86 F isio te ra p ie , D e se m b e r 1982, D eel 38, Nr. 4. S o u t h A f r i c a n p h y s i o t h e r a p y , like p h y s i o t h e r a p y in m o s t c o u n t r i e s , is b e i n g c o n f r o n t e d w i t h a g r e a t c h a l l e n g e . T he r e s p o n s e o f t h e p r o f e s s i o n , n o w , will d e t e r m i n e its f u t u re . T h e e d u c a t i o n p r o g r a m m e s h a v e a s i g n i f i c a n t r e s p o n s i b i li t y f o r d e v e l o p i n g c u r r i c u l u m s w h i c h will p r o d u c e g r a d u a t e s ’ w h o a r e a b l e t o r e s p o n d t o th e c h a ll en g es . P e r h a p s we n e e d a little less p hy si c s a n d a little m o r e e c o n o m i c s , p ol i t i ca l sc ie nc e a n d c o m m u n i c a t i o n skills t o n a m e b u t t h r e e a r e a s in w h i c h we t e n d t o d i s p l a y i n a d e q u a c i e s . U n d e r g r a d u a t e e d u c a t i o n p r o g r a m m e s , h o w e v e r , d e p e n d g r e a t l y o n t h e h o s p i t a l m o d e l s t o set the p a t t e r n . W i t h o u t po si t i v e r e s p o n s e s h e r e t o th e c h a l l e n g e s i n h e r e n t in a n i n c r e a s i n g d e p e n d e n t p o p u l a t i o n , little will h a p p e n . THE MACROPLAN FOR GERIATRIC CARE P. D E V. M E I R I N G , M .B ., B .C h ., F . R . C . P . ( E d i n ) , M . R . C . P . ( L o n d ) * S U M M A R Y A m a c r o p la n a n d a m ic r o p la n f o r g e r ia tr ic ca re a re outlined. T h e te r m s g e r ia tr ic m e d ic in e a n d th e g e r ia tr ic p a tie n t are d efin e d . A ty p ic a l e x te n d e d c o m m u n ity g e r ia tr ic te a m is illu s tr a te d b y m e a n s o f a ta b le, a s w e ll a s an o v e r a ll p la n f o r co­ o rd in a tin g th e se se rvices. T h e e x p e c ta tio n s o f th e g e r ia tric ia n in re sp e c t o f th e c o n tr ib u tio n s to b e m a d e b y th e p h y s io ­ th e r a p is t a re d is c u s s e d u n d e r f i v e headings. O P S O M M I N G 'n M a k r o p la n cn ’n m ik r o p la n vir g e r ia tr ie s e s o r g w o rd g e s k e ts . D ie te r m e g e r ia tr ie s e g e n e e s k u n d e en d ie g e r ia tr ie se p a s ie n t w o rd g c d e fin ie c r . 'n T ip ie se u itg e b r c id e g c m c e n s k a p s g e r ia tr ie s e sp a n , a s o o k 'n o o rk o e p e le n e le p la n o m hierclie d ie n s te te kodrelineer, w o rd d e u r m ickle! van ta b c llc g e illu str c e r. D ie v e r w a g tin g e van d ie g e r ia tr ie s e g e n e e s h e e r ten o p sig te van d ie b y d r a e s w at d e u r d ie f i s i o t e i a p e u t g e m a a k k a n word, w o r d o n d e r v y f h o o fd c b e sp re e k . K i n g a n d M a r t i d i p o e r o (197 8) d e f i n e a m i c r o p l a n as an a tte m p t to id e n tify a s u b s y s te m w ith a to ta l h e a lth c a re s y s te m a n d to b u ild th e f r a g m e n t s o f th is s y s te m in to an e n tity , the m ic ro p la n , w hich m u s t f t in to th e to ta l s y s te m a n d im p ro v e its fu n c tio n in g . T h e s e a u t h o r s u s e th e t e r m m a c r o p l a n to d e s c r i b e n a t i o n a l h e a l t h p l a n s o f t h e t r a d i t i o n a l k i n d ; th es e, w h e n a p p l i e d to g e r i a