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Care of the Elderly: Legal issues in relation to medical and social care of the elderly

There is little information on the incidence of complaints regarding the care of the elderly and even less about claims. Almost certainly solicitors are reluctant to get involved because however valid the claim the financial value is likely to be low. Nevertheless, there are some firm epidemiological data stemming from the Californian Insurance Feasibility Study of the 1970s when it was necessary for American insurers to consider plans for compensation other than the tort system which was spiraling out of control. The researchers from this study developed a method of retrospective case record review that has stood the test of time. It was used in the landmark Harvard Medical Practice Study and subsequently in surveys of hospital practice in Australia, the UK (London study), Denmark and New Zealand. Further studies are planned for Canada, Israel, France and Spain. In all the reported studies the message is the same. Adverse events are common in hospital practice. There is disagreement about the actual incidence but the more recent studies (including that from London) give a figure of about 10% of which about one third have a serious outcome (i.e. causing a disability that does not resolve within 1 month). About one half of these adverse events are regarded as preventable. This means that 1–2% of patients admitted to hospital have possible grounds for a claim. More than half involve patients over the age of 70 years. This is not surprising because elderly people have complex illnesses that present in subtle ways and often in patients unable to indicate when and in what way they feel ill. More than half of the post-mortem examinations, mostly of elderly people, in a district general hospital revealed pathologies not recorded by the clinicians. The diagnostic sensitivity was especially low for pulmonary embolism and acute abdominal disease. Thus there are medico-legal problems to be addressed in the care of the elderly. Perhaps there is a case for encouraging lawyers to help the general public bring these issues to light, possibly by working through the soon to be established Independent Complaints Advisory Service. We would welcome correspondence about the issues raised by this article.