The Spring Meeting of the Society in Derry/Londonderrywas a great success and everybody who spoke to me about it enjoyed it thoroughly.

In other parts of the Newsletter you will be able to read details of the meeting. I would simply like to congratulate the Organising and Scientific Committees and to thank all of those who attended. One of the highlights of the meeting was a guest lecture by Prof Bill Hazzard of the University of Washington in Seattle, who described his efforts to introduce Geriatric Medicine into the United States. This was a thoughtful lecture, mentioning negative as well as positive aspects of the developments and comparing what had been achieved in the United States with the position in the United Kingdom. A number of lessons can be learned from this.

Academic Leadership Prof Hazzard’s efforts in developing Geriatric Medicine came from an academic base. This of course, is not the usual situation in the United Kingdom, where services have developed and an academic centre has come later. Nevertheless, the importance of academic leadership in a specialty is the same in the United States and the United Kingdom. A matter of concern in British Geriatric Medicine is that having developed academic leadership and academic departments with a Chair in every medical school in the United Kingdom, the academic base of UK Geriatric Medicine appears to now be under threat. Some Chairs, previously held by leaders in the profession, are now vacant or even being eliminated. I find it interesting that at an early stage of development of some of the new medical schools, Chairs in Geriatric Medicine or equivalent subjects are being advertised, whereas in the long standing medical schools they appear to be under threat or even unfilled. Part of the problem is a lack of high quality candidates for Chairs, and it is incumbent on all in our specialty to encourage those who have an aptitude for teaching and in particular research, to consider academic careers. United Kingdom academic medicine as a whole is not strong at present, but Geriatric Medicine is suffering more than most. The new clinical research initiative with the prioritisation of stroke and Alzheimer’s disease as areas for development of research provide opportunities for Geriatric Medicine which should not be missed.

Age
Prof Hazzard mentioned the fact that twenty years ago, age 65 was considered the definition of old age but this moved to 75, and is probably now 80. While we all realise that aging is variable and there is a spectrum of old age, and that our emphasis should be on needs rather than age, it is important that we emphasise the fact that our services are for those who by any standards are very old. We must continue to emphasise the importance of introducing prevention and health promotion early in life so that the benefits can be felt in old age, but it is important that we do not get too involved in discussions of services for people who are not old, as this tends to dilute the importance of the needs of those in the oldest age groups.

Relationships with Other Specialties
Professor Hazzard made an interesting point which had not struck me before, namely that adults up to the age of 65 generally have their medical problems managed by organ specialists, those between 65 and 75 by general physicians, and those over 75 by specialists in the care of older people. This of course, is an exaggeration and is not necessarily true in the United Kingdom. However, there are lessons to be learned from this. We must ensure on the one hand, that our older patients, irrespective of age, receive the best possible treatment, and this includes very old people being managed by organ specialists.

The first session in the Spring Meeting was on renal disease in older people, where it became clear that much of the work of the nephrologists is with end-stage renal disease in old and very old people, and nobody would suggest that this is not appropriate. It is important, however, that those who are receiving regular dialysis have all their medical and rehabilitation problems managed, and close liaison between geriatric medical and nephrology services is probably just as important as that between geriatric medical and orthopaedic services - another topic of the Spring Meeting. It is equally important that all those who are providing specialist services for older patients, irrespective of the pattern of services, make it clear that their primary responsibility is for their older patients. While they may participate in the emergency management of patients of all ages, their ongoing management must be primarily for older people. Geriatric Medicine is not simply a specialty for the acute care of older people, but for rehabilitation and for links with the community.

The Voluntary Sector
Prof Hazzard mentioned that the main charitable organisations in the United States are not particularly interested in the oldest old or in the medical care of older people. This is probably also true in the United Kingdom. It is not clear why this is the case. Close working between our specialty and the relevant charities would be of great benefit to both. We of course, have different aims and objectives but our overall aim to improve the lives of older people is the same. It is important that we establish the good links with the voluntary sector and ensure that we are working together. We have expertise in the frailest and most vulnerable section of older people; they have expertise in the healthy elderly and of course, in advocacy. A synergy between the two would benefit everybody.

Research
Academic departments of Geriatric Medicine in the United States initially found it difficult to decide the areas of research on which they could place their emphasis, and which were particular for their specialty. As time has passed, they have tended to concentrate on research on Alzheimer’s Disease. This is also the case in a number of university departments in the United Kingdom and they are making major contributions in this area.

There are of course, many other areas of research, particularly in clinical and health services research and this was brought out again in the symposium on renal disease where it was emphasised how little we know of the outcomes of treated end-stage renal disease in older people, and of the factors that affect these outcomes. There are many opportunities for this type of research. The National Health Service provides particular opportunities as it is the only service in the world which provides comprehensive healthcare to the whole population, free at the point of need. We must not lose the opportunities for making a contribution to the knowledge base of the care of older people which exists in the United Kingdom and in the National Health Service.

Education
Members of our Education and Training Committee are working actively at promoting education in our specialties. With the weakening of our academic presence there may be a danger that education in our specialty is becoming more difficult. There is no need to persuade members of the BGS of the importance of education in aging and the care of older people for all future doctors, perhaps particularly for those who will not join our specialty.

Education is also a time when students take an interest in our specialty and in NorthernIreland, many of our recruits have first become interested in the care of older people as students. There is no right model for education in aging and the care of older people. What is essential is that it has a clearly identified place in the curriculum, and is seen as being just as important as any other part of the curriculum. Prof Hazzard’s aim was to infuse geriatric medicine throughout medicine. That is a laudable aim but it is difficult to achieve and to monitor. We must consider not only the present but the future, and the future will be in the hands of well educated doctors coming into our specialty.

On to Harrogate
This was only one of the many thought-provoking contributions to the Spring Meeting. As you know our Autumn Meeting this year will be in Harrogate, a beautiful place with xcellent conference facilities. I look forward to seeing as many as possible of you there.

Bob Stout