Editor: Shane O’Hanlon
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Issue 59
September 2016
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Kate Granger (1981 - 2016)
O
A tribute to a friend
n 23rd July, Kate Granger died after
several years of living with a rare
cancer.
I first met Kate, when we were both fresh faced
juniors - she was an FY2 and I was an elderly care
registrar at Leeds General Infirmary. Even then,
her values on compassionate care were welldefined. She provided first class care at every
encounter, communication was a real strength and
she loved to teach all members of the team. We
shared a passion for patient safety and
improvement.
This was the old style “firm”, and I’m sure it was
here that she was steered towards a career in
geriatrics. We were guided by our
wise and experienced consultant,
Peter Belfield, who became a
friend to both of us. Kate and I
learnt a lot together during that
“firm”, gaining confidence in
testing out new improvement
methods and ideas, and a
friendship based around our
professional values developed.
We had challenging times, but we
also had fun, driven by teamwork
and continuous learning together.
Our professional paths crossed
frequently over the next nine or
ten years. Core Medical Training
in Leeds followed for Kate -
always the perfect CMT to be on call with and to
have based on your ward. Then we were both
registrars together, followed by my having Kate as
my registrar when I became a new consultant perfect! Finally, Kate and I became consultant
colleagues in Yorkshire.
I always thought we would work together long
term, and the thing that makes me really smile is,
when I am at work, Kate is with me. Every
encounter with a patient, “hello my name is …”,
every MDT, every meeting with a new member of
the team and every morning I put on my “hello my
name is” badge, she is with me, she is behind every
little thing I do every day. It makes such a
difference.
for better health in old age
President: Prof David Oliver
President Elect: Dr Eileen Burns
Honorary Secretaries: Dr Andrew Williams and Dr Shane O’Hanlon
Meetings Secretaries: Dr Khai Lee Cheah and Dr Mark Taylor
Honorary Treasurers: Dr Juanita Pascual and Dr Owen David
Chief Executive Officer: Colin Nee
2 BGS n e w s
September 2016
In this issue
Editorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
President’s column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Older People Whisperer on compassion . . . . . . . . . . . . . . . . . .6
Hospital at Home Forum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Balancing age and organ transplantation waiting
lists: an Israeli example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Inspiration versus limitation - reflections on the
BGS/RCN conference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Why we need a clinical trials network for
perioperative medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Depression in older adults - solutions to a
common disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Interview with Tahir Masud, our future BGS
President-Elect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Elections of representatives to the Trainees Council . . . . . . .16
BGS Education and Training Representatives . . . . . . . . . . . . .17
NOTICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
BGS policy update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
BGS membership subscriptions 2017 . . . . . . . . . . . . . . . . . . . .23
Hertfordshire nutrition and wellbeing service identifying
and addressing malnutrition in the community . . . . . . . . . . .24
The Electronic Frailty Index . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Scaling the peaks - understanding the barriers and drivers
to providing and using dementia friendly community
services in rural services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Let’s dance. Put on your red shoes and dance the blues.
A good way to die . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
BGS Communications in action . . . . . . . . . . . . . . . . . . . . . . . . .29
BGS Autumn Meeting - November 2016 . . . . . . . . . . . . . . . . .31
How well are the diagnosis and symptoms of dementia
recorded in older patients admitted to hospital . . . . . . . . . . .32
Interview with Premila Fade, new BGS EoLC Lead . . . . . . . . .33
The shoulders upon which we stand - geriatric
medicine’s pioneers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
“#hello my name is”, is so much more than four little
word. Kate knew that and experienced it personally. With
those four words, the person behind the professional
facade is revealed; the hierarchy melts away, the patientprofessional barrier is lowered. There is compassion,
humanity and warmth in those words.
The little things
As Kate said, it is the “little things” that make a
difference. She “felt” the impact of those words on an
especially tough day in the early months of her illness.
Brian, the porter at Leeds, was the first person to use
them that day and, as a result of their effect on her in that
difficult moment, Kate changed the NHS.
Can one person, really make a difference? Well, yes they
can, but it takes a very special person. Kate will be the
first to acknowledge the team that supported her, just as
in the world of Geriatrics it is the team that makes the
difference. Chris, Kate’s husband, gave her the belief and
support to take her campaign far and wide; to be bold
and to believe in herself. “Turn your frustrations into
something positive.” Adam her brother, shared her
values and brought technical skills to the campaign.
Together they have changed the NHS. They sowed the
seeds of “hello my name is” champions everywhere and
I believe it will continue to flourish and spread, like no
other change I have ever seen. She told me in her final
weeks, “hello my name is doesn’t need me now”. It has a
life of its own. I have never seen any change or
improvement do that at such scale and with such power.
I am not sure I will ever see its like again in my career.
What an astounding legacy!
I admit I have felt absolutely lost on the odd occasion
when I left my badge at home. It is now on my
automated checklist before I leave the house: keys, phone
and BADGE! In fact the order is actually BADGE, keys,
phone. How does a badge do that!? It’s because it’s so
much more than a badge.
But “hello my name is” is only part of Kate’s legacy. I
have not mentioned her books, The Other Side and The
Bright Side. Then there is her charity work for Yorkshire
Cancer Centre, raising over £250,000! Her willingness to
embrace life, to accept death, to live for the moment, not
to waste time deliberating - if you believe in it, do it! - this
was the essence of my friend. She was the beneficiary of
many awards including an MBE, but she would say, “I’m
just Kate, the Yorkshire lass that happens to have
cancer”. Did I mention that she was also an amazing
cook, a wonderful wife, aunt, daughter, friend, colleague,
teacher and musician (flute).
n e w s BGS 3
September 2016
On the evening that she died, I was due to go out
with several friends for a birthday celebration. Kate
would definitely have said, “let your hair down Ali,
have a glass of prosecco and a boogie”. She loved
a dance, I don’t! She would be chuckling at my
dancing that night, but her message was always,
“embrace life”, so I embraced the dance floor for
once in my life that night.
I have learned so much from Kate. She shaped me
as a Geriatrician; she enhanced how I communicate
with everyone every day; she motivated me to take
up running for charity (I couldn’t run 5k 10 years
ago, and now I am attempting a marathon this
year!); she made me agree to be filmed, she got me
tweeting, and most importantly she inspired me to
embrace life, do new things, share my values and
believe in what I’m doing. She would want us all to
Editorial
A
utumn has arrived and with it, the winds
of change! I am delighted to take the
reins of editorship of this newsletter
from Dr Andrew Williams.
We have our final President’s Column from
Professor David Oliver, with Dr Eileen Burns ready
to take on the leadership challenges from
November. David reflects on the highlights of his
two year presidency, as he moves on to an
important role with the Royal College of Physicians
London. Thankfully he will continue to work with
us on the many areas where the organisations
collaborate and we hope that he will continue to
give us the benefit of his unsurpassed talent for
horizon scanning.
As you’ll have seen, this edition opens with the sad
news of the loss of our colleague, Kate Granger.
Ali Cracknell’s moving tribute on the front page was
first published on the BGS blog and received the
highest number of hits that any of our blog pieces
have ever seen - a testimony to Kate’s legacy. Our
be positive and to nurture her legacy of
compassionate care.
I am sure I speak for all Geriatricians in Yorkshire
and beyond, and all healthcare workers who had
the pleasure of working with her when I say, Kate,
you have made a difference. Thanks to you, we all
now do those “little things” better. Geriatrics is the
better for having had you in its fold, as is the NHS.
We have lost a true hero(ine) of Geriatrics and a
very special person, friend and colleague.
You will never be forgotten; your work continues
to spread; your values and presence are with us.
Thank you Kate Granger. Rest in peace.
Ali Cracknell
coming Autumn
Meeting has been
dedicated to her as
we celebrate her
impressive
achievements and
hope that her
legacy continues to bring humanity and compassion
to patient care. These themes are also explored in
our Older Person Whisperer comic strip, a regular
feature that members have warmly welcomed.
An interesting foil to the issue of compassionate
care is raised by one of the beneficiaries of our
BGS Nursing Study Grants (page 9). Referring to
the enthusiasm and idealism which tends to pervade
at conferences, Hanneke Wiltjer makes an
impassioned plea that we do not forget the
considerable resourcing constraints which often
thwart our desire to deliver ideal care.
Time and resource constraints have been with
professionals caring for sick and vulnerable people
for a long time, and will continue to be so. Apart
from continuing to lobby for a larger share of the
State Purse ,the only immediate choices open to
4 BGS n e w s
September 2016
health and social care professionals come down to
working to effect improvements in the microcosm
of our immediate practice, and to broadcast the
evidence of these improvements at conferences and
in the other fora available to us.
To this end, Caroline, our new Policy Manager, is
working with the Royal College of General
Practitioners to showcase examples of innovative
integrated care (page 22). The prospect of
overcoming our resource issues may not materialise
any time soon, but the will to innovate new service
models which deliver a more seamless experience
for people needing health and social care is evident.
Along with Caroline’s Policy Update, we have
Marina’s Communications and PR column (page
29). These are important areas where many
geriatricians may not actively work and we are
President’s
S
grateful to both for helping us to understand their
work on behalf of the Society.
The Society itself is in an important phase of
growth and change; our recent review has led to the
identification of areas where we can improve the
service to our members, and work better to achieve
our strategic goals. One of the most visible results
will be our new logo, coming shortly, and we hope
this gives further impetus to other recent
achievements. As part of this it is vital that more
new blood comes into the organisation; we need
members at all levels to become involved in our
committees, our events, and representation of the
organisation on areas of expertise. I’m really
looking forward to hearing from members who are
keen to come on board!
Shane O’Hanlon
column
o, here’s where I get off. As an ex-BGS
secretary and editor of this newsletter a
decade ago, and in my time more
recently as BGS President-Elect and President,
I’ve written many a column here.
But my time as BGS President formally ends at our
AGM during the Glasgow Autumn meeting and the
timing of the publication of the BGS Newsletter
means this is my last column in a BGS officer role.
I should say right away, that although we amateurs
do help by soliciting and writing content, the
unheralded heroine of the piece throughout my
time with the Society has been Recia Atkins who
does all the hard graft with the Newsletter and the
website – with both going from strength to strength
during my roles. She won’t like me praising her, but
there it is. She’s a great colleague and has become a
firm friend.
I’ve written plenty in previous editions about the
BGS, the speciality, where we’ve come from and
where we might be
heading as well as
an essay with Eileen
Burns for the RCP
,Future Hospitals
Jour nal on these
very themes –
setting out some of the existential challenges and
hard choices we face as a speciality. I won’t say
much more on this here. I am using my final
column to exercise the outgoing President’s
prerogative to say something more personal.
I’ve done my best to set out a vision and template
for joined-up services for older people – going far
broader than the roles geriatricians play in my 2014
paper for the King’s Fund, Making health and care
services fit for an ageing population. In my weekly
BMJ Acute Perspective column and my King’s Fund
blogs I’ve done my best to make some key messages
about healthcare of older people accessible to nonspecialists and I have put plenty of content into
other resources such as the HSJ Commission on the
Care of Older People and the NHS Confederation
Growing Old Together report.
n e w s BGS 5
September 2016
But there is a reason for fixed-term appointments
to elected officer roles and my time is up.
Those that went before, those that come after
We all stand on the shoulders of others and going
back to the Martin/Knight Presidencies and the
appointment of Colin Nee as an experienced,
excellent CEO, we have made a gradual shift to an
organisation which has a rolling operational plan
and set of agreed strategic priorities. The
organisation is not based on the priorities or
personalities of individual presidents. It is a wellgrooved machine into which senior officers can
slot.
I am handing over to the very capable hands of
Eileen Burns who is wise, respected and
experienced and who has been an unfailingly
supportive counsel and colleague. In a speciality
with so many female registrars and consultants,
though Eileen would never make a big thing of her
gender, it is long overdue that we have another
female president.
I am equally delighted to see Tahir Masud take over
as President Elect. He and I have been friends and
collaborators for twenty years or so, beginning with
our joint involvement in the falls and bone health
section. He is a respected clinician, academic
researcher and educator and has played a range of
key roles within the BGS – most recently, three
years as Vice President for Education and Training.
We are in safe hands – all the more so with such an
excellent employed staff team running our events,
publications, communications and policy and with
two lay trustees in Susan Went and Caroline
McInness adding so much value to the work of the
board.
As for me, the BGS has given me so many friends,
so many wonderful memories and been so
important in the development of my own career. I
am only fifty and intend to be a geriatrician for a
good few years yet. I won’t be an ex-President who
stays away from the meetings. Try to keep me away
- though my local colleagues at the Royal Berks
should now get first refusal as for the past four
years they have had to accommodate the fact that
my attendance at BGS events has been mandatory!
It would have been hard to go from being BGS
Secretary, then National Clinical Director, followed
by BGS President, to walk away from professional
leadership roles but fortunately, I do have a new
home to go to for my work beyond the wards –
having taken over as Clinical Vice President of
Royal College of Physicians London (RCP) in
August – thirty specialities to consider now and so
a new and steep learning curve for me.
