Doomed status: observations on the segregation of impaired old people.

The antecedents and consequences of the segregation of severely impaired old people within institutions is a problem that deserves more research attention than it has so far received. Given that such segregation exists and that it has some positive benefits for both staff and residents in homes for the aged, it is proposed that there exist among administration and ward staff impulses to avoid the mentally impaired aged, and that these impulses are part of a more general phylogenetic residue. Many animals show avoidance reactions in the presence of strange objects or strange conspecific individuals, and the more advanced the animal, the more disturbed he seems to be. It is suggested that the segregation of impaired old people consigns them to a doomed role, rather than a sick role, and that the process operates largely through the impact of the activation of the emergency team and the withdrawal of community support and can result in the death of the individual, partly by means of suggestion. Examples of sudden unexplained deaths are drawn from material on simpler societies.