This year’s Spring conference was held in the hospitable city of Derry. While members from all over Ireland were prominent, there was representation from all corners of the UK, and even the occasional Antipodean. Many delegates commented that this was an exceptionally well-run meeting, with none of the usual conference glitches. This had much to do with the gentle but firm time-keeping, whereby each speaker was ensured their full slot, and delegates were administered their caffeine fix on time to maintain everyone’s equanimity! Opening Address The President, Bob Stout, opened proceedings in the splendid and restored Victorian St Columb’s theatre on Thursday morning, with an insightful overview for visitors to Derry, on recent Northern Ireland history and the evolution of geriatric medicine on the whole island. Prof Stout’s memorable and often poignant address reminded those of us from outside Ireland of some of the challenges facing the Irish medical profession during the Troubles. Renal Medicine A series of three complementary talks on renal medicine took us through epidemiology, detection and management of renal disease, and dialysis. Dr Peter Maxwell, Consultant Nephrologist in the Belfast City Hospital, gave us a precise account of just how much renal disease is expected to emerge over the few decades – and it is a lot. Geriatricians are well used to dire epidemiological forecasts, but even some of us baulked at these figures. Dr Damian Fogarty, Senior Lecturer in Nephrology at Queen’s University covered methods of detecting renal disease, emphasising early referral. He went on to guide the audience through the use of ACE inhibitors in chronic renal disease, emphasising that small but stable rises in creatinine are acceptable. Dr John Harty wound up with an entertaining and enlightening overview of dialysis medicine. He used study evidence to rebut vigorously, myths surrounding the use of dialysis in older patients. In particular, he highlighted work demonstrating that dialysis is not associated with a poor quality of life in older patients; it does not cost more to administer in older patients; and contrary to what is generally thought, older people when asked, are not averse to considering long-term dialysis.		Prize Winners at the Spring 2004 meeting: The Ferguson Anderson Prize awarded to Dr Miles Witham (Dundee) for the best poster presentation: “Age is not a significant risk factor of failed trail of beta blocker therapy in older heart failure patients” The Elizabeth Brown Prize awarded to joint winners *Dr David Craig (Belfast) for best oral presentation: “The behavioural and psychological symptoms (BPSD) of Alzheimers’ Disease: Identification of four symptom clusters”; and Dr Paula Jerrard-Dunne (London) for best oral presentation entitled: “Ethnic differences in ischaemic stroke subtypes: the South London ethnicity and stroke study” The John Brockehurst Prize for best poster on practice innovation, development and audit went to Dr Paul Diggory for his poster: “Influence of guidelines on cardiopulmonary resuscitation (CPR) decisions. Seven audit cycles of CPR” *We extend a particular commendation to the medical student, Mr A Mirakhur who co-authored and presented this paper.

Eye Movements
Friday morning’s programme began with two parallel sessions. In the Ballroom, Dr Mark Gibson, a consultant neurologist from Belfast, gave a fascinating talk entitled, “Eye movements: the clinician’s friend”. Citing lessons from neuroanatomy, engineering, clinical stories, and movies, he cleared up (some of) the mystique that surrounds the diagnosis and management of abnormal eye movements. Using clinical examples and video clips, Dr Gibson reminded us of the importance of the patient’s history in narrowing the differential diagnosis (and in avoiding referral through several disciplines), the necessity for a thorough examination, and the consideration of non-neurological (e.g. thyroid disease, paraneoplastic) and reversible (myasthaenia, orbital foreign body) causes. Dr Gibson emphasised the value of photographing and videoing where possible, and we certainly benefited from those illustrations.

The platform presentations covered a range of topics including predictors of diastolic dysfunction, quality of life and screening in heart failure, genetics and mortality, treatment of carotid sinus syndrome, and smoking cessation advice. The talks also demonstrated a wide variety of study designs and populations, from prospective randomised controlled trial in ten patients, to cross-sectional studies of several hundred! All papers prompted active discussion in the packed Ballroom.

Myeloproliferative Disorders
The other morning meeting began with Dr Mary Mullin’s “Myeloproliferative Disorders - a Problem in Old Age”. This lecture provided a clinically useful review of the management of common presentations of haematology problems in older age. It was particularly interesting to hear how advances in pharmacology are revolutionising treatment, for example in the use of imatinib (Glivac) in chronic myeloid leukaemia.

There followed a selection of papers from Manchester, Belfast, Galway, London and Cardiff. Topics included physiotherapy approaches; spirometry issues in airways disease; growth hormone and/or testosterone on body composition and physical performance; issues on breaking bad news; delirium in emergency medical admissions, contrasting community versus hospital acquired; and the use of chair and bed sensors to prevent falls in hospital.