Many of the big issues facing the RCP – around
workforce, training, CPD, examinations, Future
Hospitals, clinical quality, leadership and medical
professionalism, as well as the future of “expert
generalists” and integrated services are highly
relevant to the BGS and its members – with
geriatrics being the biggest speciality in the RCP
family and most physicians of all specialties treating
older people with frailty and multimorbidity. So I
will still be working closely with the BGS, its
members and officers.
The BGS itself ? Our biggest challenge is ensuring
that our three key income streams (Age and Ageing,
our conferences and meetings and our
membership) remain robust and that we are able to
pursue our strategic objectives and run a broad
range of activities on a small staff team that doesn’t
outstrip the cost base, nor overwhelm them all with
work.
The makeover of the website and the organisational
rebranding, both of which gained momentum from
our members services review will be unfolding after
I have stood down but I will be watching with
interest.
My final plea, with the BGS having been a huge part
of my life since I joined as a 26 year old registrar is
this. Please get involved! We need more people including trainees, younger consultants, nurses,
GPs, Psychiatrists and AHPs getting involved in the
work of the Society. Our strength is in the expertise,
networks and clinical credibility of our members
and getting involved is “win/win” - you will get as
much out of your involvement as the Society
benefits.
Thanks to you all for putting up with me. It’s been
a blast and as Paul Knight said, before me, the most
fulfilling role I am ever likely to play in my
professional career. I am a committed geriatrician
and I can’t think of a better bunch of people to
hang around with or to help lead.
Bye now.
David Oliver
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September 2016
The older person whisperer on compassion
(from seven demons)
Old Person Whisperer explains: This comic was part of a
series I did called, "Seven Demons". Inspired by Lynda Barry
(a comics artist who calls her work "autobiofictionalography"), I drew comic strips about the things
that persistently trouble me about being a doctor.
Compassion is definitely one of my demons and this issue is
particularly relevant in the light of Kate Granger’s legacy.
There are a million excuses why we aren't as compassionate
as we should be as doctors. I'm interested in how we deal
with the guilt when we fail to treat people in the way we are
supposed to.
n e w s BGS 7
September 2016
Hospital at Home Forum
23 November, co-located with the BGS Autumn Meeting
Older people are presenting to acute hospitals
in greater numbers, year on year. Predictions
of the future demographic raise serious
questions about the sustainability of hospital
based services. The Future Hospitals
Commission recommended the development
of specialist hospital services in the
community, delivering new and innovative
services closer to the point of need.
Older people’s services in particular are
challenged to meet existing and predicted
demand. Recent headlines have highlighted
inadequate alternatives to admission for older
people. Yet older people should receive high
quality, safe and effective care, best suited to
their needs, including Comprehensive Geriatric
Assessment. Services need to be designed from a
patient centred perspective, but they must also be
high-quality, safe and affordable.
Evidence from meta-analysis of admission avoidance
hospital at home suggests that there may be a benefit
to treatment in the patient’s own home as an
alternative to acute admission for some patients. Some
elements of Hospital at Home are plausibly suited to
older people where displacement can lead to
disorientation or delirium and increase the risk of
institutional care. Advanced frailty and end of life care
can potentially be delivered in the patients preferred
place of care. Yet some will question whether care in
the patient’s own home can really match hospital based
management of acute conditions in truly ill patients.
The evidence base is small and fragile and further
research is desperately needed. Services are now
springing up around the country in response to rising
unscheduled care demands and sometimes in response
to political pressures. A key question for the future of
acute care of older people may be whether Hospital at
Home really could provide a safe and effective add-on
to existing models of care. Where is the evolving
evidence base and is it adequate to justify service
development or commission service roll out? Are these
services mature enough to tackle unscheduled care in a
sustainable fashion? What should the future workforce
look like? Are such services too expensive to be viable
alternatives to hospital admission?
This year will see the first UK wide Hospital at Home
Forum, hosted at the BGS Autumn meeting in Glasgow.
This will be a truly multidisciplinary meeting running in
parallel with the first day of the Autumn Meeting on the
23rd November and hosted by the Community SIG. The
Hospital at Home Forum has been organised with the
intention of addressing questions, providing an
opportunity to network and seeking to build on the
existing evidence base and share best practice. We
hope delegates will learn from models of Hospital at
Home across the country as well as contribute to our
understanding of such services.
Speakers from across the UK will describe the current
evidence base and ongoing Hospital at Home trials as
well as evolving clinical services. This one day forum is
open to allied health practitioners, nursing and medical
staff. The day will be split between plenary sessions and
workshops. The plenary sessions will seek to describe
the evidence and clinical service around the country
whilst the workshops will get to grips with service
development, workforce planning, cost effectiveness
and the role of health and social care integration.
Further details about the one day conference, including
booking arrangements, will be available online along
with a programme for the day. Please check
www.bgs.org.uk for details.
Graham Ellis
Associate Medical Director, Older Peoples Services
Honorary Senior Clinical Lecturer, University of
Glasgow National Clinical Lead for Older people and
Frailty, HIS Wishaw General Hospital
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September 2016
A question of ethics
Balancing age and organ transplantation waiting lists: An Israeli example
Following the acceptance of their commentary in the Age and Ageing Journal, Professor
Israel Doron summarises the procedure undergone by him and his colleagues, to address
the discriminatory practice of imposing age limits on organ transplantation waiting lists in
Israel.
Across the globe, societies are struggling to shape
their practices and policies regarding organ
donation and transplantation. This dynamic reality
is evolving as the world ages and ageism is being
recognised and increasingly resisted. Nevertheless,
when comparing laws and regulations in this field,
one finds that despite the fact that many countries
have abolished recipients’ chronological age as a
formal limitation criterion for listing for
transplantation, the recipients’ age is still very
relevant.
Like other countries, Israel is struggling to shape its
organ donation policies. The policies of the Israeli
National Transplant Center have traditionally
limited listing candidates for the various
transplanted organs (except kidneys) by maximal
age criteria, mainly due to shortage in donated
organs. However, following public criticism of this
seemingly discriminatory rationing, in 2013 the
Ministry of Health appointed a committee to
examine the use of chronological age criterion for
inclusion in the organ
transplantation waiting list
...chronological age,
and for organ allocation
in and of itself, should not policy.
be a factor at all. The
concerns pertained to the The committee comprised
fear of assigning value to 25 members, including
each year of life, and the professionals,
subsequent decision that
some people are "worth
more" and some are
"worth less".
representatives of older persons' associations, and
representatives of candidates for organ
transplantation. In addition, the committee
canvassed public opinion by public invitation to
appear before it, and to submit views and policy
positions.
The committee first requested its transplant experts
to review clinical data based on impact of
recipients’ age on outcome in the various
transplanted organs. Although negative correlations
between recipients’ chronological age and posttransplant patient survival are evident for all organ
recipients, the transplant experts did not consider
the magnitude of survival differences among the
various age groups to justify exclusion from the
candidates’ waiting lists.
Given this medical perspective, the committee
addressed the ethical, social and legal issues
stemming from the exclusion of older people from
the list of transplant candidates. One of the key
utilitarian arguments which was raised was based on
the assumption that older people have completed a
good portion of their life expectancy, and
accordingly, one should prefer the young who have
yet to enjoy this. However, the committee deemed
this approach incompatible with the changes in the
social and legal perception in Israel, and sought to
establish a more egalitarian and just approach.
Once it was clear to the Committee that it should
move beyond the narrow issues of age as an
exclusionary rule, and into the issue of the use of
recipients' age as an additional relevant criterion in
shaping a fair and objective organ allocation policy,
the opinions differed. The majority opinion in the
committee was that recipients’ age by itself should
not be considered during organ allocation. In this
sense, chronological age, in and of itself, should not
be a factor at all. The concerns pertained to the fear
of assigning value to each year of life, and the
subsequent decision that some people are "worth
n e w s BGS 9
September 2016
more" and some are "worth less".
Assigning value to recipient and
organ life expectancy is, according to
the majority opinion, an unrealistic
task that neutralises all those "life
events" that unavoidably intervene in
the course of life.
by its majority’s position, the
committee
recommended
ignoring
recipients’
chronological age in organ
allocation, as long as there is
no medical cause for
differentiation on the basis of
age. The committee has
recommended
that
each
candidate for an organ transplant should be
evaluated, amongst other criteria, for his or her
frailty status and that this criterion should be
incorporated into the decision-making process of
listing candidates for transplantation.
...the second
[consideration] is the
significance of the
number of years the
donated organ, as a
public resource, will
serve its recipient.
The minority position, on the other
hand, argued that chronological age should be
considered as a break-even allocation consideration.
This position relied on two main reasons: one is the
cycle of life – there is significance to the years a
person has already lived and to those he is expected
to live (even if this is only according to the
statistical life expectancy); and the second is the
significance of the number of years the donated
organ, as a public resource, will serve its recipient.
The Israeli experience, as described above,
exemplifies in our view, the complicated reality that
many societies face today: a reality that combines
population ageing with changes in norms and
values. The Israeli committee recommended the
abolition of chronological age as an excluding
criterion for listing candidates for transplants. Also,
These recommendations were approved and
formally adopted by the Ministry of Health in Israel
as of April 2014. Yet, it is for future studies to
assess the impact of these recommendations on the
reality and experience of organ transplantation in
Israel.
E Katvan, I Doron T Ashkenazi, H Boas,
M Carmiel-Haggai, M Dranitzki-Elhalel,
B Shnoor, J Lavee
University of Haifa, Israel
The full commentary may be accessed in Age and Ageing (http://ageing.oxfordjournals.org/)
Inspiration versus limitation
C
reflections on the BGS/RCN conference
onferences are excellent places to hear
about great initiatives and to renew our
notions of ‘ideal care’.
For one day possibilities and opportunities seem to
overcome limitations and obstacles imposed during
every day practice, and for one day a positive
attitude gives inspiration and newfound energy.
In April this year, I attended the RCN Older
People’s Forum and BGS Joint Conference 2016,
courtesy of a grant awarded by the British
Geriatrics Society. It was a well-organised event
with a number of poster presentations, key note
speakers, and parallel session speakers throughout
the whole day. It provided sessions on a number of
settings where care for older people is relevant,
giving each participant a choice of sessions to
attend. Many great initiatives were presented, and I
was particularly impressed with a session by Louise
Marks on a triangle of care, stressing the
importance of involving the carer of the patient
who suffers from dementia, in the process of
admission to hospital.
10 BGS n e w s
September 2016
It is not fair to heap
disapprobation on hard
working nurses who work in a
care system in which
pressures are sometimes so
high that a bed becomes more
important than the individual
‘blocking’ its use for
somebody who at that time
really needs medical care.
I also enjoyed a session
where a new set-up of care
for older people in hospital
was explained by Amanda
Futers, showing very
promising results.
But...
Amidst all this positivity,
one aspect seemed to be
missing:
the
implementation of new
ideas within the challenging environment of health
care today. It is inspiring to hear of positive results
in certain narrow fields of care, but care for older
people is a complex discipline where time and
money is limited, especially within the pressured
NHS environment. One powerpoint presentation
showed the reduction in funding for social services
over the past years against a rising number of older
people with care needs. When I go into work
tomorrow and start my duties on the ward, we
might very well be short of staff again and despite
this shortage, the Trust may suddenly decide to
increase our number of beds.
One speaker
explained the
importance of
taking time to
include
the
carer of a
dementia
patient in the
process of a
h o s p i t a l
admission.
A n o t h e r
s p e a k e r
recommended
a course around dementia care for around nine
professionals for £1,500. More time should be
spend on skin care; we should focus on pain
management; or invest time in assisting patients
with Parkinson’s Disease. Every speaker was right,
and every speaker was passionate about their
initiative. Often they were able to show remarkable
results and feedback for their initiative. However,
the presentations failed to take account of how
each initiative is carried out over and above the
routine care needs which are ever-present. How do
we get the time to implement these new initiatives
as part of the pressurised routine tasks we have to
fulfill? How are over-worked demoralised
professionals engaged and inspired; how are these
worthy initiatives to be financed? These are relevant
questions in the real clinical world.
The health care environment is challenging, and
sometimes during such conferences the
understanding of reality is diluted in a welter of
positive exhortations. The word ‘bed blocking’ was
mentioned in an example where health care
professionals had been overheard using the term in
relation to one of their patients. Everyone agreed,
professionals should not use this term; that it is
insulting to older people who deserve our care and
respect at all times. However, in the collegial
atmosphere of a conference amphitheatre, where
we sip tea and hear about ‘ideal care’, we should not
forget why the term ‘bed blocking’ found its way
into the frontline staff lexicon. We all understand
that a ‘bed blocker’ is not at fault for ‘blocking the
bed’. ‘Bed blocking’ is simply a term to describe an
ugly symptom of an overstretched care system with
too many patients and not enough resources. It is
not fair to heap disapprobation on hard working
(and essentially caring) nurses who have been raised
and influenced by a care system in which pressures
are sometimes so high that a bed becomes more
important than the individual ‘blocking’ its use for
somebody who, at that time, really needs medical
care. Sometimes, it feels like there is an
unbridgeable gap between the day of the frontline
professional and the day where we all sit in
comfortable chairs, sip lots of tea and get saturated
in powerpoint presentations of ‘important’
initiatives which should become part of our already
pressurised day in our frontline roles. Somehow, we
need to bridge that gap, if we are going to make the
conferences more useful.