t r i c s , will i n c l u d e c o n s i d e r a t i o n o f so ci al a n d d e m o g r a p h i c f a c t o r s a n d t h e t o t a l p l a n n i n g f o r c a r e o f g e r i a t r i c p a t i e n t s in h o s p i t a l s a n d t h e c o m m u n i t y by all ag e n c i e s a n d d i s c ip l i n e s t h a t m u s t b e in v o l v e d in de l i v e r i n g su c h car e. T h e r e will t h e r e f o r e be a s t r o n g e l e m e n t o f s t a t u t o r y c o n t r o l a n d c o o r d i n a t i o n if t h e m a c r o p l a n is t o be a n ef fic ien t m e d i u m f o r c a r e o f t h e frail a n d sick elde rly . A s by n o m e a n s all e ld er ly p e r s o n s c a n be clas sif ied as g e r i a t r i c , it is n e c e s s a r y t o d e f i n e t h e t e r m as th a t b ra n c h o f g e n e r a l m e d ic in e c o n c e r n e d w ith th e c lin ica l, p re v e n tiv e , r e m e d ia l a n d s o c ia l a s p e c ts o f illn ess in th e e ld e rly . T h e g e r i a t r i c p a t i e n t c a n be d e f i n e d ( S h a p i r o , 1979) as an e ld e r lv p e rso n who is n o t a b le o r lik e ly to be a b le to m a in ta in in d e p e n d e n c e in th e c o m m u n ity w ith o u t h e lp in s o m e o f the su p p o rtiv e , b a sic o r r e m e d ia l n eed s. It m u s t by n o w be a p p a r e n t t h a t g e r i a t r i c c a r e c a n n o t be th e ex clu si ve m o n o p o l y o f th e d o c t o r sin c e a n u m b e r o f di sc ip l i n e s a n d t e c h n i q u e s , as well as v o l u n t a r y a n d s t a t u t o r y ag e n c i e s , m u s t be e m p l o y e d t o d e l i v e r c a r e o n a b r o a d f ro n t in h o s p i t a l s , n u r s i n g h o m e s , ol d ag e h o m e s , ' sh e l te re d h o u s i n g a n d th e c o m m u n i t y . A m a c r o p l a n will b e m a d e u p o f a n u m b e r o f m i c r o p l a n s . In e n u n c i a t i n g t h e p r i n c i p le s o f * W i l l i a m S l a t e r P r o f e s s o r a n d H e a d o f G e r i a t r i c Un it , U n i v e r s i t y o f C a p e T o w n . R e c e i v e d 13 O c t o b e r 1982. m a c r o p l a n n i n g in thi s c o n t e x t , it is n e c e s s a r y to lay d o w n a n u m b e r o f m i c r o p l a n s a n d t h e n t o i n d i c a t e h o w b es t thes e c a n be c o o r d i n a t e d a n d a p p l i e d in t h e m o s t co s t ef fective way . In d a y t o d a y h e a l t h c a r c o f ag e d ' p e r s o n s , the g e r i a t r i c i a n m a y be l o o k e d u p o n as th e c o n d u c t o r o f the o r c h e s t r a , w h o , whil e h a v i n g a vit al c o o r d i n a t i n g role, c a n n o t p r o d u c e g o o d m u s i c un l es s all t h e i n d i v i d u a l pl ay er s a r e c o m p e t e n t , d i s c i p l i n e d a n d c o o p e r a t i v e . L ik e w i se , no m a t t e r h o w g o o d t h e i n d i v i d u a l p l a y e r s m a y be, a c a c o p h o n y will r e s u l t f r o m t h e i r t o t a l l y u n c o o r d i n a t e d e f f o r t s in a t t e m p t i n g t o r e n d e r a d if fi cu lt p e r f o r m a n c e w i t h o u t a c o n d u c t o r . T h e v a r i o u s d i sc ip l i n e s , skills a n d a g e n c i e s w h o s e m i c r o p l a n s f o r g e r i a t r i c p r a c t i c e m u s t c o n