2004 Autumn Scientific Meeting
- Highlights of the Harrogate Conference

The Autumn Scientific meeting at Harrogate International Centre was a resounding success.

Any concerns about the change in venue disappeared almost as soon as we arrived at what can only be described as a fantastic conference facility. Fears that the move from London might lead to a drop in delegates did not materialise. In fact, this Autumn Meeting had the second highest number of registrations in the history of the meeting, attended by members from all regions of the UK, the as usual strong representation from Ireland, as well as delegates from further afield including the Netherlands, New Zealand and Australia.

Future Models of Care
The Conference started with an excellent Wednesday afternoon session on ‘Future models of Geriatric Care’. Dr John Pounsford from Bristol spoke on the Evercare Model of Managed care, a model of chronic disease management based in Mineapolis, USA that caters for a population of 60,000 vulnerable older people and is managed at a Primary Care level. Nurse practitioners carry out patient assessments, co-ordinate care and link with general practitioners. The main aim is to manage chronic disease proactively, preserve independence, function and quality of life thereby keeping older vulnerable people healthier in the community.

In December 2002, representatives from 11 Primary Care Trusts (PCT) from the UK were invited to Minneapolis. After reporting their findings back to the UK Department of Health, similar pilot projects were approved throughout the UK. A total of 72 practices with 1200 patients were enrolled. Three Advanced Nurse practitioners (APN) per PCT were recruited and trained to care for approximately 50 patients per APN. Patients over 65 years with 2 or more hospital admissions during the previous 12 months and living at home were enrolled, evaluated by an APN and given an Early Alert Tool that allowed them to call for help if and when needed. Monthly meetings between GPs and geriatricians helped plan future care. The schemes are still ongoing and the final report is due in 2005.

Prof Chris Ham from the University of Birmingham elaborated on the Kaiser Permanente Model of Managed care, an integrated organisation which is both insurer and provider of healthcare to an older population in California, USA. Commenced in the 1930s, its core features include focussing on chronic disease, multi-specialty practice, using intermediate care models, supporting patients and families to take care of themselves. Care pathways and protocols are extensively used, with strong emphasis on rehabilitation and discharge planning early, following hospital admission. There is no primary care/secondary care divide, doctors are shareholders and commitment, not compliance, is the secret of its success. It uses almost one third fewer bed days than the NHS, as significantly more care is delivered outside the acute hospital setting.

Prof John Young from Leeds and Bradford School of Medicine spoke on the role of Community hospitals (CH). Though an already well established component of health care delivery, a lot of uncertainties remain. To start with, there are at least 6-7 definitions of community hospitals. They provide a spectrum of care in the UK ranging from secondary (rehabilitation, hospital) to primary care oriented (GP based care) with a wide variation in numbers of beds and facilities available. A UK National survey in 2001 (Seamark et al BJCP 2001) found the median number of beds was 33 with range from 20 to 50 with mean distance from a DGH of 14 miles. The functions of CH included acute, rehabilitation, palliative and respite care. The majority of CH provide a multi-disciplinary care environment but are without on-site diagnostic facilities. There is a move towards further development of community hospital services – there were 471 such hospitals in 2001 with numbers increasing slowly. There is a lack of controlled trial evidence about the effectiveness of CH. Further research is needed in this area as they represent a major resource to older people and are strongly supported by the public in the UK.

This year’s Marjory Warren Guest Lecturer was Prof Alistair Burns who expertly reviewed the progress that has been made in our understanding and treatment of Alzheimer’s Disease in the last few years. He placed particular emphasis on recent research examining the role of cholinesterase inhibitors, aromatherapy (terpenoids), and bright light therapy in the management of behavioural disturbance and psychiatric symptoms in dementia. He also reminded us of the data showing excess stroke associated with olanzapine and risperidone use in patients with dementia, with a Number Needed to Harm over 1 year, of 6. The psychosocial always being dear to psychiatrists’ hearts, he finished by sharing with us snapshots of his cars including personalised number plates ALZ 1906 and ALZ 1907. If you don’t appreciate the significance of these dates, you should have been at this Autumn’s meeting!

Treatment of heart failure
The Trevor Howell Guest Lecture was given by Prof Aronow, Professor of Medicine, New York Medical College and Adjunct Professor of Geriatrics and Adult Development, Mount Sinai School of Medicine. Prof Aronow has made an enormous contribution to research in geriatric cardiology and gave a comprehensive overview of the evidence base for the treatment of heart failure with ACE inhibitors, beta blockers, spironolactone and the more recent trials on angiotensin II blockers. He reviewed emerging treatments in the field such as statins. He reminded us of the importance of diastolic heart failure in older people, though compared to systolic heart failure it has tended to be neglected by the research trials.

Infections
Other highlights of the meeting included an excellent overview of Nosocomial infections in older people by Dr Dilip Nathwani focussing particularly on difficulties in recognising infection as well as managing the epidemics of MRSA and Clostridium difficile infections in older people. Lectures on both skin cancer and pressure area care in older people were expertly delivered by Drs Leslie Millard and Chris Patterson respectively. The importance of prevention, spiralling costs and associated litigation threat with the latter in particular, were sobering thoughts for all present.

Delirium
Dr David Anderson gave an insightful lecture on Delirium management in older people while Dr Suzanne Kite delivered a superb overview addressing palliative care issues in non-malignant disease. Important themes from her talk included addressing patient and carers needs rather than focussing on specific diagnoses, i.e. patient-centred rather than service-centred care should be our priority. Using integrated care pathways to deliver optimal care to dying patients is the way forward while the role of all health care professionals to complement specialist palliative care services was emphasised.

Visual difficulties
Dr Wendy Franks reminded us that 5% of over 75’s have chronic open angle glaucoma, which in the early stages is associated with gradual loss of superior visual fields and doesn’t result in a major change in visual acuity until the later stages. Patients should avail themselves of free eye tests for the over 65’s, if glaucoma is to be detected early and benefit is to be derived from the treatments available including the well tolerated topical prostaglandin agonists, which at least in Moorfields, appear to have largely replaced topical beta blockers.

The important bits
The meeting as usual gave ample opportunity for meeting up with friends and colleagues. The poster sessions, Exhibition, lunches and coffee breaks were easily accommodated in a spacious exhibition hall with lots of space to stop and chat. The Dinner was a fine affair with most of us kept laughing in our seats long after the meal had finished, courtesy of the after-dinner speaker Dr Colm O’Mahony. Many congratulations to all involved in the planning and organisation of a successful move to Harrogate and an excellent scientific meeting!

Dr J Butler, Dr S Ahmad, Dr A Gupta
Dr M S O’Mahony, Dr J White
BGS Cymru