Although the BGS has organised several multi-disciplinary meetings within the framework of the Spring and Autumn meetings, this was the first stand alone conference, designed to underpin our developing relationships with our allied professions.

This fact was emphasised by Jerry Playfer in his introductory remarks when he also told the audience that the BGS was reviewing its membership categories with a view to making it easier for all health care professionals to become involved in its activities. Ian Philp, National Director for Older People's Services drew attention to the progress that had been made in implementing the National Service Framework in England, and went on to describe some of the other initiatives. These included: placing stroke within the work of the vascular board, making falls and fractures a priority for the delivery board, and increasing the emphasis on good terminal care services and dignity on the wards.

Timely geriatric assessment
Simon Auty, a GP from Salford gave an account of his experiences of intermediate care. Simon is a GP with a special interest in geriatric medicine, who has lead responsibility for a range of intermediate care services in his PCT. He stressed the importance of flexibility in establishing services in conjunction with the local consultant service, thus allowing autonomy for innovation and the need for multidisciplinary working that satisfied the needs of Clinical Governance. In a complementary paper David Black emphasised the evidence-base for ensuring that comprehensive geriatric assessment was at the heart of chronic disease management and that when successfully undertaken it reduced mortality and institutionalisation and increased functional ability. He commented on the enormous variations between hospitals in length of stay of older people, whilst those for younger patients were much more uniform throughout the country. He advocated the establishment of clinical directorates across the present primary/secondary care divides and emphasised that clinicians should lead change.

PD and multi-disciplinarianism
There followed a series of clinical updates. Doug MacMahon reminded us that up to 2% of the population will develop Parkinson's disease, and emphasised how multidisciplinary care was complementary to modern drug treatment.

In introducing his very entertaining talk on falls, Jed Rowe reminded the audience of the high prevalence of falls in older people and its importance as the major factor leading to institutionalisation. He emphasised the importance of only undertaking carotid sinus massage in specialised settings, having first obtained consent. In his update Lalit Kalra stressed the importance of the potential of improving the outcome of stroke by early intervention. He described his experience of thrombolysis assisted by the use of perfusion CT scanning to complement standard techniques. This allows for the identification of viable brain tissue that might still be salvaged by thrombolysis whilst avoiding the risks when infarction had already been clearly established. He also emphasised the need to seek and treat causes of early deterioration.

In his update on dementia, Ian McKeith described the importance of early diagnosis, the multidisciplinary assessment of patients and the role of pharmacotherapy. He also stated that attempts to classify patients within a specific diagnostic category may be inappropriate, given the overlap between Alzheimer's, vascular and Lewy-body pathology. He advocated the use of cholinesterase-inhibitors in all three common types of dementia although only 10-15% of patients showed a marked benefit. He also commented that withdrawing anti-psychotics from patients with dementia because of the risk of stroke may be an over-reaction, and that individual assessment of the risk and benefit in each patient is required.

The keynote lecture after lunch was given by Gordon Lishman, Director General of Age Concern England. He described a recent meeting at which all present had had personal experience of unacceptable levels of care, and that although the NSF had proved a spur to improving services there was still a long way to go to combat ageist attitudes in the delivery of services. He stressed the importance of good information sharing and the need to offer real choices to older people. This could be achieved by placing the older person in the leadership of their own care.

These themes were continued in a panel presentation chaired by Stuart Bruce on feeding issues in hospital in which Philip Hurst (Age Concern England), Miriam Palk (Nurse), Judith Jackson (SALT) and Margot Gosney (Geriatrician) each gave short talks. A wide-range of themes emerged from these presentations including repeated emphasis on the autonomy of the patient in making decisions about the feeding, the issues of providing appropriate food, at appropriate times, with appropriate utensils, in an appropriate environment ("who eats in a toilet?" was the question raised about presenting food to a patient in bed), the need to utilise the results of swallowing assessment in a more holistic fashion, and the importance of malnutrition within the hospital setting and the need to implement robust methods to treat it and tackle its underlying causes. The mismatch between those needing nutritional support and those actually receiving it was a concern, and the possibility of a national multi-disciplinary audit was conceived as a suitable area for further working by the BGS inter-disciplinary committee that planned this conference.

The meeting was well-attended and there was lively discussion cut short by the bell for lunch and tea. We were delighted that the platform presentations were complemented by submitted posters. Their standard was exceptionally good, and rating them was a difficult task for the assessors. The second prize was awarded to Louise Crabtree and her colleagues in Gateshead for her work demonstrating the importance of a specialist medical input in a Community Resource Team for Older People - audits confirming the BGS view and that of the two speakers on Intermediate Care (mentioned above). The first prize was awarded to Joanne Fitzpatrick (Senior Lecturer in Nursing) and her colleagues at King's College London for a beautifully presented poster that surveyed a large group of health care support workers and showed the value of an education programme designed to satisfy their needs. Our congratulations to them, and all the other poster submissions. Our thanks also to Medical Education Partnership Ltd who organised the conference on behalf of the BGS.

Peter Crome
Doug MacMahon