t r i b u t e t o the{ o v e r a l l m a c r o p l a n , a r e b r ie fl y i n d i c a t e d so t h a t t h e v a r i o u s w o r k e r s in t h e field c a n h a v e s o m e id e a w h e r e t h e i r i n d i v i d u a l c o n t r i b u t i o n s will fit i n t o th e g e n e r a l s c h e m e o f th i n g s. T A B L E I s h o w s th e c o m p o s i t i o n o f a t y p i ca l e x t e n d e d c o m m u n i t y g e r i a t r i c t e a m . R a t h e r t h a n a g e o g r a p h i c a l l y lo c a t e d e n t i t y , thi s t e a m will ( p a r t i c u l a r l y in a n e n v i r o n m e n t w h e r e g e r i a t r i c m e d i c i n e is n o t yet well d e v e l o p e d ) te n d t o be c o n s t i t u t e d by a list o f p e r s o n s o r ag e n c i e s , a v a i l a b l e w h e n r e q u i r e d . H o w e v e r , in a w el l - ru n G e r i a t r i c U n i t t h e r e will be r e g u l a r m u l t i d i s c i p l i n a r y ca s e d i s c u s s i o n s as p a r t of' the p r a c t i c a l w o r k o f th e U n i t a n d it is w h e n thi s is well d e v e l o p e d a n d p e r t i n e n t t o the w o r k l o a d t h a t a G e r i a t r i c U n i t is at its be st . It is, h o w e v e r , o n l y t h o s e m o s t clos ely c o n c e r n e d w i t h d i r e c t d a y to d a y c a r e t h a t will m ee t in the w a r d s o r o u t p a t i e n t clinics in h o s p i t a l s , clinics a n d d a y h o s p i t a l s . A n o v e r a l l p l a n f o r c o o r d i n a t i n g th e s e m a n y se rv ic es ha s b e e n p r e s e n t e d ( M e i r i n g , 1982a) as i n d i c a t e d in T A B L E 2, w hi ls t t h e p l a c e o f h o s p i t a l - b a s e d se rv ic es is i l l u s t r a t e d in fig. 1. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) p h y s io th e ra p y , D e c e m b e r 1982, Vol. 38, No. 4 87 T A B L E I T H E D I S C I P L I N E S A N D A G E N C I E S I N C L U D E D IN T H E T Y P I C A L G E R I A T R I C S E R V I C E * . 1. G e r i a t r i c i a n o r d o c t o r w i t h in t er es t in c a r e o f th e ag ed. 2. O t h e r m e d i c a l , su r g i c a l a n d d e n t a l sp e ci al i st s a n d p r a c t i t i o n e r s a s r e q u i r e d . 3. H o s p i t a l , c o m m u n i t y li ais o n a n d c o m m u n i t y n u r s i n g services. 4. P h y s i o t h e r a p i s t . 5. O c c u p a t i o n a l t h e r a p i s t . 6. S oc ia l w o r k e r . 7. D i e t i c i a n . 8. S p e e c h t h e r a p i s t . 9. O p t o m e t r i s t . 10. H o s p i t a l l a b o r a t o r y a n d r a d i o l o g ic a l s t a f f a n d o t h e r te c h n i c i a n s ( o r t h o p a e d i c w o r k s h o p s , etc.). 11. H o s p i t a l a d m i n i s t r a t o r s a n d p l a n n e r s a n d leg isl ato rs. 12. H o s p i t a l d o m e s t i c s t a f f a n d d r iv er s . k)3. C h i r o p o d i s t s . *14. V o l u n t a r y w o r k e r s , h o m e he lp s, v isi to rs. 15. C o m m u n i t y a g e n c i e s f o r c a r e o f th e ag ed . 