Developing geriatric medicine in the USA
In the first of three excellent guest lectures we were treated to the fascinating and thought-provoking story of Prof William R Hazzard’s seminal contribution to the growth of geriatric medicine and gerontology in the USA. Prof Hazzard’s main strategy has been to focus on strengthening academic geriatric medicine, thereby increasing professional respect and attracting more doctors to the specialty: “Research is central to academic values and power; shun it at your peril.” The massive funding for Alzheimer’s Disease research in the USA has been, and remains, an important means of attracting academic physicians to geriatric medicine. Prof Hazzard also discussed the differences in clinical geriatric medicine between the UK and the USA. Clinical geriatrics remains a minor specialty in the USA, in marked contrast to the UK (in which we now form the largest group of hospital-based physicians). This is certainly more a consequence of cultural differences but also has much to do with comparatively modest rates of pay for USA geriatricians, in which consultations for any specialty are paid at a unit price, regardless of the complexity of the problems they deal with. It seems that, in the attitudes of many of the broader medical community at least, there is still a long way to go on both sides of the Atlantic. Prof Stout has covered this lecture in more depth in the President’s Column.

Consent, capacity and human rights
Prof Tony McGleenan, who holds the Chair of Law at the University of Ulster, imparted a clearly-presented and practical overview of the legal perspectives on the medical ethics of end-of-life and capacity. He focused particularly on articles in the European Convention on Human Rights. Prof McGleenan tied each of the points he was making to familiar cases, for example that of Dorothy Pretty. Another interesting feature was the contrast in the differing approaches to applying a legal framework around the concept of capacity in Scotland, England and Wales, and Northern Ireland.

Cheyne, Stokes and Adams
Friday’s midday guest lecture was delivered by Prof Davis Coakley, who holds the Chair of Medical Gerontology at Trinity College, Dublin. He spoke to the subject of “Cheyne, Stokes and Adams, the Men Behind the Eponyms”. Prof Coakley delivered an erudite historical treatise, which brought us back to the medical Dublin of the 18th and 19th century, beautiful illustrated by historical documents and publications. The practice of medicine in a bygone era was brought alive in the lecture and Prof Coakley’s work in the field of geriatrics and gerontology was acknowledged by the President of the Society at a dinner later in the evening, when Prof Coakley was presented with the President’s medal.

Coeliac disease
In St Columb’s theatre on Friday afternoon Dr Simon Johnston, a well known expert on coeliac disease, presented a comprehensive survey of this condition. He emphasised that coeliac disease can present at any age, is variable in its severity and so is not always clinically apparent, and that it should always be considered in cases of iron deficiency anaemia.

In the platform presentations, brave medical student, Mr A Mirakhur described a large study which used principal components analysis to identify clusters of variance in the behavioural and psychological symptoms of Alzheimer’s disease. Another well-powered study highlighted the value of distinguishing between fluid and crystallised intelligence in relation to white matter lesions in the brain. Other talks covered the high prevalence of dementia in Parkinson’s disease, the influence of carriage of the APOE epsilon 4 allele on aggressive behaviour in Alzheimer’s disease, and the possible role of higher cortisol levels on variations in cognitive ageing.

Colorectal cancer
The other parallel session on Friday began with a detailed account from Dr Richard Wilson of various chemo-therapeutic regimes in colorectal cancer, with the take-home message that the prognosis for this disorder is better than it used to be, and that we should consider referring for assessment. Talks on stroke followed, ranging from genetics to the management of faecal incontinence. On the latter, Dr Danielle Harari presented an innovative randomised control trial which demonstrated the value of a single educational nurse encounter in providing long-term improvements in bowel function in stroke patients.

Sponsored Symposia
The sponsored symposia included a vigorous debate on the role of geriatricians in the management of Alzheimer’s disease, a series of talks on the management of patients with fragility fractures, the growing role of ARBs in the treatment of hypertension, stroke prevention, and the complexities of treating Parkinson’s disease in older patients.

Conclusion
Apart from the pleasure of meeting up with old friends and enjoying the delights of this beautiful part of Northern Ireland, the scientific content of the meeting demonstrated the impressive range of clinical and scientific interests in geriatric medicine. Let us hope that with the difficulties afflicting academic medicine in general, that geriatricians active in research will persist in producing high quality science which influences our understanding of ageing and disease, and which will serve to raise the profile and status of our specialty.

Our thanks to Northern Ireland’s Spring Meeting committee who worked so hard to make this meeting the success that it was, and as always, to our conference organisers, Hampton Medical Conferences.

And so, on to Harrogate in the Autumn, when the mantle of journalism moves to Wales while we, the faithful recorders of this, the Derry meeting, relax in the knowledge that our time is done for another 18 months!

Alasdair MacLullich, Kevin Kelleher
Susan Shenkin, Brian McGurn ,
and Mark Barber