Health care has two sides. On the one hand, it gives
the healthcare professional the satisfaction of
knowing that he/she can truly make a difference. It
is a source of considerable personal development
and it provides considerable scope for expressing
one’s creativity in solving problems that arise. On
the other hand, there is the grinding, demoralising
reality of staff shortages, growing demands,
diminishing time and constant resourcing
challenges. The more positive side is the one usually
presented at conferences. Marrying idealism with
reality continues to be our biggest challenge yet.
Hanneke Wiltjer
PhD-candidate in Nursing at the University of
Warwick
n e w s BGS 11
Why we need a clinical trials network
for perioperative medicine
The National Institute of Academic Anaesthesia has
established the Perioperative Medicine Clinical Trials
Network (CTN) to develop, support and co-ordinate
world class multi-centre clinical trials in the UK. The
network is anaesthetic led but will be a community
for any and all investigators with an interest in
building the evidence base for better perioperative
care for surgical patients.
We need better evidence to guide patient care
The care of patients undergoing major surgery remains
an area of unmet need. More than 300 million patients
undergo surgery worldwide each year. Assuming
hospital mortality of 1 per cent, non-cardiac surgery
will be associated with 3 million deaths worldwide each
year and complication rates up to ten times this figure.
Improvements in perioperative care may therefore
have a substantial impact on public health, but large
scale changes in healthcare policy require a robust
evidence base which is lacking. The principal obstacle
to the successful completion of major trials is patient
recruitment. Clinical trials networks allow us to
organise the many and varied contributors into
effective collaborative teams with a shared belief in the
wider objectives of the group. The resulting high rates
of successful trial completion generate confidence
amongst major funding organisations, while the sense
of ownership amongst grassroots clinicians promotes
speedy implementation of trial findings.
What will the clinical trials network do?
The core objective of the CTN is to create an
environment which allows everyone with an interest in
perioperative care to make a meaningful but realistic
contribution to clinical trials and observational studies.
We are keen to engage with anyone who shares our
goals, and clearly there are many members of the
British Geriatrics Society who do just that. The CTN will
promote and facilitate an effective working
relationship between trial organisers and investigators
in individual hospitals. This, in turn, will ensure strong
engagement with the research and with
implementation of the research findings. The CTN has
an inclusive culture, with recognisable roles for every
member of the group, even though the projects are
large collaborations.
What type of research will the CTN focus on?
The CTN will primarily support research projects
September 2016
involving the recruitment of patients where the aim is
to improve outcomes following surgical treatment. The
primary focus will be on large clinical trials (500+
patients) but some smaller studies will be appropriate
for CTN support, especially if these are likely to
translate into subsequent larger trials.
How can I take part?
Joining the CTN is simple. Visit our website
www.pomctn.org.uk to find out more. There are two
main categories of membership. The principal
investigator scheme is intended for members who will
routinely be able to act as local leads for studies in their
hospitals. In the majority of cases, these will be
consultants but there are some exceptions to this.
Trainee doctors, nurses and allied health professionals
will usually join the local investigator scheme but this
does not preclude them from acting as principal
investigator for individual studies. In addition, the CTN
will run a more intensive chief investigator training and
mentorship programme for a small number of talented
individuals who wish to lead their own clinical trials.
The CTN is more than just a mailing list, and we will be
looking for members to play an active role. New
members will be able to upload a two page CV and
Good Clinical Practice (GCP) for research certificate,
whilst principal investigators will be expected to lead at
least one study in their hospital in every two year cycle.
However, we do realise that until we have a diverse
portfolio of studies, it will be difficult for every member
to contribute. That of course means we need a
membership which represents the great breadth of
clinical staff involved in the care of patients admitted
for surgical treatments, so that trials proposed by the
CTN membership offer opportunities for all.
Will there be Network meetings?
The first CTN meeting will be held in Birmingham in on
9th November 2016. It is approved for five CPD points
and has a delegate fee of £45. Visit our website to view
the programme and register:
www.pomctn.org.uk/Meetings
Rupert Pearse
Professor of Intensive Care Medicine
Queen Mary University of London and Barts Health
NHS Trust
12 BGS n e w s
Depression in older adults
September 2016
O
Solutions to a common disorder
ne in four older people has
depression which requires
treatment1,2 with a prevalence of
between 3 and 15 per cent in the
community and even higher in the
inpatient and care home population.
Depression is the leading cause of suicide in older
adults, with high risk of completed suicide,
especially with men living alone being at particular
risk3.
Physical illness is associated with higher risk of
depression and is three times as common in
people with end-stage renal failure, chronic
obstructive pulmonary disease and cardiovascular
disease than in people who are in good physical
health4.
It is important to treat depression as it is
associated with increased mortality and risk of
physical illness and can lead to an increase in
length of hospital duration in those inpatients with
untreated depression. A diagnosis of depression in
those over 65 increased subsequent mortality by
70 per cent5.
In acute general hospitals, diagnosing depression is
made more difficult due to various factors
including effects of hospitalisation, duration of
admission, coexisting physical illnesses and
concurrent multiple medications. An increased
length of stay can cause isolation as well as
institutionalisation in older adults and can further
complicate the picture.
Assessment and diagnosis
In older adults the diagnosis of depression can be
missed due to ageism, delirium, or stigma
associated with mental illness or the presence of
cognitive impairment.
The clinical features of depression in the older
people can include disturbances in sleep and
appetite, low energy levels, tearfulness, anxiety and
somatisation as well cognitive impairment. The
degree of cognitive impairment can be severe
enough to be mistaken for the start of dementia.
Other causes of depression need to be considered
as well (Box 1 and 2)4.
Box 1 : Medications that may cause depression
Antihypertensives
Beta Blockers
Calcium Channel Blockers
Corticosteroids
Prednisolone
Analgesics
Codeine
Opioids
Anti-Parkinsonian drugs
Box 2: Physical disorders that may cause
depression
Endocrine/metabolic eg Hypothyroidism,cushing’
syndrome,hypercalcaemia
Organic Brain disease eg Stroke,SLE,Parkinson’s
disease
Occult carcinoma eg Pancreas
Chronic Infections eg Brucellosis,Herpes zoster
Management
The management of depression in older adults
includes both medication and psychological
therapies – both have good evidence of
effectiveness.
Antidepressants are effective with moderate to
severe depression. NICE guidelines (the
recommendations of which are along the same
lines of prescribing as for younger adults) suggest
that first line treatment should be with an SSRI
(selective serotonin reuptake inhibitor). Several
other antidepressants and mood stabilisers are
available, such as SSRIs (Sertraline), SNRI
(Venlafaxine),
Mirtazapine,
Tricyclic
antidepressants and MAO Inhibitors.
n e w s BGS 13
September 2016
The choice of antidepressant is guided by the
patient’s previous experience of an antidepressant,
and by co-morbidities and side effects.
Antidepressants should be tried for at least four
weeks. However in older adults it may be helpful to
persist at an age appropriate dose for a minimum
six weeks before adjudging the drug to be
ineffective. If there is partial response, it may be
sensible to persist another six weeks. Careful
monitoring of side effects such as insomnia,
agitation, headache, sexual dysfunction,
gastrointestinal disorders (including GI bleeding)
and hyponatraemia is essential. It is important to
remember potential drug interactions. People with
dementia may experience depression, which may
be difficult to diagnose but needs treatment to
improve quality of life.
Antidepressants should be continued for at least
six months. Response to Antidepressants is about
40-60 per cent and long term treatment (at least 2
years) for relapse prevention should be considered
in people who have had recurrent depression.
For severe depression, with or without psychotic
symptoms, where response to treatments is poor,
electroconvulsive therapy is considered as an
effective treatment.
It is important to remember that suboptimal doses
References
1. Godfrey M et al (2005). Literature and policy review on
prevention and services. UK Inquiry into Mental Health and WellBeing in Later Life. London: Age Concern/Mental Health
Foundation.
2. Craig R, Mindell J (eds) (2007). Health survey for England
2005: the health of older people. London: Information Centre.
3. Alexopoulus A (2005). Depression in the elderly. Lancet
365:1961– 1970.
4. Baldwin R and Wild R. (2004).Management of depression in
later life. Advances in Psychiatric treatments,vol 10,131-139.
5. Dewey ME, Saz P (2001). Dementia, cognitive impairment and
mortality in persons aged 65 and over living in
the community: a systematic review of the literature.
6. Depression in Adults : Recognition and Management CG90
(2009). https://www.nice.org.uk/guidance/CG90
7. Age Concern (2006). Promoting mental health and well-being
in later life: a first report from the UK Inquiry into Mental Health
and Well-Being in Later Life. London: Age Concern/ Mental
Health Foundation.
8. Egede LE (2007). Major depression in individuals with chronic
medical disorders: prevalence, correlates and association with
health resource utilization, lost productivity and functional
disability. General Hospital Psychiatry 29(5): 409–416.
of anti-depressants used for an inadequate time
period could cause limited response. There is a
need for integrated approaches in terms of
pharmacological, social and psychological aspects.
Patient education is important, especially in terms
of highlighting the importance of diet, exercise
and treatment of physical illness. In older adults
close working with family and giving hope is
important too.
Depression occurs in 40 per cent of people living
in care homes7 and often goes undetected. There is
evidence to show that training care home staff to
recognise possible symptoms of depression can
improve detection. Using a collaborative care
approach to manage depression is often effective
in improving outcomes.
Referral to Old Age Psychiatry should be
considered if there is diagnostic difficulty, high
risk of suicide or self harm, little or no response
to antidepressants and self neglect.8
Psychological therapy is the other option for
management. A range of different therapies are
available such as Supportive psychotherapy, CBT
(Cognitive Behaviour therapy), Interpersonal
therapy, Marital therapy and Psychodynamic
psychotherapy. NICE favours use of CBT
(Cognitive Behaviour therapy) and Interpersonal
therapy. There is good evidence for the
effectiveness of a number of psychosocial
interventions such as Cognitive Behavioural
Therapy (CBT), Behavioural Activation and
Problem Solving Treatments. More research is
needed in this area however psychological
therapies are valued by patients and can be
preferred to use of medication.
Conclusion
Depression is common in Older Adults and if left
untreated could increase mortality, morbidity and
disrupt quality of life. Mental health promotion to
improve wellbeing and prevent social isolation is
also important to prevent depression in older
adults.
Sharmi Bhattacharyya
Consultant Psychiatrist, Wrexham, BCUHB,
Honorary Senior Lecturer, University of Chester
Anitha Howard
Consultant Psychiatrist, Bensham Hospital,
Gateshead
14 BGS n e w s
September 2016
Interview with Tahir Masud
our future BGS President-Elect
Tahir Masud (Tash) will take on the mantle of BGS President-Elect in November, when Eileen
Burns inherits the office of BGS President from David Oliver. We asked him about his vision for
the BGS.
We asked Tash: What attracted you to geriatric
medicine as a specialty generally?
After I passed my MRCP in 1988, I was appointed
to a three year general medical registrar rotation
(pre-Calman registrar days) in Newcastle where we
did six monthly rotations of different specialities. I
found that the six months of Geriatric Medicine
was the most intellectually rewarding and I really
enjoyed working in the multidisciplinary team. I
had originally considered respiratory medicine as a
career but after six months of doing Geriatric
Medicine I changed my mind and had no hesitation
in applying to a Senior Registrar Rotation in
General and Geriatric Medicine in Barts and
Whipps Cross at London. It was the best career
decision I ever made and have never regretted it. I
worked with some great role models in Newcastle,
London and Nottingham, who continued to inspire
me.
It is said that this is a good time to be a
geriatrician. You have practised geriatric
medicine when it was largely a Cinderella
specialty. There was a time when it was
something that trainees ‘defaulted’ into, rather
than being their first choice. Now the specialty
has attained a certain ‘glamour’. What factors
do you think, led to this improvement in image?
It has been a real pleasure and very satisfying to see
Geriatric Medicine develop, as you say, from a
“Cinderella” speciality in the 1980s to one of the
more popular specialities now. In my view the
credit goes to the early geriatricians who fought
hard to develop the services that older people
needed despite much negativity from other
specialists at the beginning. I also feel that in the
1990s, geriatricians getting involved in acute
general hospitals and doing some general internal
medicine really helped in breaking down barriers,
and once other specialists saw, first hand, what we
had to offer, it quickly became apparent that the
medical community could not cope without our
particular skills.
Now everyone
wants a bit of us
- from surgeons
to oncologists,
from emergency
departments to
the community!
The BGS has
among
its
strategic
objectives, the
development
of a range of education and professional
development to its members. What progress do
you feel we, the BGS, are making in getting
geriatric medicine into the undergraduate
general medical curriculum? And do you feel we
can do more?
The BGS has had an undergraduate curriculum
now for many years, which has been updated
several times. This has certainly impacted on
developing the curricula in most medical schools.
We have done surveys of medical schools’ curricula
to see how they map to the BGS curriculum, and
we have fed back the gaps identified to the medical
schools concerned. Subsequent surveys have
shown improvements. However there is still some
way to go in some schools and we will continue to
monitor teaching of undergraduate Geriatric
Medicine and offer advice and help where
necessary.