16. ‘T h e i n f o r m a l s e c t o r ’ eg. s c h o o l c h i l d r e n , c h u r c h m e m b e r s , t h e g r a n n y n ex t d o o r , etc., etc. * As all e l e m e n t s h a v e a role w i t h o u t w h i c h t h e t e a m c a n n o t f u n c t i o n o p t i m a l l y t h e o r d e r in w h i c h t h e y ar e a r r a n g e d d o e s n o t i m p l y a n y p r e c e d e n c e . Fig. I . A n i d ea l How sy s t e m f o r a h o s p i t a l b a s e d g e r i a t r i c service, t a k e n f r o m a ty p i ca l U . K . G e r i a t r i c Un it . * I n d i c a t e s th e likely d e g r e e o f i n v o l v e m e n t o f p h y s i o ­ t h e r a p y s e rv i ce s as se en b y th e g e r i a t r i c i a n . T A B L E 2 T h e s c h e m e f o r o v e r a l l p l a n n i n g f o r c a r e o f t h e elderly: A. D E F I N I T I O N O F G E R I A T R I C S A N D T H E G E R IA T R IC PA T IE N T . B C ARE O F T H E E L D E R L Y IN T H E C O M M U N IT Y A N D H O S P IT A L . 1. The d octor and allied health care w orkers 2. The overall plan for ca re o f the aged 2.1 T h e cl in ic al a n d p r e v e n t i v e role o f t h e d o c t o r 2.2 L e a r n i n g a n d t e a c h i n g r ol es o f t h e d o c t o r 2.3 T h e t e a m a p p r o a c h t o h o s p i t a l , c o m m u n i t y a n d s o c ia l f a c t o r s in g e r i a t r i c ca r e 2.4 T h e p l ac e o f h o s p i t a l b a s e d se rvices 2.5 C a r e o f t h e t e r m i n a l l y ill. 3. S ta tu to ry and coordinated care for the elderly on a n ation-w ide basis 3.1 H e a l t h A c t o f 1977 a n d o t h e r le g is la ti o n 3.2 H e a l t h M a t t e r s A d v i s o r y C o m m i t t e e a n d its S u b c o m m i t t e e - f o r H e a l t h Se rv ice s f o r t h e A g e d 3.3 N a t i o n a l N e t w o r k o f r e g i o n a l c o o r d i n a t i n g c o m m i t t e e s in m a j o r c e n t r e s 3.3.1 C o o r d i n a t i n g w o r k of: 3 . 3 . 1.1 S t a t e H e a l t h : M e n t a l h e a l t h , D i st r i c t s u r g e o n s . D i s t r i c t n u r s i n g se rvi ces 3.3 .1.2 P r o v i n c ia l h e a l t h a u t h o r i t i e s 3.3.1.3 M e d i c a l a s s o c i a t i o n 3.3 .1.4 L oc al a u t h o r i t i e s 3.3 .1 .5 V o l u n t a r y b o d i e s a n d a ge n ci es . T A B L E 3 P e r c e n t a g e p o p u l a t i o n 65 a n d o v e r , 1970 a n d p r o j e c t e d in y e a r 2000. B lac k W h i t e C o l o u r e d A s i a n M a l e F e m . M a l e F e m . M a l e Fe m. M a l e F e m 1970 3.22 4.01 5.45 7.59 2.7 3.3 1.8 1.6 2000 2.97 4.17 7.7 9.9 3.0 3.62 2.7 3.9 A m i c r o p l a n fo r g e r i a t r i c p r a c t i c e by d o c t o r s c a r i n g f o r the a g e d h a s b e e n d e s c r i b e d ( M e i r i n g , 1982b), m a k i n g spe cific m e n t i o n o f t h e m e m b e r s o f t h e t e a m t h a t a r e ca l l e d u p o n , i n c l u d i n g t h e p h y s i o t h e r a p i s t , a n d e m p h a s i z i n g the p a r a m o u n t i m p o r t a n c e o f i n t e r d i s c i p l i n a r y c o o r d i n a t i o n . P o p u l a t i o n p r o j e c t i o n s ( T A B L E 3) s h o w t h a t c a r e o f the a g e d c a n be e x p e c t e d t o a b s o r b a n e v e r - i n c e a s i n g slice o f the a v a i l a b l e h e a l t h c a r e r es o u r ce s . I s a a c s ( 1 96 9) d e s c r i b e d th e g e r i a t r i c p a t i e n t as a n el d e r l y p e r s o n , o f t e n o f a d v a n c e d age , o f t e n li ving a l o n e o r h a v i n g lost c o n t a c t w it h f a m i ly o r f ri e n d s , w h o m a