One of the good things about going on holiday to the same place is that one can settle in quickly. It is somewhat similar with the Novotel Hotel.

We know our way around, we know there is a good conference hall and we know where to go for food… or a drink. It works well. It is not a holiday, of course, but one looks forward to meeting friends and acquaintances. The programme looked varied and gratifyingly wide ranging.

Wednesday was given to a joint project with the Society for Research in Rehabilitation and focused entirely on rehabilitation. The packed hall included an audience of geriatricians, nurses, physiotherapists, occupational therapists and others.

Rehabilitation

The first speaker was Prof Ann Chamberlain from Leeds who gave a thought-provoking lecture covering the history of rehabilitation in the community and providing an overview of the services which have been developed, passing through day hospitals, young disabled units, early discharge teams, outreach teams, post hospital discharge rehabilitation, specialist community teams and use of volunteers. Stroke units have been shown to be beneficial in terms of reducing mortality and morbidity; this focused management should be widened to other categories of disease requiring more functional assessment and care. Debate continues regarding generic and specific rehabilitation.

Prof Chamberlain reminded us that community rehabilitation will be PCT led. A comprehensive service should be developed which is sensitive to the wishes of disabled persons, is accessible and will prevent un-necessary use of hospitals. Evidence for rehabilitation is not easy to obtain. Prof Chamberlain described straightforward trials showing that some patients do better with home physiotherapy rather than attending the hospital from home regularly.

The cost of community rehabilitation is much the same as in hospital, and it is important to realise some patients do better with home rehabilitation than others. There is a concern with staff burnout; there needs to be a united vision, nurturing of ideas, away days and CPD. Community rehabilitation can not be done successfully in isolation. It takes place in many places and in different ways. However it is done, one should strive to make sure it is done well.
This set the scene for further interesting contributions on early supported discharge, care home rehabilitation, intermediate care, generic/specific rehabilitation and the culture of teams. The day went well, but one had the feeling that with greater future collaboration such events will be even better.

Stroke
On Thursday, early birds caught the breakfast symposium on “Waking up to the risk of stroke”. Unfortunately, I didn’t wake up early enough to have the breakfast, so the day started with hunger pangs. They were soon forgotten though with the enthusiastic talks by Prof Donnelly (Nottingham), Prof Steve Jackson (KCH) and Dr Martin James (Exeter). Interesting points discussed included diurnal variation in the time of onset of cardiovascular events, cognitive decline post stroke, and the fact that we have a long way to go before stroke services can adequately respond to demand.

Prof Cameron Swift gave the Presidential welcome address to open the main conference. There followed parallel sessions on Rheumatology and Health Services Research. Prof Paul Dieppe (Bristol) had been asked to update us on “Therapeutic advances in the management of osteoarthritis”. He announced this would be a simple task as, in his opinion, there have not been any! He stayed on the podium long enough to demolish Cox II inhibitors as well as complementary/alternative medicine, believing these have added nothing to OA treatment. Sometimes Prof Dieppe has his tongue in his cheek, but he is always good value.

Prof Allan Stirrat (Sunderland) was originally appointed as a general orthopaedic surgeon, then he progressed to being an upper limb surgeon, and is now an upper, upper limb surgeon…hence his talk on the painful shoulder! He outlined the causes of pain in this ball and saucer joint and emphasised the importance of making a correct diagnosis, warning us particularly against missing posterior dislocations. The place of ultrasound and MRI were clarified, while the need for surgery in rotator cuff injuries requires careful consideration as surgery can make matters worse. Joint replacement works especially well for OA pain.

Prof Sturrock (Glasgow) completed the session with an excellent overview of recent advances in the management of rheumatoid arthritis. Use of ultrasound and MRI for showing joint changes which are not visible on X-rays was discussed and we learnt more about use of anti-cytokine and TNF alpha monoclonal antibodies/ receptor blocker therapy.

In the next session Prof Betteridge (London) summarised cholesterol metabolism and reviewed cholesterol lowering trials, emphasising that statins are beneficial in older patients. In the parallel session, SpRs presented interesting studies on stroke. Dr Wright (Glasgow) found that hypertension and adverse physiological features predicted stroke in progression; Dr Smith (Wycombe Hospital) improved acute stroke care with minor intervention based on the NSF; and Dr Coull (Oxford) reported that although daily emergency stroke clinics reduced referral delays from 19 to 5 days, this was still suboptimal.