The BGS also has a great relationship with the
Geriatric Medicine SAC and will continue to help
deliver postgraduate training in the speciality.
What do you believe will be the biggest
challenge/s in healthcare during your
presidency?
There is a lot of uncertainty at present, given the
n e w s BGS 15
September 2016
current economic situation and the ramifications of
Brexit. Hopefully by the time I start my presidency
in November 2018 the situation may be a bit
clearer. The demographic changes in society means
that we are going to have to continue to lobby the
government to make sure that older people get the
healthcare resources that they need. We will need to
develop new ways of doing things to meet the
demands, both in the acute hospitals and also in the
community. I am convinced that we have the
experience to help shape the changes needed and it
is very heartening to see that geriatricians, both
established and younger ones, are full of energy,
have innovative ideas and are playing important
roles in many organisations, in delivering change.
Presently, the RCP (London) administers much
of the post-graduate educational offering in
geriatric medicine. Do you feel that the BGS
should become more involved as an
organisation, in these programmes and how
can we strengthen our links with the College to
achieve our strategic objectives?
It is vital that we work closely with the RCPL.
There is a great need to upskill other specialities in
the basics of geriatric medicine. We have already
started in this process by working with and
influencing curricula of other specialities such as
Emergency Medicine. It is pleasing to see that
geriatricians are increasingly being asked to speak
and teach at different conferences and CME days
and we will try and increase our influence within
the RCPs. Similarly we also need to use our
expertise to upskill GPs in managing frail older
people and the BGS has an important future role in
this.
Another strategic objective agreed at the
Trustees’ Away Day was to extend our
membership among non-doctors. How do you
feel we can achieve a balance between meeting
this objective while, at the same time, retaining
and strengthening our offering to doctors?
Multi-disciplinary working is one of the bedrocks
of our speciality and it is only a natural
development to encourage more non-doctor
healthcare professionals to join the Society. By
doing this, hopefully we can influence the
development of services for older people that
meets their needs, not just from the medical
perspective, but more holistically. The BGS has
already helped to develop a Geriatrics curriculum
for ANPs. Having more members who are nurses,
physios and OTs can only enhance our speciality,
although at the same time we must continue to
provide education and training that meets the need
for geriatricians of all grades.
Academic mentorship
for clinical trainees
It is an exciting but challenging time to be a
trainee. Gaining a solid clinical education is the
priority but there is a large range of general
skills that are also required for life beyond CCT.
All doctors need to be involved in audit and
research. This may entail being ‘research aware’ –
able to use the results of research studies to inform
clinical practice or directing patients to
involvement in local research studies; ‘research
active’ – participating in research studies to inform
future treatments and models of care; or being a
‘research leader’ – designing and running research
studies and training programmes.
In South East Scotland we have implemented
several initiatives which have contributed to our
dynamic and thriving academic department, which
works in partnership with NHS colleagues who are
supportive of all the ongoing research activity. We
share these ideas here, and would be happy to hear
from other units and regions, of ideas which have
worked to ensure that geriatric medicine is
practised in a realistic, compassionate and evidence
based way.
Academic
expectations: as academic
representative on the training committee, I contact
all trainees at the start of ST3 (or LAT post),
provide a document on our academic expectations,
and meet them to discuss their options for
academic training. The Training Committee expects
16 BGS n e w s
September 2016
each trainee to i) attend a research training course
by end of ST4 (e.g. http://events.rcpe.ac.uk/
events/449/critical-appraisal-and-research-for-trainees);
ii) produce a critical appraisal of a paper at a
journal club (set one up if it doesn’t exist!); iii)
undertake an evidence based medicine/systematic
review by the end of ST4, ideally in partnership
with another trainee, with senior supervision.
Dr Terry Quinn and colleagues run an EBM and
SR training day in Glasgow, which our trainees can
attend, and there is an annual EBM day organised
by Dr Angela Campbell in Glasgow where trainees
can present their review in a supportive
environment. We then expect them to present this
at a Scottish and National BGS event and submit
for publication.
Trainees are expected to iii) write a review article on
a clinical topic - with appropriate supervision - by
the end of ST6. This may be the topic in the EBM
review, and may form the basis of local or national
guidelines and they should, iv) aim to have one
article published and one abstract presented at a
learned society by the end of ST6. Note that the
BGS accepts clinical effectiveness presentations
(e.g. completed audit loops, guideline development)
Election of representatives
to the Trainees Council
Deadline: Friday 11th November 2016, 17:00
The BGS Trainees Council needs new representatives.
Prospective candidates who want to join the BGS
Trainees Council are welcome to self-nominate and are
invited to submit expressions of interest to
[email protected] for one of the three available
voting positions. All applicants MUST be a members of
the BGS
These positions are:
Policy and BMA liaison representative (Applicant must
be ST3+)
Education, training and development representative
(Applicant must be ST3+)
Junior member representative (Applicant must be a
Foundation year or core medical trainee)
Academic mentors
A system of academic mentors was initially
introduced by Prof Gillian Mead. It matches each
trainee with a consultant who can provide advice
on academic training. The mentors are mainly
clinical consultants who have had some research
experience during their training, and can support
trainees in planning their projects as outline above.
They direct trainees to the appropriate person for
more academic training if required, e.g. for time
out of programme. The relationship is trainee-led:
i.e. the trainee is expected to contact the mentor
and ensure that expectations are met. Progress is
reviewed at ARCP.
This system has worked well in South East
Scotland to support trainees in this aspect of their
training, and has contributed to the feeling that
research is ‘everybody’s business’ and integral to
the future success of our speciality. Please do get in
touch for more information, or with other
successful initiatives.
Susan Shenkin
Clinical Senior Lecturer, University of Edinburgh
and Honorary Consultant NHS Lothian
[email protected]
If elected, posts are for 2 years in duration (2016-2018).
Should there be more than one nomination per
position, a ballot will be held. Online voting will open in
the week preceding the BGS Autumn conference and
close during the trainees' meeting (25th November)
where the results will be announced.
If you are keen to know what the roles involve please
check out the BGS Trainee Council page
(http://www.bgs.org.uk/index.php/maingroups/
trainees/86-secttrainees/traineesnewsflahs/1676traineecouncil) or contact the current representatives
individually.
All expressions of interest must be emailed to the chair
of the trainees council at [email protected].
Expressions of interest should be no longer than 1-2
paragraphs, outlining why you wish to take on the role.
n e w s BGS 17
September 2016
BGS Education and Training Representatives
who we are and what we do
In our regular Trainees’ Column, Hui Sian Tay
and Yasmin Kaur describe the nature of their
work as officers on the BGS Trainees’ Council
as well as recent developments.
As BGS Education and Training trainee
representatives, we have the privilege of
representing trainees at the Joint Royal Colleges of
Physicians Training Board (JRCPTB) Specialty
Advisory Committee (SAC) in Geriatric Medicine and
the BGS Education and Training Committee (ETC).
Each meeting is held four times a year and there, we
undertake to communicate the views of trainees.
Geriatric SAC
The Geriatric SAC consists of all the Training
Programme Directors for all regions and they feed
back directly to the SAC. Thus the purpose of the
Geriatric SAC is to continually review and improve
the curriculum, including changing to the ePortfolio
to add specific guidance. The Specialty Certificate
Exam (SCE) results are reviewed annually and
contribute to future changes. The SAC is directly
involved in the recruitment process and this feeds
into discussions surrounding workforce planning.
BGS Education and Training Committee (ETC)
The ETC is a BGS committee made up of geriatrics
representatives for all grades of training including
undergraduate. It has a broader mandate,
reviewing the geriatric education of all. Examples
include the introduction of a geriatric component
into the old age psychiatry curriculum, including
aspects of integrated care and palliative care. The
ETC has also contributed to the development of the
curriculum in Geriatric Medicine for Advanced
Nurse Practitioners and EU curriculum in Geriatric
Emergency Medicine. The committee also works
with the GMC and Medical Schools Council on the
development of undergraduate teaching in
geriatrics.
Both committees discuss any concerns that have
been raised by trainees and the GMC National
Training survey data is discussed at length.
Communication
As well as keeping in touch with regional trainee
representatives, we
communicate
developments
through our regular
trainees’ e-bulletin, so
please sign up to
receive these updates.
BGS Trainees’ Council
The BGS Trainees
Council meets twice a
year and brings all the
trainee representatives together.
Achievements over the past year
The SCE examination fees have been reduced by 25
per cent. In response to the SCE Resources Survey
which was completed in December 2015, a Geriatric
SCE resources page with links to mock papers and
revision resources is now up and running on the
trainees’ section of the BGS website
(www.bgs.org.uk/index.php/
assessment-66/sce-resources-and-mock-exams).
Recent curriculum changes include the
strengthening of Orthogeriatrics and moving PeriOperative Medicine to the higher grid. The DixHallpike and Epley manoeuvres will also be added
as DOPS. These geriatric curriculum changes will be
implemented in September 2016. We have also
been involved in developing the key guidance for
the training requirements for old age psychiatry,
community geriatrics, and continence.
We have had the opportunity to participate at
various career fairs, helping to promote Geriatric
Medicine, which has contributed to this role being
varied, educational, inspirational and very
satisfying.
If you have any queries, please do not hesitate to
contact us at [email protected] and/or
[email protected].
Hui Sian Tay and Yasmin Kaur
BGS Education and Training Representatives
18 BGS
notices
September 2016
British Geriatrics Society
Autumn Meeting 2016
Wednesday 23 - Friday 25 November
SECC, Glasgow
The BGS annual autumn scientific meeting
offers a multidisciplinary programme:
Key sessions:
u
u
u
u
u
u
u
Hospitals at Home
Stroke
Service Development
Delirium
Polypharmacy and prescribing in older people
Health Promotion
Perioperative assessment of older people undergoing surgery
CPD accreditation will be applied for and usually provides 6 CPD points
for each day of the conference
Who should attend:
u Consultants and specialist trainees
in geriatric medicine
u Doctors training in related specialties
u GPs wsi in Older People
u Foundation year and CMTs
u Medical students
For more details on the programme visit: www.bgs.org.uk
[Select Events and Conferences/BGS Autumn Meeting]
RCN END OF LIFE CARE EVENTS - RUNNING FROM
OCTOBER TO DECEMBER
Event title: Let’s talk about end of life care – RCN and NCPC joint
workshop (Newcastle): Date: 19th October 2016 at Northumbria
University, Faculty of Health and Life Sciences, Coach Lane Campus,
Northumbria University, Newcastle upon Tyne, NE7 7XA
Website: http://www.rcn.org.uk/news-and-events/events/eolcnewcastle
Event title: Let’s talk about end of life care – RCN and NCPC joint
workshop (Torquay): Date: 1st November 2016 at Rowcroft Hospice,
Avenue Road, Torquay, Devon, TQ2 5LS
Website: http://www.rcn.org.uk/news-and-events/events/eolctorquay
Event title: Let’s talk about end of life care – RCN and NCPC joint
workshop (Glasgow): Date: 30th November 2016
Venue: Marie Curie Hospice, Balornock Road, Glasgow, G21 3US
Website: http://www.rcn.org.uk/news-and-events/events/eolcglasgow
Event title: Let’s talk about end of life care – RCN and NCPC joint
workshop (London): Date: 8th December 2016 at RCN HQ, 20 Cavendish
Square, London, W1G 0RN
Website: http://www.rcn.org.uk/news-and-events/events/eolc-london
GERIATRICS FOR
JUNIORS
Updates in Elderly Medicine for
Foundation Year and Core
Medical Trainee Doctors
8 October 2016
Nottingham
Front Door Geriatrics – how to be
a medical detective
Frailty and the ageing body
Dizziness – the dos and don’ts
Stroke medicine essentials
Common-sense continence care
Community geriatrics – life
outside the hospital... and much
more.
www.bgs.org.uk [See
Conferences and Events]
n o t i c e s BGS 19
September 2016
EUGMS
ADULT SAFEGUARDING AND ELDER ABUSE
Adult Safeguarding and Elder Abuse courses held throughout the year
not only give you and your colleagues understanding of recent
legislation but also their practical application in protecting and
supporting older people.
Known and provisional dates
for EUGMS Meetings
(4)5-7 October 2016
12th EUGMS Annual Congress,
Lisbon
(18)19-22 Sept 2017
13th EUGMS Annual
Congresss, Nice
Probably 3-5 Oct 2018
14th EUGMS Annual Congress,
Berlin, date tbc
http://www.eugms.org/
RELIGION,
SPIRITUALITY AND
END OF LIFE CARE
A Royal Society of Medicine
Event
24 October 2016
London
This meeting aims to bring
together religious and spiritual
leaders and clinical experts to
deliver a range of perspectives
in how to provide end of life
care
Objectives: Understand the
perspective on end of life care
from those with religious beliefs
and those with none; Balance
the clinical and spiritual
approaches to end of life care.
www.bgs.org.uk [Select External
Events]
These are in-depth, half-day courses covering a range of topics
surrounding elder abuse; what it is, why it happens, prevalence, risk
factors and how best to respond. The session additionally covers
capacity, powers of intervention, the Care Act and specific legislation for
elders in Scotland and Wales.
