Department of Geriatric Medicine, Glasgow Royal Infirmary. Maureen Livingstone was the Social Worker at Lightburn Hospital, Glasgow. Yvonne Neville was Senior Research Assistant at the Department of Geriatric Medicine, Glasgow Royal Infirmary.
‘Read this lively and well written book before you next consult with your geriatric colleagues.’ W. Lawton Tonge, British Journal of Psychiatry (1972)
‘…a magnificently readable book full of the drama, the sadness, the courage and the cruelty of old age.’ Malcolm Johnson, Journal of Social Policy (1973)