y b e a s p i n s t e r , w i d o w e r o r b a c h e l o r a n d w h o su f f e rs f r o m t w o o r m o r e d i s a b l i n g d i s o r d e r s w h i c h i n c l u d e d s t r o k e s , g a i t loss, falls, m e n t a l i m p a i r m e n t a n d i n c o n t i n e n c e . B a se d u p o n t h e first h u n d r e d re fe rr a l s t o t h e G e r i a t r i c U n i t o f G r o o t e S c h u u r H o s p i t a l a n d th e U n i v e r s i t y o f C a p e T o w n , th e f o l lo w in g R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) 88 F isio te ra p ie , D e se m b e r 1982, D eeI 38, Nr. 4. t e n t a t i v e d e f i n i t i o n m a y be of fe r e d : T h e g e r ia tr ic p a lie n l is an e ld e r ly p e r s o n w h o se in d e p e n d e n c e is im p a ir e d o r lo st b eca u se o f th e s im u lta n e o u s p re se n c e o f tw o o r m o r e p r o b le m s o f a c lin ic a l a n d s o c ia l n a tu re . S u c h a p a tie n t is li k e l y to b e o f a r e la tiv e ly a d v a n c e d age. to he s o c ia lly a n d e c o n o m ic a lly d is a d v a n ta g e d a n d to h a ve a c o m b in a tio n o f d isa b lin g d iso rd e rs or s y m p to m s th a t c o m m o n ly in c lu d e str o k e s , in c o n tin en ce, c rip p lin g c a r d io -p u lm o n a r v diso rd ers, lo ss o f m o b ility , f a l l s a n d p s y c h ia tr ic a b n o rm a litie s . F r o m th e s e d e f i n i t i o n s , t he ex p e c t a t i o n s o f t h e g e r i a t ri c i a n in r e s p e c t o f t h e c o n t r i b u t i o n s t o be m a d e by the p h y s i o t h e r a p i s t be g i n t o f o r m a c l e a r e r i m a g e . W i t h thi s a s a b as is f o r f u r t h e r d i s c u s s i o n a n d c o o p e r a t i o n b e t w e e n thes e t w o di sc ip l i n e s , it c o u l d lea d t o t h e f o r m u l a t i o n o f a m i c r o p l a n f o r p h y s i o t h e r a p y f o r t h e a g e d . T h e s e e x p e c t a t i o n s c a n b e e x a m i n e d a s follows: T H E C L I N I C A L A ND P R E V E N T I V E R U L E S O F T H E P H Y S I O T H E R A P I S T . T h e p h y s i o t h e r a p i s t h a s t o s t u d y th e d i s e a s e s p e c t r u m in t he a g e d a n d th e p e c u l i a r i t i e s a n d d i sa b il i t i e s o f thes e d i s e a s e s in t h e i r t o t a l p e r s p e c t i v e to f o r m u l a t e th e t r a i n i n g a n d w o r k c o n t e n t r e q u i r e d t o m ee t t h e s e cha ll en g es . P a r t i c u l a r a t t e n t i o n s h o u l d be p a i d t o e d u c a tin g d o c to r s a n d p r e v e n t i v e h e a l t h a u t h o r i t i e s to re fe r ca s es w it h ea rl y o r mild d i sa b il i t i e s s u c h a s m i n i m a l o s t e o a r t h r i t i s , m i n i m a l s t r o k e s a n d m u s c l e w e a k n e s s o f t h e very a g e d . R e s e a r c h c o u l d be d i r e c t e d t o w a r d s f i n d i n g th e o p t i m a l s o l u t i o n s t o thes e p r o b l e m s a n d t h e bes t m o d a l i t i e s o f t r e a t m e n t . C o o p e r a t i o n in t h e t o t a l e f f o r t o f r e h a b i l i t a t i o n will t h u s be very i m p o r t a n t . T H E L E A R N I N G A N D T E A C H I N G R O L E S O F T H E P H Y S I O T H E R A P I S T . T h e s e a r e i n t i