Upcoming Dates: 3rd October 2016 ; 17th November 2016; 10th January
2017; 24th February 2017; 31st March 2017
All of our training is held in London and easily accessible from local and
national transport links.
Or call us on 020 8835 9280 or email us for booking forms and the
option to book with an invoice at [email protected]
STROKE MASTERCLASS
26th November 2016 9.30am - 1.30pm
Manchester Central Library Meeting room 3
The Stroke Masterclass conference offers
the thoughts of highly knowledgeable
speakers from NHS Teaching Hospital
Trusts and Higher Educational Institutes,
sharing both professional and personal
experiences. The day will highlight how to
optimise stroke care and will feature
insights into the future direction of stroke
management.
The half-day programme includes:
* Assessing patients with possible stroke - mimics and chameleons
* The new face of stroke treatment
* Reducing the risk of stroke recurrence in clinical practise
* Expert panel
* Stress management for the overworked practitioner
Normal Price: £100
Early Bird Price: £90
Website: http://cpdiq.co.uk/
20 BGS
September 2016
notices
IRISH GERONTOLOGICAL SOCIETY
30 September - 1 October 2016
Killarney, Ireland
The 64th Annual & Scientific Meeting of the Irish Gerontological
Society (see website for registration and programme)
Conference Theme: Developing Cultures of Excellence in Ageing and
Exploring the Needs of Marginalised* Groups
*May include but is not limited to disability, chronic conditions,
migrants, prisoners, the Travelling Community and rural communities
Venue: The Malton Hotel, Killarney, Ireland
http://www.irishgerontology.com/events/igs-64th-annual-scientificmeeting-sept-2016
PARKINSON’S
ACADEMY
Advanced MasterClass 2016
Previously known as the Classic
MasterClass, this course is
designed for consultants,
experienced Parkinson's nurses,
final year registrars, GPwSIs,
associate specialists and staff
grade physicians.
The course will deploy taught
sessions and mentorship (a
mentor will be appointed for each
participant). Find out more by
watching the Academy videos at
parkinsonsacademy.co/courses
www.bgs.org.uk [Select External
Events]
NIHR CAMBRIDGE
BIOMEDICAL LECTURE
Roseanne Kenny speaks at the
NIHR Cambridge Biomedical
Research Centre Distinguished
Visitors Lecture
15 March 2017, 17.00 - 19.00
CRUK Cambridge Research
Institute Lecture Theatre - Li Ka
Shing Centre Robinson Way,
Cambridge, CB2 0RE, United
Kingdom
Title of talk: "New insights into
clinical implications of
cardiovascular ageing”
www.bgs.org.uk [Select External
Events]
The BGS regrets that owing to restrictions on space, we are not always able
to publish all events we have been asked to publicise. Please visit the BGS
Events section of www.bgs.org.uk for details of more events and the
Resources section for courses related to geriatric medicine and for
downloadable programmes and registration material.
BGS EVENTS
REGIONS AND SIGS
BGS West Midlands
22 September 2016, Birmingham
BGS Northern
28 September 2016, James Cook
University Hospital,
Middlesborough
Geriatrics for Juniors
8 October 2016, Nottingham
BGS South West
10 October 2016, Exeter
BGS North West
20 Oct 2016, Manchester
Bladder and Bowel problems in
older people (Continence Care)
20 Oct 2016, Manchester
BGS Northern Ireland
10 November 2016, Belfast
2016 BGS Autumn Scientific
Meeting
23 - 25 Nov 2016, Glasgow,
Scotland
BGS Oncogeriatrics, 8 December
2016, London
BGS West Midlands
16 March 2017
BGS Yorkshire
29 March 2017, Pinderfields
BGS Yorkshire
27 September 2017, Pinderfields
BGS Yorkshire
28 March 2018, Pinderfields
More details on:
www.bgs.org.uk
(Select Conferences and
Events)
n o t i c e s BGS 21
September 2016
From
biogerontology to stroke
The British Geriatrics Society wants to showcase your research
One of the BGS’s primary
objectives is to showcase
high quality scientific
research at its bi-annual
conferences
Why Submit Your Work to the BGS Conferences?
Visit
www.bgs.org.uk
u Present your research to an audience of peers and
or
colleagues from the UK and overseas
http://tinyurl.
u Get detailed feedback from recognised experts in the field of study com/nrprkmh
u Meet others working in similar areas and initiate collaborations
The BGS is looking for work in the categories of:
u
u
u
u
cardiovascular disorders
movement disorders
stroke
falls and fractures
u
u
u
u
u
osteoporosis, rheumatology and bone health
frailty and sarcopenia
dementia, delirium and mental health
pharmacology
research into ageing and improving
the health of older people
u
u
u
u
health promotion
health service delivery
epidemiology
bladder and bowel health
Original research and clinical quality studies will be considered for presentation as a poster or as a platform
presentation. Authors do not need to be BGS members to participate.
Two chances each year to showcase your research at the leading UK conferences in older
people’s care
Your abstract will undergo an initial adjudication process and once accepted you will benefit from a facilitation process
at the conference when two experts in your field will discuss your research with you and will give you constructive
advice.
Four prizes are awarded at each meeting for: the best platform presentation; the best scientific research poster; the
best clinical quality poster; and the best poster led by a nurse or therapist. Where work has been approved in the
facilitation process, the abstract will be published as an online supplement of the Age and Ageing journal.
Submission windows:
Spring 2017
Submissions accepted:
Submission deadline:
Date of meeting:
1 November 2016
1 December 2016
26-28 April 2017 Sage, Gateshead
Autumn 2017
1 May 2017
1 June 2017
22-24 November
2017 - London
Already exhibited your poster at conferences
of other specialist societies?
Give it greater exposure and gather further
feedback by submitting it for presentation at a
BGS meeting!
Following a review for suitability, it will be on
display at the conference for delegates to view, but
will not be adjudicated or published post event.
22 BGS n e w s
September 2016
BGS Policy Update
Introducing myself
I joined BGS as Policy Manager at the beginning of
June, and I am delighted to be here. Before that I
worked at the Charity Commission where I was a
senior policy manager, and before that I worked in
the voluntary sector, including leading the public
policy and research team at the disability charity,
Scope. My expertise is in policy, research and public
affairs. I have an MSc in Voluntary Sector
Organisation from the London School of
Economics.
In my first few weeks at BGS I attended a series of
meetings and conferences which helped get me up
to speed quickly. Attending the Acute Frailty
Network conference, and the Nurses Fellowship
conference, provided a snapshot of some of the
excellent practice that exists alongside the
challenges currently faced by geriatricians, nurses
and other health professionals.
Since June there have been some significant policy
developments, and I am enjoying working with
BGS officers and colleagues in the secretariat to
ensure that we engage and respond swiftly.
Key policy developments
BGS’s written evidence to the House of
Commons Health Select Committee Inquiry on
planning for winter pressure on A&E
departments: As part of its Inquiry into pressures
on A&E departments, the Health Select Committee
issued a call for written evidence. BGS sent a
submission from David Oliver and Eileen Burns, in
which we call for recognition that there are limits to
the steps that hospitals themselves can take to
lessen winter pressure, and that the underlying
structural issues must be addressed.
BGS
submission http://www.bgs.org.uk/pdfs/0818_2016
_bgs_winter_pressures.pdf has also been
published on the Select Committee’s webpages.
The Committee will be holding a series of oral
evidence sessions in the autumn, before publishing
a final report of their findings and
recommendations.
CQC report on integrated care: On 12 July the
Care Quality Commission (CQC) published its
report, Building bridges, breaking bar riers:
integrated care for
older people, which
highlighted some
significant
shortcomings in
the delivery of
integrated care for
older people. CQC
made a number of
recommendations to address some of the barriers
that exist at present.
BGS issued a media statement backing CQC’s call
for integrated patient centred care, in which we
recognised that while there is a clear commitment to
delivering integrated care, there is still a long way to
go. We were pleased that our statement was widely
shared, and was published on CQC’s website.
National Audit Office (NAO) and Public
Accounts Committee (PAC) reports on delayed
discharge and discharging older people from
acute hospital: On 26 May the National Audit
Office published a report examining how effectively
the health and social care system is managing the
discharge of older people from hospital. Their
conclusions highlighted that unnecessary stays in
hospital result in worse health outcomes for
patients. They also waste strained NHS hospital
resources, creating avoidable costs for social care
and community healthcare.
The Public Accounts Committee for England then
held its hearing on the findings of the NAO’s
report, and their report of the hearing was
published on 19 July. The report makes
recommendations for overcoming boundaries
between health and social care, addressing
variations in local performance, the need for better
sharing of patient information and the need for
financial incentives to reduce delays. We now await
Government’s response to PAC’s report.
Letter from Jeremy Hunt MP, Secretary of State
for Health: Following the outcome of the
referendum on Britain’s membership of the
European Union on 23 June, Teresa May’s
appointment as Prime Minister and her reappointment of Jeremy Hunt as Health Minister,
n e w s BGS 23
September 2016
we wrote to Jeremy Hunt calling for a national
strategic direction for older people living with
frailty, dementia, complex needs and multiple longterm conditions. We were pleased to receive a reply
in which the Minister recognised the ‘major role in
shaping our society and the place older people have
in it’ which the membership of BGS plays, and
expressed his commitment to working together
with us to achieve that.
Sustainability and Transformation
Plans (STPs): Readers may have
seen a BGS blog published in early
August which provides information
about STPs. In this blog I asked for
members to get in touch to let me
know more about your own
knowledge and involvement and the
opportunities, issues and concerns
that you think they present. Please
do get in touch with me directly at
[email protected] if you can.
the last few months we have been involved in a joint
project with RCGP. The outcome will be a joint
report by BGS/RCGP on ‘Delivering integrated
care for older people with frailty: innovative
approaches in practice’. The work has been
overseen by a small project group which has a mix
of members and staff from both RCGP and BGS.
The aim of the report is to inspire both
commissioners and practitioners developing
innovative models of health care for older people.
The report will contain case study examples across
a range of settings that are already working well in
practice. We are working towards publishing the
report before the end of 2016.
Update of BGS guidance on commissioning
health care in care homes: We will be publishing
an updated version of our guidance on healthcare
in care homes to include reference to guidance and
guidelines that have been issued since the guidance
was first developed in 2013. Our aim is to publish
the updated guidance by the time the Autumn
conference takes place.
Current programme of work
Autumn conferences and meetings: I will be
attending the Labour Party conference in Liverpool
and Conservative Party conference in Birmingham
where I will be doing all I can to raise the profile of
BGS, and attending as many relevant fringe
meetings as possible. I am currently in the process
of arranging for a BGS member to join me.
Joint BGS/RCGP report on integrated care: For
Engaging with BGS policy function: I have met
some of our members at our annual trustee away
day, and at other committee meetings, and I am
looking forward to meeting many more members in
the autumn, when I will be attending the Wales and
Northern Ireland Councils, and the autumn
meeting in Glasgow. If you have any questions,
comments or ideas about ways in which the BGS
delivers its policy function please don’t hesitate to
contact me.
Caroline Cooke
BGS Policy Manager
BGS MEMBERSHIP SUBSCRIPTIONS 2017
The British Geriatrics Society’s membership financial year
runs from January to December. The annual subscription
fees were set by the Society’s Finance Committee and
were ratified by the Board of Trustees. They will go before
the membership at the AGM in Glasgow. The are:
UK Consultants: Not paying by direct debit: £203; Paying
by Direct Debit: £183
Trainees, research fellows, staff grade, associate
specialists, part time consultants (who work less than 7
sessions per week) and clinical assistants in the UK: Not
paying by direct debit: £119; Paying by Direct Debit : £99
General Practitioners, SHOs, Core Medical Trainees, Retired
members, Scientists and Professions Allied to Medicine
(Nurses, Therapists) wishing to receive full benefits (Age &
Ageing journal): Not paying by direct debit: £101; Paying by
Direct Debit: £81
Overseas Members - Doctors permanently resident outside
the UK (including the Republic of Ireland): £94
Non-medically qualified people in professions allied to
medicine not wishing to receive full benefits (this category
does not include a free subscription to Age and Ageing)
Not paying by Direct Debit: £49; Direct Debit: £29.
24 BGS n e w s
September 2016
Hertfordshire Nutrition and Wellbeing Service
identifying and addressing malnutrition in the community
Hertfordshire Independent Living Service is a charitable social enterprise supporting older
people in Hertfordshire to live independently. It is the largest provider of meals on wheels
in the country, providing hot nutritious food on behalf of Hertfordshire County Council, to
thousands of older or vulnerable people.
More than just a meal
In 2015, the Nutrition and Wellbeing Service was
launched, aiming to tackle malnutrition in the
community. A small team of two dietitians and a
registered nutritionist lead the service, offering a
‘Nutrition and Wellbeing check’ to all clients. The
check consists of a visit from a member of the
team, where nutritional status is assessed using the
Malnutrition Universal Screening Tool (MUST)
(See box 1). Questions around health and lifestyle
are asked to ascertain the root cause of
malnutrition, and whether the client can be
supported in any other way (see box 2).