Posters
There were 69 posters on display at the conference. As usual they were in the same room as the 24 pharmaceutical exhibitions, which worked well as each stand had many visits from members.

The prize for the best oral presentation was awarded to Dr Cox (Dundee) who reported on visual impairment in fractured neck of femur patients. The poster prize went to Dr Johns (Newcastle upon Tyne) who looked into the diurnal rhythm of TFF2, a cytoprotective peptide which contributes to mucosal protection in the upper GI tract.

Parallel sessions followed in therapeutics, falls and bone disease, Care Home medicine/Health Promotion, and Parkinson’s disease.

The second afternoon parallel session was again a difficult choice between Issues in Caring for Older People and Special Senses. Prof Chakravarthy (Belfast) updated us on macular degeneration, discussing aetiological/ environmental factors such as cardiovascular disease, cigarettes, oxidative stress and serum carotinoids; treatment with different forms of photocoagulation, antioxidants, zinc and statins was discussed. Due to visual compensation, patients may not present until their second eye develops the condition; they should then be fast tracked to an ophthalmologist.

Marjorie Warren lecture The Marjorie Warren lecture was delivered by Prof Michael Lye. He described physiological and structural changes that occur in the heart with age, before concentrating on diastolic function/ failure and CCF, pointing out areas requiring further research. He believes it is important to recognise when cardiac failure is terminal and to treat accordingly. Above all, Professor Lye communicated his great enthusiasm for our specialty.

Blood pressure and cold coffee
Friday started with continental breakfast, which was true to form in that the coffee was only just off cold. The following symposium on treating high blood pressure to prevent strokes in elderly patients turned out to be a presentation of the LIFE trial results by Prof Coats (London), Dr Brady (Glasgow) and Dr McIntyre (Hastings). The results indicate that prevention of vascular events depends not only on lowering blood pressure, but also on what agent is used for treatment. Patients received Losartan or atenolol. Despite the blood pressure being lowered equally in the two groups, there was a significantly greater reduction in strokes and total mortality in the treatment group. Patients up to 80 were entered into the trial. When questioned from the floor about treatment of the very elderly, the panel commented that there was no evidence beyond 80, although some patients would have been older than this when the trial finished. This seemed to be a missed opportunity. There is plenty of evidence from vascular disease trials showing that treatments which are beneficial for younger adults are as, or more beneficial in the elderly. Lack of specific evidence beyond a certain age should not equate with there being evidence not to treat.

Parallel Sessions
The main meeting continued with two parallel sessions, a vascular update and palliative care/clinical practice, the latter being ably chaired by two SpRs, Cathy Church (Northumberland) and Jugdeep Dhesi (SE Thames). The speakers at the vascular session were three non-geriatrician professors. Prof Mendelow (Newcastle) confirmed that across Europe the neurosurgical treatment of intracerebral haemorrhage varies enormously; in Lithuania over 90% of patients receive operations compared to only 2% in Hungary. He described the STICH trial for intracerebral haemorrhage which involves elderly patients up to 90 years of age and will soon be completed. So far, at six months post operation only 16% have had a favourable outcome; conscious patients with focal deficits on admission to hospital have had the best outcome, while comatosed patients on admission have done poorly. We await the detailed results with interest. Prof Mendelow also mentioned the ISAT trial in which endovascular coiling was superior to clipping aneurysms in patients with subarachnoid haemorrhage. Octogenarians who were confused on admission following a SAH had a poor prognosis.

Prof McCollum (Manchester) discussed advances in management of aortic aneurysms. Main messages here were that painful or tender aneurysms need referral as 20% rupture in the next year, while with asymptomatic aneurysms it depends on the patient’s general condition and age, as well as the aneurysm size, with surgery being beneficial at 6cms or more. He emphasised the importance of cardiological assessment and use of autologous blood transfusions. Advances in endovascular repair were described. In the third presentation Prof O’Brien (Newcastle upon Tyne) gave an overview of vascular dementia, covering the history, diagnostic criteria and drug treatment.

