Abstract
I read with interest the paper by Nowak and Hubbard 1 on falls, frailty and complex systems failure. Some 30 years ago when I started in general practice, I was struck by the obvious similarities between the natural stages of childhood development and the almost exact reverse counterpart seen in ageing. From this perspective, the flourishing business of local residential homes for the elderly seemed a logical family substitute providing similar functions of supervision, care and support, addressing independence, cognitive function decline, emotional needs, mobility and continence.
This, then, was the ‘cradle to grave’ domain occupied by general practice which I began to see as maturation: the differential processes in complex biological systems that lead to the attainment of full and independent adult functional capacity, through to the systems failure seen in ageing. Extrapolating from Nowak and Hubbard's paper perhaps a concise name would be useful to describe this process and I would suggest dematuration, the reverse of maturation.
This model offered a greater understanding of much of my daily workload and 30 years on, fundamentally, little has changed.
Footnotes