Those at risk of malnutrition are offered a bespoke
higher energy menu from the meals on wheels
service, additional energy-dense and fluid-rich
snacks at no additional cost, and those at
particularly high risk are offered one to one advice
from one of the in-house dietitians. Furthermore,
clients may be referred to external services such as
lunch clubs, a continence service, or mobile
opticians to improve quality of life and address any
health concerns. Clients are reviewed regularly to
monitor their nutritional status and general
wellbeing.
Box 1: BAPEN’s ‘Malnutrition Universal
Screening Tool’ (MUST)
• MUST scores are calculated by looking at a person’s
Body Mass Index (BMI) and recent unintended
weight loss
• The risk is ranked as follows: 0 (Low), 1 (medium),
2+ (high)
• Depending on the risk, interventions are put in place
to improve MUST score
For more information see www.bapen.org.uk/pdfs/
must/must_full.pdf
Box 2: Lifestyle topics covered during a
Nutrition & Wellbeing Check
• Frailty assessment using the PRISMA Frailty
Questionnaire
• Health background
• Information on recent hospital admissions - strength
assessment
• Care and support provision
• Loneliness and isolation
• Appetite, chewing and swallowing issues
• Hydration status and continence issues
• Oral Nutritional Support (ONS) prescription
• Mobility issues and recent falls
• Memory concerns and dementia diagnosis
• Sensory issues including sight and hearing
• Practical issues e.g. shopping, access to a computer
Results so far
The screening programme commenced in October
2015, and as of August 2016, the team have visited
224 clients across Hertfordshire. The data so far
suggest that at the initial point of contact:
• 33% were at risk of malnutrition
• 16% had a BMI of over 30kg/m2 indicating
they are obese
• 15% are being prescribed Oral Nutritional
Supplements.
Reviews of those at risk are conducted every three
n e w s BGS 25
September 2016
months (or earlier if a need is identified) and those
at low risk are revisited in six months. Early figures
have shown that at the first three month review (37
clients):
• 43% of clients at risk of malnutrition have
improved their MUST scores following
intervention
• 46% had a MUST score which remained stable
• 11% of clients had a worsened MUST score due
to health issues or advancing dementia
Looking forward
The team are continually analysing the effect of the
interventions to make improvements. The
screening process provides a unique insight into the
root causes of malnutrition, allowing for the team
to focus on interventions that target some of the
most vulnerable groups. For example, education
sessions for carers which focus on supporting
clients living with dementia to eat well have just
been launched, as well as resources to help tackle
dehydration (36% of clients screened reported that
they had less than the recommended six to eight
cups of fluid a day) are currently being developed.
With a food first approach, the team also plans to
decrease the reliance on oral nutritional
s u p p l e m e n t s,
and
reassess
frailty status and
its link to poor
nutrition.
By
building
stronger links
with
other
health and care
providers and
support groups,
the team hopes
to expand and
promote
a
service which
looks to take a
preventive
approach in tackling malnutrition.
For further information on the project please
contact the Nutrition & Wellbeing Team at
[email protected].
Emmy West R. D.
Dietetic and Wellbeing Officer
Hertfordshire Independent Living Service
The Electronic Frailty Index (eFI)
using available data to identify frailty
Andy Clegg writes about the electronic frailty index (eFI), which describes data routinely
available in the GP electronic health record. The full report on its development and testing
was published in the Age and Ageing Journal earlier this year.
International guidelines recommend that frailty
should be identified routinely so that a more
holistic approach to care can be taken, and
effective treatments provided. However, the main
difficulty with identifying frailty routinely is that
the tools that are available, such as measuring
walking speed, grip strength, or frailty
questionnaires, require additional resource, and
might be inaccurate.
We therefore developed an electronic frailty index
(eFI) that uses data that is routinely available in the
GP electronic health record, to identify and
determine the severity grade of the frailty. We
tested the eFI using data from around one million
UK patients in two large research databases
(ResearchOne and THIN). The eFI enables
identification of older people who are fit, and
those with mild, moderate and severe frailty. It
accurately predicts risk of nursing home
admission, hospital admission, length of hospital
stay and mortality. The eFI therefore represents a
major advance in frailty care because, for the first
time, it enables identification of frailty using
routinely available data, without the need for an
additional clinical assessment.
26 BGS n e w s
September 2016
The eFI has been implemented into the SystmOne
GP electronic health record and implementation
into the two other main UK GP electronic health
records (EMISWeb and Vision) is at an advanced
stage. The eFI is being used by GPs across the
country to develop better, more proactive care
pathways for older people with frailty to improve
health and wellbeing in later life. Examples include
using the eFI to develop a tiered community frailty
service for older people, identify patients for
pharmacist-led medication reviews, and identify
patients for proactive falls prevention treatment.
The full report on the development and testing of
the eFI is available at http://ageing.
oxfordjournals.org/content/early/2016/03/03/ageing.
afw039.full.
For more information on how the eFI is being
used,
and
case
examples,
visit
www.improvementacademy.org/improving-quality/
healthy-ageing.html
Scaling the peaks
Andrew Clegg
Academic Unit of Elderly Care and
Rehabilitation, University of Leeds
Understanding the barriers and drivers to providing and using dementia
friendly community services in rural areas
Fiona Marshall outlines a proposed study to plan for rural communities in which people
with dementia and their families and carers no longer feel isolated and unsupported.
In recent years there have been several major
initiatives to change the way that society is able to
respond to the growing number of people with
dementia. The ideal is a “dementia friendly society”
where people with dementia, and those who care
for them, are not alienated or merely tolerated, but
are enabled to sustain their local connections and
lead meaningful lives.
As we know, living with dementia proffers many
challenges and can leave families isolated, lonely
and exhausted. As a society we need to minimise
obstacles and promote valued connections within
local communities. We know that these connections
help to generate a sense of wellbeing and there are
ways in which society’s infrastructure can be
adapted to optimise community participation of the
more vulnerable of its members, including those
with dementia. By infrastructure, we mean
businesses, public services and the voluntary
sector.
The recent publication of the “Dementia Atlas” by
the government provides a visual map of living
with
dementia
in
England
The
(www.bbc.co.uk/news/health-37092989).
information used to develop the map relies on a
range of data, most of which depends upon a
formal diagnosis of dementia. Various kinds of
information are provided in clear ways which, by
one click, allows the viewer to see how a region
compares with its neighbours. The map is a good
starting point for exploring the regional differences
in the care of people with dementia and includes
the rates of diagnosis, emergency admissions to
hospital, end-of-life care and the degree to which
there is an infrastructure to allow the person with
dementia to die at home if he/she so wishes.
There are currently wide regional differences
between the various criteria comprising ‘dementiafriendliness’. One section of the Atlas includes a
measure of how dementia friendly an area is
compared to the national average. A key measure
gives an indication of the number of individuals
who have attended a Dementia Friends session to
learn about living with dementia. Whilst this
scheme is to be lauded as a way of improving our
knowledge about dementia, reducing stigma and
stimulating inclusion, it is also a broad measure of
how dementia friendly a community actually is.
Building and sustaining dementia friendly
communities is a challenge which many key
organisations, such as GP surgeries, NHS hospitals
and care providers are enthusiastically engaged in.
Small local businesses such as hairdressers, postoffices and pubs are managing to provide dementia
n e w s BGS 27
September 2016
friendly places, often in the absence of any national
small “grassroots” initiatives which seek to value all
initiative, but in a genuine desire to support local
members of a community. So far the findings
residents. However, much more can be done and
suggest that the church, local shop, pub and
the real strength of developing such communities
agricultural markets are seen as pivotal places which
lies in the participation of people actually affected
are valued by members of the community; arguably
by dementia, be they family
more so than public services
caregivers, neighbours or
locations such as health centres,
providers of services. My ...the findings suggest that the libraries and village halls. Robust
own work seeks to examine church, local shop, pub and reliable and affordable facilities
what makes a dementia agricultural markets are seen as such as transport, internet and
friendly community and pivotal places which are valued landline services, fuel and housing,
understanding the diverse by members of the community; as well as accessible health and
needs
of
different arguably more so than public social support are all considered
communities.
Rural services locations such as health fundamental to rural dementia
communities, for example, centres, libraries and village friendly communities.
face different and particular
halls.
challenges which are often
We are currently seeking to recruit
overlooked by national bodies.
up to 90 families living with
dementia as part of the longitudinal study to
There are larger numbers of older people living in
understand their experiences and views about living
rural than urban areas in the UK, yet the majority of
in the Peak Park. Each family will be visited by the
dementia care research is located within urban areas.
research team every few months to discuss their
A study funded by the Alzheimer’s Society and
everyday lives and explore what they value the most
located at the University of Nottingham bucks this
in their communities. This will include physical,
trend by seeking to understand the particular
social and community sharing activities in addition
circumstances of living with dementia amongst
to the everyday needs.
rural dwellers. However idyllic the scenery of rural
areas such as the National Peak District, developing
This information will be used to develop a visual
a dementia-friendly community in these more
and conceptual map of the area to identify the types
isolated places comes with a range of challenges not
and locations of dementia friendly communities.
faced in more urbanised areas.
The map will be freely available on the internet. We
also plan to make a toolkit so that communities can
In a study called Scaling the Peaks; Understanding
build their own dementia friendly communities in
the barriers and drivers to providing and using
ways which are useful for their residents. This will
dementia friendly community services in rural areas:
help in the future planning of services and support
the impact of location, cultures and community in the
the development of truly dementia friendly
Peak District National Park on sustaining service
communities across the trajectory of living with
innovations, we will visually map the services and
dementia.
resources available to people with dementia and
their carers, and examine how these are affected by
Older people and their caregivers are very welcome
the local geography and seasons of the year. This
to discuss the possibility of taking part in the study
study includes people with dementia and the
by contacting Dr Fiona Marshall by email on
[email protected] or mobile on 07920
providers of support in a very rural location with a
813613. A formal diagnosis of dementia is not
particular interest in what makes a dementia friendly
necessary to take part but participants do need to be
community as told by older people with dementia.
seventy years or over. Family and friend caregivers
In short, we are examining the ways in which rural
are also invited to take part and can be any age over
dementia friendly communities operate.
eighteen years.
We commenced work with voluntary, health and
Fiona Marshall
social care providers by regularly meeting with them
Project Lead
to observe and discuss the ways in which they
For more information:
collaboratively work to build and maintain dementia
www.alzheimers.org.uk/site/scripts/documents_info.ph
friendly communities. Early evidence suggests that
p?documentID=2997
there is a diverse and committed number of mostly
28 BGS n e w s
September 2016
“Let’s dance. Put on your red shoes and dance the blues.”
- a good way to die -
My father “lost his fight against cancer”. The truth is he didn’t even try to fight it, so one must assume
that my father was “a loser”. David Bowie recently died from cancer too and danced his way to death.
Bowie went quietly. There was not a lot of talk
about it; and rather than focusing on death, he
chose to focus on life. Ever the consummate
performer, he steeled “every nerve and sinew” to
sing and dance till the end. That was my father’s
choice too, as he was efficiently investigated and
found to be palliative. He chose a low tech, minimal
intervention death at home. He wanted to
maximise his time with his loved ones and limit
contact with NHS facilities.
My brother was the human hoist; my sister the
eternal optimist; and I, the realist. I would ask
helpful questions like: “Do you wish you were dead
now, dad?”
My father fought in life; against successive, corrupt
Sri Lankan governments, then in the UK to
become one of the first overseas university
consultants in Glasgow. He fought for his patients
and against the erosion of hospital beds and
services. The result of this was a massive cerebral
haemorrhage at the age of 60. He was not for
resuscitation, and I asked, “Do you wish you were
dead now dad?”
“If I am still alive, it is for a reason” came the curt
response.
Defying science, (for we had seen him Cheyenne
stoking), he fought again and limped out of
hospital six weeks later.
“If you say, ‘run’, I’ll run with you”
“I’ll get radiotherapy if you want me to.” he
informed us.
“This is about you, not us, dad”.
I knew his mind only too well, a little something to
give my mother hope when, as a family of doctors,
we knew this was the last dance.
“What do you want?”
“I want to go home” he said, and so we did.
We celebrated several family events, the last of
which was my nephew’s ninth birthday party, two
weeks before he died. His wonderful, attentive
general practitioner had put him on steroids for
cerebral spread, as he had nearly lost his vision. The
steroids had made him sing, “Happy Birthday”
garrulously. He was unimpressed when this was
pointed out by my dear insightful brother.
“Because my love for you, would break
my heart in two”
My mother would not let him go and so he tarried
a while with us. I prayed to my grandfather in
heaven, “take him,” but he was not ready.
“Where are you going, my darling?” my mother
cried.
“When is a good time to die?” he responded, as he
held her hands. The answer was easy: “The day
after me”.
He was fully involved in organising his funeral, to
minimise the stress to us all. I can remember as if
it were yesterday, dad’s hairdresser coming to the
house. He wanted to look good in “the box”.
“Your daughter has made a mess of your hair, Sam.
I can keep coming to the house if you need”.
“Truly Caroline, there will be no further need,” he
said.