Continuing professional development (CPD)
Prof Castleden brought us up-to-date on the BGS CPD programme and the present meeting forms part of a five year rolling programme. The syllabus address is: www.geriatricssyllabus.com
He commented that there is a definite USA bias and if anybody feels they have the expertise to improve any part of it, then please contact him: c.castleden@clara.co.uk. Professor Castleden will be standing down as Director of CPD for the BGS, so he is looking for expressions of interest from potential successors.

Longevity and ageism

The Trevor Howell Lecture “Ageism in the era of longevity”, was given by the distinguished Professor of Geriatric Medicine from New York, Prof Robert Butler. A person of wide interests, it is not surprising his talk started with a short history of the emergence of geriatric medicine and covered the need to improve eating habits and physical activity in children, changes in the retirement age, and gene medicine. He lamented the lack of academic departments of geriatric medicine in the USA, and the fact that it often takes illness of high profile people such as Ronald Regan, before changes are initiated to improve care of older people.

He believes old age should be a time of vigour, vitality and economic asset.Professor Butler enjoyed recounting what happened when Jeanne Calment, America’s oldest woman, had her most recent birthday. One of the journalists present tentatively asked if he would be seeing her next year, to which she replied without hesitation, “I don’t see why not, you look to be in pretty good shape!”

Car mobility
The afternoon started with an absorbing clinical update session on the fitness to drive. Expert talks were given by a geriatrican (Prof Marottoli, Yale), psychologist (Catarina Lundberg, Stockholm), occupational therapist (Kate Cranwell, Dublin) and specialist driving assessor (Brian Ellison, MAVIS, UK). The emphasis was on enabling the elderly to drive rather than stopping them. We learnt how patients should be assessed, what could be done to help older people remain car mobile, and how to approach informing patients who should stop driving. Assessment requires a multidisciplinary approach.

The final session before the AGM was a debate, the motion being, “This house believes that acute hospital care for older people should be delivered by an age-related geriatric medicine service”. Andy Davies (Sunderland) and Jim George (Carlisle) spoke for the motion, with Sarah Smith and Adam Darowski (both from Oxford) opposing it. This is, of course, an old chestnut and it was good to hear the arguments eloquently stated by very committed younger geriatricians. Particular mention should be made of Sarah Smith who, as an SpR made her points with great confidence and clarity. That was not enough though to persuade all the audience, for there are some intransigent views out there! Needless to say, when it came to comments from the floor, people were not slow in stepping forward to state their preference. The proceedings were firmly chaired by Prof Stout who had to call a halt to the barrage of opinions from the audience. On putting the motion to a vote, he immediately declared a draw (most present were mesmerised by the speed with which he counted the votes!).

We mustn’t forget all the other meetings in the conference which needed to be arranged, such as for the SpR research surgery, SIG Committees, poster assessors and the Chairmens’ briefings.

Bi-annual dinner and entertainment
As always, the dinner was a jolly affair, with superb food and an atmosphere of increasing conviviality (the excellent wine had nothing to do with it!). Dr Marion Hildick-Smith was presented with the Founder’s Medal and Dr Colin Currie gave a lively after-dinner speech which prepared us nicely for -

Cantabile, a group of four unaccompanied male singers. An imitation of instrumentalists playing a Duke Ellington theme and a further imitation of a very old, cracked Frank Sinatra record were the highlights ...a skilled and brilliant performance.

Prize Winners Gallery

Prof Cameron Swift presents Dr Marion Hildick-Smith with the President's Medal	Prof Ray Tallis recieves the 2002 Dhole Eddlestone Memorial Prize

On behalf of Dr Shannaz Awan, Dr Cassidy accepts the 2002 Ferguson Anderson Prize			Dr Vivienne Tut accepts the Elizabeth Brown Prize

Our thanks must go to the Meetings Secretary, Dr Janice O’Connell, for masterminding such a successful and enjoyable conference. What an enormous task. She in turn, I am sure, would like to thank everybody at the BGS central office for their hard work behind the scenes, all accomplished in good spirit.

Roger Lewis
England Representative on the Executive Cme