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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 May 19; 334(7602): 1019–1020.
PMCID: PMC1871785
Older People in Care Homes

How to bring about changes

Paul Whitby, clinical psychologist

McMurdo and Witham bring to mind the poor level of care that so many elderly people have to tolerate when they find themselves in residential care.1 The question is how to alter the institutional system that so often seems to work against the interests of the individual.

We underestimate just how stressful it is for nurses and care assistants to provide intimate, personal care non-stop, day in day out, week after week. Unlike junior doctors, who also have this sort of stressful contact, these people are generally not on an upward career track. Stress may be measured by how strongly it is avoided, and staff turnover is an enormous problem in care of the elderly.

Amore subtle emotional avoidance also occurs when interactions are carried out in a forced cheery manner, ensuring everything is kept at a superficial level. Nurses simply are not provided with sufficient resources to take on all their patients' problems.

There are some shining examples of good practice in various areas of health care. For example, when I asked, Action on Elder Abuse was unable to find any reports of abuse or neglect from hospices in the United Kingdom. We desperately need to learn from these examples. We also require urgent investment at the ward sister, matron, head of home level so that these people become the clinical heroes who can protect, inspire, and lead their staff in the Sisyphean task of long term care of elderly people.


Competing interests: None declared.


1. McMurdo MET, Witham MD. Health and welfare of older people in care homes. BMJ 2007;334:913-4. (5 May.) [PMC free article] [PubMed]

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