We all giggled nervously, sarcastic until the end. I
gathered the shorn, soft fleece..a keepsake for the
grandchildren.
The days passed and we reminisced, drank malt
whiskey each night, watching him pretend to eat,
but we could see that he was suffering. We heard
my mother say to her ancient gods, “This has to
stop”.
n e w s BGS 29
September 2016
The next day he finally accepted the morphine and
took death by the hand. Forty eight hours later, it
was over.
“Let’s dance to the song we’re playing”
That was ten years ago, following which I wrote an
article called, “How to die”.
I wrote how my father had taught me that dying
could be simple, but we complicate it. My siblings
and I observed in the papers that proportionately
more doctors die at home. Why should our patients
not have this privilege too, if they want it? Perhaps
we are not making it clear to them when hospitals
have little more to offer. My sister says no one was
interested back then; the time was not right.
Perhaps they’ll listen now?
I changed career after my father died and became
involved in “end of life care” and the hospital at
home service.
A host of lovely volunteers and our glamorous
blonde minister enhance the lives of our patients,
singing and giving hand massages, painting nails
and playing games…if they want it.
People like Bowie and my father knew how to die:
“Life in your years …not years in your life ..Let’s
dance”
S Sanders
Community Geriatrician
BGS Communications
in action
Working towards a new look, a new feel and a
higher profile for our Society
It has been a busy summer for BGS
communications with good progress being made
on our new logo and related graphics, a raised
profile in the press and headway in increasing our
membership.
New BGS logo
There has been substantial progress in re-branding
the Society with a new and more modern image.
The concept for the new logo has been completed
by our designer, John Spencer. We canvassed
reaction to his design and I’m pleased to report that
the majority of the feedback was largely positive.
We feel that this is a good indication that the new
logo and related graphics will be positively received
by BGS members, and our wider audiences. The
next step will be to gain approval from the Board
of Trustees next month. The new logo and
publications templates will then be applied to
several key BGS publications and communications
channels, such as Twitter and the BGS Blog. We
plan to be ready to launch the new ‘brand’ in
January 2017.
As part of the overhaul of our publication
templates, we commissioned a new photo library to
bring our members'
work to life.
We retained the
highly
esteemed
photographer Slater
King in early August
,to create a library of
BGS photographs
which capture the
diversity of the Society’s
membership, and illustrate its core values such as
the importance of multi-disciplinary teams,
compassionate care and patient focus. I joined the
photographer and his assistant on the photo shoot,
which took place over a two day period at a variety
of locations including two hospitals, a care home
specialising in residents with dementia, a GP
surgery and a patient’s home. These photographs
will play an important role in our new identity and
we would like to send our thanks to everyone who
took time from their busy schedules to host us on
the day.
BGS in the news
Efforts to improve media relations are also proving
effective with the BGS featuring in 47 different
publications since June including The Guardian,
30 BGS n e w s
September 2016
Forbes, Yahoo News and The Nursing Times. Of
particular note was BGS President-Elect Professor
Tahir Masud’s interview on BBC Radio 4's
Woman's Hour on Monday 22 August. Professor
Masud discussed a recent study which suggests that
calcium supplements may increase dementia risk
for stroke survivors. In addition to widespread UK
coverage, the BGS also received coverage in eight
other countries, including China, Japan, Mexico,
India and the United States. Four press releases
were sent out between June and August including
two Age and Ageing press releases ‘Moderate
alcohol consumption associated with improved
health in older people’, ‘Pain profiling has the
potential to improve quality of life for older
patients’ and a BGS Media Statement supporting
the CQC Report ‘Building Bridges, Breaking
Barriers’.
A sample of the BGS photograph
portfolio
Growing the reach of Twitter and the BGS blog
From a social media perspective the BGS continues
to go from strength to strength. Our Twitter
account @gerisoc is performing well and now has
over 8,700 followers and gains on average, five new
followers a day. The BGS blog is also performing
extremely well with the total number of visitors in
2016 already exceeding the total number of visitors
for the whole 2015. The top performing blog
during this period, which is also the best
performing blog of all time, was ‘Kate Granger
1981-2016’ attracting an impressive 9,512 views.
Our Patron HRH The Prince of Wales
We are delighted to announce that HRH The
Prince of Wales has renewed his Patronage of the
Society for a further five years. The Prince of Wales
has been Patron of the Society since 1993 and the
renewal of his Patronage coincides fortuitously
with the upcoming seventieth Anniversary of the
BGS in 2017. We will keep BGS members apprised
of our plans to celebrate this significant milestone.
BGS Membership; Medical students and
foundation year doctors
Finally, as part of the BGS strategy to increase our
membership, a communications campaign is
currently underway to recruit medical students and
foundation year doctors. This has included
emailing all Deaneries, a Twitter campaign aimed at
the top 50 medical schools in the UK and stands at
relevant career fairs including the Royal Society for
Medicine, University St Georges of London and
the Medics of North Wales. Goody bags and flyers
have also been created to be handed out at these
fairs. So far the
recruitment campaign
has
been
highly
successful with a
significant number of
medical students and
foundation
year
doctors joining the
BGS since it was
launched. If you
would like to help us
raise awareness of the
BGS to medical students and foundation year
doctors in your area please get in touch, we would
love to hear from you.
I look forward to seeing many of you at our
Autumn Meeting in November, where I will be live
tweeting from the sessions, as well as greeting
delegates on the BGS Stand. If you would like to
discuss any aspect of
the Society’s
communications, or media relations, in the
meantime, please call me on 0207 608 8572 or
email [email protected] .
Marina Mello
BGS Communications Manager
n e w s BGS 31
September 2016
BGS Autumn Meeting – November 2016
The local organising committee in Glasgow have
been preparing for the last two years to welcome
the BGS Autumn Meeting in November. We are
delighted to have such a varied and stimulating
programme and are hoping for a well attended,
stimulating and interactive conference where good
ideas about innovative new services and research
programmes will enthuse the membership in their
ongoing care of older people in the United Kingdom.
23 November : We will start on Wednesday 23
November with a joint meeting with the Hospital at
Home Group in Scotland (see page 7) along with our
Community Geriatrics Section. Graham Ellis, who is
well known to the Society for his innovative service
redesign and evaluation of implementation of
Hospital at Home, has led on the programme for
Wednesday as an excellent overview of the different
models of practice around the UK. The goal of
improving care of older people in their own homes is
high on our agenda and those of our politicians in
Scotland and it will be relevant for all. We are very
keen that our colleagues in nursing and AHP practice
are aware of this meeting as it would be an ideal
stand-alone day for them to join us at the
Conference. Please spread the word to your nurse
practitioners and AHPs. Remember the BGS will
support attendance with reduced registration rates
and, in some cases, grants to cover the costs.
Following our evening sponsors’ symposium, we will
have a drinks reception in the SECC to allow some
networking and to get tips on the best dining
experience in Glasgow from the locals.
24 November : Our programme for Thursday 24
November has something for everyone.
Presentations
in
Orthogeriatric
Service
Development, Thyroid Disease in Older People,
Delirium, Health Promotion and Stroke are amongst
the topics in a very varied platform. We were very
pleased to hear that Sir Muir Grey, Director of the
Better Value in Health Care and Professor of
Knowledge Management at the University of Oxford
has agreed to give our guest lecture on the Thursday
teatime – How to Stay Young and Get Younger – who
could miss this?
Our conference dinner will be held in the Grand
Central Hotel, one of the old railway hotels in the
very centre of Glasgow. It has been refurbished in the
last few years and provides a very plush setting for an
evening dinner. You will be delighted to know we
have secured the services of one of the best ceilidh
bands in Scotland to provide us with entertainment
and exercise – even if you do not know the dances, a
friendly Scot will take your hand and lead you
through the steps. I promise you will enjoy it! Please
sign up when you book your conference registration.
25 November : Again, a variety of topics are covered
that are relevant to us all. Improving Care for Older
People with Christine McAlpine, Jason Leitch doing a
double act, both having been heavily involved in
quality improvement work for older people in
Scotland. Tom Downes will give a wider view on this
too.
We are delighted to be able to announce that due to
Graham Ellis’s links with the Cochrane Collaboration,
he has secured the services of Professor Laurence
Rubenstein from Oklahoma, USA, to give the Trevor
Howell Guest Lecture on Friday morning. His
experience at assessing the evidence for
comprehensive geriatric assessment has been a
game changer. Please do not miss this.
We will learn more about molecular biology, head
injury and polypharmacy and will finish the early
afternoon with a tour de force on Surgical Patients
Comprehensive Geriatric Assessment.
Take Home Message
Book up for BGS Glasgow Autumn Meeting 23-25
November 2016. The weather is likely to be dull and
rainy so spending time indoors will be no loss. We do,
however, promise a very warm Glasgow welcome.
Thanks to Geraint Collingridge and his team at BGS
for organisational support in pulling this programme
together. All that is needed now for a successful
conference is for you to attend.
We look forward to seeing you then.
Jennifer Burns
Chair: Glasgow Autumn Meeting Organising
Committee
32 BGS n e w s
September 2016
How well are the diagnosis and symptoms of dementia
recorded in older patients admitted to hospital?
In a paper published in Age and Ageing, Dr George Crowther and his colleagues from the
University of Leeds confirm the mismatch between dementia symptom prevalence and the
identification of dementia and the recording of its symptoms in patients attending hospital.
In the United Kingdom dementia is generally
diagnosed in the community by mental health
services. However if the same patients are
admitted to a general hospital their care is
usually managed by a separate healthcare
trust and the handover of clinical information
between organisations is potentially
unreliable.
Dementia is a common comorbidity in older people
admitted to the general hospital. Prevalent in around
42 per cent of patients, these are people who often
have difficulty communicating their needs, and in a
hospital setting there is a high prevalence of delirium
(66 per cent), and psychological symptoms in the
absence of delirium - depression (34 per cent),
anxiety (35 per cent), delusions (11 per cent) and
hallucinations (15 per cent). In order to provide
quality care that meets the needs of this patient
group, healthcare professionals in hospital need to be
aware of the diagnosis and be able to recognise
psychological symptoms and delirium.
Previous attempts to describe dementia prevalence,
and the symptoms associated with it, in a general
hospital setting have involved prospective
assessment. These methods may give an accurate
account of the hospital prevalence, but they
potentially overestimate the actual clinical record,
that is, the number of patients with a pre-existing
diagnosis of dementia identified as such during their
hospital stay and the number of symptoms recorded.
Our research aimed to describe any such
overestimation in order to highlight areas of unmet
need.
We conducted a dataset linkage study,
retrospectively reviewing 116 patients with known
dementia diagnosed by mental health services,
admitted to a general hospital. Both their community
psychiatric notes and hospital notes were scrutinised,
ascertaining the accuracy of dementia diagnosis
recording by the general hospital and all episodes of
documented psychological symptoms and delirium.
Diagnostic Accuracy
The results demonstrated that despite a large
number of patients with known dementia being
admitted to hospital, the diagnosis remains
undocumented in around 26 per cent of them. In
order to improve this, healthcare professionals need
access to reliable diagnostic information. This
requires closer collaboration between mental health
and hospital healthcare information systems. ‘Patient
passport’ systems such as the butterfly scheme or
‘This is me’ booklet that encourage people with
dementia to inform hospital staff of their diagnosis
also have a role to play, however they all require opt
in and are easily fallible to human error.
Psychological Symptom Recording
The prevalence of documented psychiatric symptoms
(10 per cent) and delirium (11 per cent) in people
with dementia in the general hospital was also lower
than would be expected. This is unlikely to reflect a
low symptom prevalence, but rather a mismatch
between symptom prevalence and symptom
recognition and recording, indicating a possible
barrier to providing optimum care. Enabling staff to
recognise and record symptoms and researching the
most effective ways to achieve this are important
priorities for improving care for hospitalised patients
with dementia.
George Crowther
NIHR Clinical Lecturer in Old Age Psychiatry,
John Holmes
Senior Lecturer, Old Age Psychiatry
Michael Bennett
Professor of Palliative Medicine
University of Leeds
The fully referenced study may be accessed in Age and Ageing (http://ageing.oxfordjournals.org/)
n e w s BGS 33
Interview with Premila Fade
September 2016
new BGS End of Life Care Lead
We spoke to Prem Fade who has recently accepted the reins of BGS End of Life Care Lead from
Martin Vernon who is now working in his new role with the Department of Health. Prem is a
Consultant Geriatrician at Northwick Park Hospital in London; she is a member of the BGS Policy
Committee and past Chair of the BGS Medical Ethics and Law Special Interest Group.
What does the role entail?
I don’t claim any special knowledge or expertise but
I am passionate about improving end of life care
for our patients.
My role as lead is to ensure the voice of the BGS is
heard when national strategy and guidelines are
being formulated and, to develop links with other
strategic organisations involved in end of life care.