m a t e l y b o u n d u p w it h t h e clini cal a n d p r e v e n t i v e r ol es s u g g e s t e d a b o v e , t h e t h r e e pi l l ar s o f an y a c a d e m i c d i s c ip l i n e be i n g r e s e a r c h , se rv ic e a n d t e a c h i n g . T H E T E A M A P P R O A C H A p r o d u c t i v e , m u l t i d i s c i p l i n a r y t e a m e f f o r t h a s been s t a r t e d in t h e G e r i a t r i c U n i t a t C o n r a d i e H o s p i t a l a n d it is w o r t h y o f n o t e t h a t the R e g io n a l D i r e c t o r o f S t a t e H e a l t h h a s r e c e n t l y a p p o i n t e d a D i s t r i c t P h y s i o t h e r a p i s t . T h e r e p o r t o n h o m e c a r e t e a m s in C a n a d a h a s a l r e a d y b e e n m e n t i o n e d br ief ly ( S h a p i r o , 1979) in r e f e r r i n g to the a t t r i b u t e s o f t h e g e r i a t r i c p a t i e n t . In thi s r e p o r t S h a p i r o d e s c r i b e s in d e t a i l t h e c o n c e p t o f h o m e c a r e t e a m s as d e v e l o p e d in C a n a d a , a n d H u n t a n d C r i c h t o n ( 1 977 ) h av e d e s c r i b e d h o w t h e d e v e l o p m e n t o f th e h o s p i t a l - l i k e h o m e c a r e in S a s k a t o o n r e s u l t e d in a m a r k e d c o s t r e d u c t i o n as c o m p a r e d t o i n s t i t u t i o n a l ca re . A s p h y s i o t h e r a p i s t s p l a y a v ital ro le in th e s e c o m m u n i t y servic es, a n d we h a v e h a r d l y s c r a t c h e d t h e s u r f a c e o f this p o t e n t i a l d e v e l o p m e n t in S o u t h A f r i c a , a v as t fi eld o f s t u d y a n d d e v e l o p m e n t is o p e n a n d o f fe r s a v er y e x c i t i n g c h a l l e n g e to th e p h y s i o t h e r a p y p r o f e s s i o n in t h e y ea r s a h e a d , p r o v i d e d it is m a t c h e d by su f f i c i e n t f u n d i n g t o m a k e it p o ss ib le . T h e p o t e n t i a l f o r cost s a v i n g h a s , h o w e v e r , b e e n p o i n t e d o u t so t h a t th i s will be m o n e y well s p e n t . T H E P L A C E O F T H E P H Y S I O T H E R A P I S T IN H O S P I T A L - B A S E D P R O G R A M M E S . A s in t h e clin ica l ro le d e s c r i b e d a b o v e , s t u d y o f th e special p r o b l e m s o f t h e el d e r l y a n d a w i ll in gn es s t o w o r k in an e x t e n d e d t e a m h a v e p o t e n t i a l f o r g r e a t d e v e l o p m e n t in p r o d u c i n g t he h o s p i t a l - b a s e d t e a m s t h a t f o r m s u c h an es s e n t i a l a n d s u c ce ss fu l p a r t o f t h e f u n c t i o n o f British G e r i a t r i c U n it s. C A R E O F T H E P A T I E N T IN L O N G STAY I N S T I T U T I O N S F O R C A R E O F T H E A G E D . H e r e m a i n t a i n i n g m o b i l i t y f o r as l o n g as po ss i b l e is e s s e n t i a l a n d in th e p r e s e n c e o f s t a f f s h o r t a g e s th i s im plies g r o u p a c t i v i t y , ex er cis es a n d g a m e s . M u s i c is a n ideal m e d i u m f o r this a n d t h e r e h a v e b e e n r e q u e s t s t o e s t a b l is h a p o s t - g r a d u a t e c o u r s e in r e m e d i a l m us ic . T h e p o t e n t i a l for close c o o p e r a t i o n b e t w e e n t e a m m e m b e r s is e n o r m o u