Changes due to aging occurred are primary aging is usually due to interactions between genetic and environmental factors. Examples include lung cancer in susceptible individuals who smoke, hypertension in susceptible individuals with high salt intake, and diabetes in those with a thrifty genotype who adopt a more profligate lifestyle. Additionally there are genes which influence more general, cellular aging process.

Only now are specific genetic disease susceptibilities being identified, offering the potential to intervene early and to modify risk. While many geriatricians welcomed the emphasis on nonhospital based geriatric medicine others have warned against intermediate care being a covert form of ageism which allows rationing of acute hospital medicine in favour of less expensive and often less effective care. Intermediate care is for patients who do not fit into either acute or chronic stable categories, although these overlap.

The emphasis of intermediate care tends to be not primarily medical but multidisciplinary and holistic. There are two main bodies of patients: Those requiring rehabilitation, rehousing or both in a post-acute illness setting usually recruited from acute wards-step down care community dwelling patients who require nursing therapy input often following an acute or sub-acute deterioration, in order to avoid a hospital stay –m step up care or admission avoidance. The arrangement of intermediate care teams has been developed locally and varies and varies enormously in staffing facilities ethos and access. Some projects concentrate on very specific groups while others are more generic. Most regions have several complementary services.

Such as discharge coordinating teams for nurse, therapy or social work teams that bridge the interface between hospital and community based services. Families are more likely to be supporting older members. Retired people comprise a growing market and companies/ industries that accommodate the needs/wishes of older people will flourish. Transport, housing and infrastructure must be built or adapted. Political power of older people will grow. Health care and disability services the prevalence and degree of disability increases with age.

Regards
John George