In particular; to highlight the needs of older people
and the contribution that both the BGS as an
organisation and its membership make in
promoting, developing and providing high quality
care for older people nearing the end of life. This
is important now more than ever because end of
life care is finally getting the prominence it deserves
in national policy and commissioning. Specialist
palliative care services are branching out into noncancer diagnoses, however traditional models of
palliative care do not meet the needs of our patients
and it is imperative that our skills, knowledge and
understanding of the complex interplay between
aging, frailty, chronic disease and acute illness are
utilised when new services are designed and
developed. Geriatric medicine is at its heart, a
balancing of (patient centred) objectives –
prolonging life, reducing disability, improving
symptom control, whilst acknowledging that life is
finite and may be nearing its end. A significant
proportion of our work is palliative but because we
don’t always use this terminology our skills and
expertise in this area have, in the past, been underestimated. My goal is to ensure our voice is heard.
What is your background and why did you
choose geriatric medicine?
When I started out in my medical career twenty
years ago, I thought I wanted to be a neurologist.
When I didn’t get the job I wanted, my consultant
at the time (a gastroenterologist) suggested that I
think about geriatric medicine. I thought at the time
that he was trying to let me down gently, telling me
I was not good enough to be a neurologist but
I started to question more and more,
the goals of medicine and began to
understand that being a geriatrician is
as much about acknowledging the end
of life as it is about prolonging life.
actually he recognised my strengths better than I did
myself.
Set on the path of geriatric medicine, I increasingly
saw the ethical nature of the decisions being made
and took a brief detour to study an MA in medical
ethics and law. I started to question more and more,
the goals of medicine and began to understand that
being a geriatrician is as much about acknowledging
the end of life as it is about prolonging life.
During my first consultant post in Dorset, I worked
in collaboration with my palliative medicine
colleagues to improve end of life care in the
hospital (using the AMBER care bundle and cowriting a personalised care plan for the last days of
life to replace the LCP), and the community (we
developed a unified DNACPR policy for Dorset,
trained nurses to do end of life care plans with
PEACE and ran a training programme to accredit
nurses to discuss and sign DNACPR forms).
What are the big issues facing Drs/geriatricians
in EOLC?
In the past, geriatricians had to strive to ensure
older people had the same access to advanced
medical technology as younger patients. However,
the tide has now turned and increasingly the focus
of our practice is to explain the limitations and
adverse consequences of medical interventions to
our patients and their families. With an increasingly
aged population suffering from multiple chronic
diseases, our strengths are our generalist knowledge
and skills, and our ability to factor frailty into the
34 BGS n e w s
September 2016
complex medical decisions which need to be made.
The development of highly technical medical
specialities has led to fragmented medical care to
the detriment to our patients. And so the focus of
the BGS has changed to highlighting the need for
integrated multispecialty multi-professional personcentred care for older people. Our challenge
moving forward is to change the way our colleagues
in other specialities make treatment decisions with
older patients. We need to improve their training
and skills so they can recognise frailty and its impact
on their treatment decisions, so that we can work
better together to achieve better living and dying for
our patients.
Why do many people still die in hospital even
though they say they want to die at home?
There are several reasons for this: Recognising that
a person is in the last phase of life is sometimes
difficult, particularly if the person is not suffering
from cancer but has a severe chronic disease and/or
is frail and very old. The Gold Standards
Framework (GSF) prognostic indicators may be
helpful here.
The person and their family may have difficulty in
accepting that life prolonging medical treatment is
not in the person’s best interests. Sometimes there is
genuine uncertainty about outcome and conflicting
priorities e.g. campaigns to improve early
recognition of MI, stroke and sepsis, which are
considered to be potentially reversible lead to more
frail older people being conveyed to hospital earlier.
Poor communication and co-ordination of care,
particularly between primary care, secondary care,
social care, and out of hours services, is another
significant factor. This can potentially be avoided
by advance or end of life care planning and care
coordination delivered by multidisciplinary
community teams in the home or care home.
However, alternatives to hospital admission are not
usually available 24 hours a day (due to cost and
manpower factors) and this limits their impact.
References
1. www.ambercarebundle.org
2. PEACE developed by GSTT
3. Goldstandardsframework.org.uk
4. ‘One chance to get it right’ leadership Alliance for the Care
of Dying People June 2014
5. ‘End of Life Care Audit- dying in hospital: National report for
England 2016’ Royal College of Physicians of London March 2016
What is replacing the Liverpool care pathway
(LCP)?
The Liverpool care pathway was developed to
transfer best practice in care of the dying from the
hospice to the acute hospital setting but
unfortunately, in translation and implementation, it
came to be seen by some as a generic protocol and
tick box exercise.
In the most damning criticisms, the LCP was cited
as a way of withholding food and fluids from
patients to starve them to death. The demise of the
Protocol in 2013 led to a hiatus which has been
partially filled by guidance from The Leadership
Alliance for the Care of Dying People LCDP in
2014. Rather than producing another care
plan/pathway five priorities of care were
established, namely: i) identification that the person
may be dying; ii) sensitive communication of this
information to the patient and their family; iii)
patient and family involvement in decisions about
care; iv) addressing the needs of the
family/significant others; and v) an individualised
care plan which includes food and drink, symptom
control, psychological, social and spiritual support,
agreed, delivered and reviewed with compassion.
In 2015 The Royal College of Physicians audited
end of life care in acute Trusts. The audit had two
elements; an organisational review of services and
protocols, and a case note review based on the five
priorities of care. 142 acute Trusts participated and
the results showed 66 to 83 per cent compliance
with the five clinical standards, results defined as
‘encouraging’ by the audit lead, Professor
Ahmedzai.
How does it feel on the ground?
The demise of the LCP coupled with the Tracey
judgement (Article 8 of the Human Rights Act and
DNACPR decisions) have left clinicians
understandably nervous about making DNACPR
decisions and discussing withdrawing life
prolonging treatment. This is where we, as
geriatricians, need to show leadership in our acute
Trusts and ensure discussions and decisions are
made by appropriately trained and experienced
healthcare
professionals
with
enhanced
communication skills. Assessing acutely unwell
patients and devising appropriate treatment
escalation plans is our bread and butter, working
with our palliative care colleagues we can ensure
good symptom management and high quality end
of life care at home or in hospital.
n e w s BGS 35
The shoulders upon which we stand
September 2016
- geriatric medicine’s pioneers -
Mike Denham, past President of the BGS, BGS archivist and historian returns with our
regular feature on the history of geriatric medicine and the events which led up to the
introduction of the welfare state and the National Health Service. Here he provides a
mini-biographies of some of the geriatricians who practised at a time when geriatric
medicine did not enjoy the status and recognition that it does today.
Dr Thomas Newton Rudd (1906-1995) qualified
from London Hospital in 1930. Initially he entered
general practice in Cornwall and joined 128 Field
Ambulance in Exeter in 1934. At the outbreak of
the war, he joined the RAMC, was a medical
specialist at the Royal Herbert Hospital, Greenwich
before commanding a medical division in Algeria
and Normandy. After demobilisation in 1945, he
continued as an active territorial, commanding 128
Field Ambulance for several years and as a full
colonel, he commanded a general hospital in the
Army Emergency Reserve. After the war, he joined
an experimental group practice, which operated at
Tiverton and Belmont Hospitals. The poor
standards of care in the latter unit caused him to
institute regular ward rounds, keep notes, send
elderly men with untreated hernias for surgery and
remobilised them for discharge. His nursing
lectures were published in the Nursing Mirror.
In 1957, he was
appointed
consultant
[He] returned ... as a consultant
geriatrician
at
physician to Brighton Women’s
with
Hospital: an appointment Southampton
responsibility for 300
rapidly terminated when he was
beds, taking over from
discovered to be a man!
Eric Brooke who had
recently died.
He
developed an excellent geriatric service at
Moorgreen hospital with a psychogeriatric service
at Knowle hospital. He was active in the BGS and
energetically championed the creation of the
Medical School at Southampton. In retirement, he
wrote a report for the WHO on geriatric services in
Cyprus and was a guide at Winchester Cathedral.
Dr Richard Stevens (1912-1998) qualified in 1937
from Cambridge University and St. Thomas’
hospital. In 1940, he joined the RAMC serving in
the Middle East, Italy and Austria and was
mentioned in dispatches. After demobilisation, he
worked in general practice but returned to hospital
medicine in 1960 as consultant physician to the
Brighton Women’s Hospital: an appointment
rapidly terminated when he was discovered to be a
man! Nil desperandum, he was appointed
consultant geriatrician at Ashford Kent, having
‘learnt the ropes’ from Trevor Howell. He
developed a major interest in stroke management
and worked for many years with the Chest, Heart
and Stroke Association. He assisted in the
commissioning of the new William Harvey
Hospital at Ashford and was medical administrator
of the Canterbury Postgraduate Centre. In 1997,
he was awarded the BGS President’s medal.
Dr Raphael Tepper (1916-1990) graduated from
Manchester University in 1943. He worked in
hospital medicine until 1950 before moving into
general practice. In 1963, he switched to geriatric
medicine becoming senior registrar in the geriatric
department of Crumpsall Hospital, Manchester,
and in 1966 became a consultant geriatrician in the
Ashton, Hyde and Glossop group of hospitals
before moving Bolton 18 months later. He retired
in 1981. He wrote several papers, served on
hospital committees, the Health Advisory Service
and the council of the BGS. He enjoyed golf and
had a keen appreciation of music.
Dr. William Tod Thom (1917-2006) graduated
from Edinburgh University in 1940 and joined the
RAMC serving in Africa and India, leaving in 1946
with the rank of Lt. Colonel. He then joined the
Colonial Service working as a medical officer in
Tanganyika, Somaliland, and latterly Sarawak.
On his return to the United Kingdom in 1964, he
was a medical officer in Birmingham before
returning to Scotland in 1966. There he joined the
36 BGS n e w s
September 2016
Scottish Home and Health Department becoming a
principal medical officer. His principal concern was the
medical services for older people and carried out
pioneering work in exposing the appalling conditions in
many long-stay hospitals in Scotland. Between 1977 and
1982, he was director of the Scottish Health Advisory
Service.
Dr Peter Thomas Tweedy (1920-2002) qualified from
St. Bartholomew’s Hospital in 1942, undertook firewatching during the London Blitz, served with the
RAMC and landed in Normandy on D+3. He advanced
with the British troops to Nijmegen, where he met a
young girl who later became his wife.
He was appointed consultant geriatrician to the
Stockport hospitals in 1959 where he had responsibility
for several hundred patients in four hospitals. He
developed a thriving service, which expanded to three
consultants. In retirement, he helped to raise funds for a
rehabilitation centre for head injury patients and served
on the local St. Ann’s hospice.
Dr Marjory Warren (1897-1960), the mother of
British geriatric medicine, has been the subject of
innumerable articles. For those who wish to go back to
the beginning, try the Oxford Dictionary of National
Biography.
Dr John Wedgwood (1919–2007), was born into the
world famous pottery family and was a non-executive
PUBLICATIONS INFORMATION
The BGS Newsletter is published every second month by:
British Geriatrics Society
Marjory Warren House, 31 St John’s Square, London EC1M 4DN
Tel: 020 7608 1369 Fax: 020 7608 1041 Url: www.bgs.org.uk
Email: [email protected]
The opinions expressed in articles and letters in the BGS Newsletter are
the views of the authors and contributors, and unless explicitly stated to
the contrary, are not those of the British Geriatrics Society, its
management committee or the organisations to which the authors are
affiliated.
The mention of trade, corporate or institutional names and the inclusion
of advertisements in the Newsletter does not imply endorsement of the
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©British Geriatrics Society 2016
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director for some twenty years. He qualified from
Trinity College, Cambridge and Guy’s Hospital in
1943. In 1944, he joined the RNVR serving in the
Mediterranean and in the Far East on the
minesweeper HMS Squirrel. He was wounded
when the ship was mined and sunk. These injuries
caused such increasing discomfort that he gave up
his intention to be a surgeon and become a
physician. He decided on geriatric medicine
following his experiences when he surveyed 200
neglected chronic sick patients in a local workhouse
in Cambridge.
His first consultant post was in 1960 at Bury St
Edmunds, where he had no medical, rehabilitation,
or secretarial staffs. He was responsible for 243
patients in old overcrowded infirmaries, one of
which still had gas lighting. In 1968, he became
consultant geriatrician at the Middlesex Hospital
but in 1980, he moved to the Royal Hospital for
Incurables in Putney, as medical director and
chairman of the board of management, and stayed
there until he retired in 1986.
He was very active in the BGS, serving as treasurer,
chairman of the executive committee, and
chairman of the editorial board of Age and Ageing
(1969–86). While treasurer he placed the Society on
a firm business footing and established it as a
registered charity. In 1987, he was appointed CBE,
and in 1994, he was awarded the BGS presidential
medal.
Dr Terence Charles Picton Williams (19191996) qualified from St Mary’s Hospital in
1943 and served in the RNVR from 1944 to
1947. He was encouraged to enter geriatric
medicine by Sir Ferguson Anderson and
following training posts, he became consultant
physician at St Thomas’s Hospital in 1963.
He created a thriving unit in the South Western
Hospital, Stockwell, set up 2 day hospitals,
established an acute assessment geriatric ward
in St Thomas’ Hospital and integrated general
medicine with geriatric medicine. He retired in
1984 but was soon appointed associate
professor in the division of medicine (section
of clinical gerontology) at the University of
Saskatchewan to advise on strategic planning
and clinical care.
Michael Denham