s a n d o ffe rs g r e a t s c o p e f o r i m p r o v e m e n t o f t h e o f t e n d r e a r y q u a l i t y o f life f o r t h e i n h a b i t a n t s o f l o n g s t a y facilities. C O N C L U S I O N T h e s y n t h e s i s o f m i c r o p l a n s f o r g e r i a t r i c c a r e by v a r i o u s d i s c ip l i n e s c o n c e r n e d w i t h th i s se rv ic e w i t h su i t a b l e c o ­ o r d i n a t i o n a n d s t a t u t o r y c o n t r o l s , c a n be e x p e c t e d t o result in a t o t a l p r e v e n t i v e a n d c u r a t i v e se rv ice f o r t h e elde rly . In G r e a t B r i t a i n t o t a l c a r e f o r t h e a g e d is well d e v e l o p e d , bu t this it se lf h a s r e s u l t e d in a n u m b e r o f p r o b l e m s as p o i n t e d out by P i c t o n W i l l i a m s ( 19 81 ) a n d it w o u l d be a pi ty in a c o u n t r y like S o u t h A f r i c a , w h e r e g e r i a t r i c s is j u s t e m e r g i n g as a m u l t i ­ d i s c i p l i n a r y sp e c i a l t y in its o w n r i g h t, t o d i s s i p a t e o u r en e r g i e s a n d s c a rc e r e s o u r c e s by h a v i n g t o c o r r e c t costly m i s t a k e s . It is f o r th i s r e a s o n t h a t it h a s b e e n t h o u g h t n e c e s s a r y to c o m m e n c e a n e x a m i n a t i o n o f t h e rol es o f the i n d i v i d u a l d i sc ip l i n e s a n d t o call f o r d e f i n i t i o n s o f th eir f u n c t i o n s in a series o f m i c r o p l a n s . T h e s e in t u r n will finally a d d u p t o a h ol is ti c c o n c e p t o f c a r e f o r t h e a g e d , th e so- cal led m a c r o p l a n f o r g e r i a t r i c c ar e , a n d t h e p u r p o s e o f t h is p a p e r is to i n t r o d u c e t h e g e n e r a l c o n c e p t t o o p e n f u r t h e r d i s c u s s i o n t o w a r d s this id eal. Re fe re nc es H u n t , T . E. & C r i c h t o n , R. D . (1977). O n e t h i r d o f a million d a y s t o c a r e a t h o m e 1959 t o 1975. C anad. M e d . A ss. J. 116, 1351-1355. I s a a c s , B. (1969). S o m e c h a r a c t e r i s t i c s o f g e r i a t r i c p at i e n t s. S c o t t M e d J , 14, 243-251. K i n g , M . H. & M a r t o d i p o e r o , S. (1978). H e a l t h m i c r o ­ p l a n n i n g in d e v e l o p i n g c o u n t r i e s . In t. J. H e a lth S e r v . 4, 65 3- 66 4. M e i r i n g , P. d e V. ( 1 9 82 a) . P l a n n i n g f o r c a r e o f t h e a g e d . T h e a g e d in a m o d e r n so c i et y , a se l e c t i o n o f l e c t u r e s at th e 1982 S u m m e r S c h o o l . D e p a r t m e n t o f E x t r a - M u r a l S tu di es , U n i v e r s i t y o f C a p e T o w n . M e i r i n g , P. d e V. ( 198 2b ). W h o c a r e s ? A m i c r o p l a n for g e r i a t r i c p r a c t i c e . .S' A f r M e d J 62, 391-393. P i c t o n W i l l i a m s , T. C. (1981). T h e f u t u r e o f ge r i a t ri c m e d i c i n e . ./ R C o ll P h y s ic ia n s L o n d o n 1, 45-47. S h a p i r o , E. (1979). H o m e c a r e : a c o m p r e h e n s i v e ov er vi ew . Po li cy P l a n n i n g a n d I n f o r m a t i o n B r a n c h . D e p a r t m e n t o f N a t i o n a l H e a l t h a n d W e l f a r e . O t t a w a . R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )