Bernard Isaacs & Maureen Livingstone 
Survival of the Unfittest [PDF ebook] 
A Study of Geriatric Patients in Glasgow

Originally published in 1972, this book is an analytical account of the socio-medical tribulations suffered by Glasgow’s east-end elderly leading to referral to geriatric wards. It examines why so many old people suffer from physical, mental and social deprivation in the final years of their lives. It shows by statistical studies and illustrative case histories that the basic cause is the survival into old age of people who are unfit to care for themselves, in such numbers that help from families, neighbours, the social services and the NHS is insufficient. From this study the expression the "geriatric giants" or the four I’s was coined: impairment of intellect (cerebral dysfunction), incontinence, immobility and instability (falls). The term 'giant’ is seen to refer both to statistical frequency and to the huge personal burden of sufferers, escalating the need for socio-medical intervention. Prophetic in its predictions that the huge and complex social care problem would grow in the future much of this book remains relevant today.