Wecome to this, my first editorial since taking over from Kevin Kelleher and straight away, let me say a big thank you to Kevin for all the work he did as Honorary Secretary of the Society, and for bringing his unique brand of intellect, culture and dry wit to the leading articles in the Newsletter.

I write these words having literally just returned from another fantastically successful conference in Harrogate. Although a more detailed account appears in the first pages of this newsletter, I must say that amongst a number of really excellent presentations the talk by Monty Silverdale at the evening Parkinson's disease symposium really stood out. Not only did he have to contend with raindrops falling on his head, but he managed to describe the action of neuro-transmitters in the Basal Ganglia with stunning simplicity in a sort of “Dyskinesia for Dummies”. Outstanding.

Is the British Geriatrics Society for Older People?
Although the answer may seem self evident, the contribution to Society life made by Trainees representatives was recently highlighted at the UKMC by the President. The confidence, maturity and thoughtfulness of Sally Briggs, Sandy Thomson, Phyo Myint, David Hargroves and others representing trainees on the Society’s committees has recently demonstrated that younger members have an enormous amount to contribute. So why is it that more younger members, both trainees and newly appointed consultants do not come forward to seek office in the Society? If anyone has any suggestions, please contact me. We would like to publish your views on the matter.

So which one is the undercover nurse?
Although it is yesterday’s news I thought it worthwhile revisiting the BBC programme “Undercover Nurse”, shown earlier this year. At the BGS we had advance warning of the programme’s airing and had prepared a press statement which was overtaken by the tragic events in London on July 7th. Nonetheless, despite some misgivings over the morality of using undercover techniques to film in public institutions and concerns about consent issues, many of us were taken aback by the examples of poor care, symptom control, feeding issues and unrecognised death that appeared to have been unearthed in the programme. As geriatricians, we naturally believe this is because the needs of older people are unrecognised and that society does not value or respect people of advanced age, but I have seen similar attitudes to younger people with disabilities, mental health problems or alcohol related illness. This leads me to suspect that although age is a big factor in manifestations of prejudice and inequity, maybe it is being forced out of the mainstream through disability, deprivation or disadvantage that is the issue.

Delirious about Dementia
With this issue you will find enclosed a copy of “Delirious about Dementia”, an educational initiative produced with support from Shire Pharmaceuticals by a consensus group of geriatricians, Old Age Psychiatrists and liaison mental health nurse specialists to raise awareness of dementia and delirium. The document includes useful guidance on the assessment of cognitive function using an elegant algorithm. Occasionally though, old fashioned clinical acumen helps make the diagnosis. A case of apparent delirium was recently presented to me on the ward round. I smiled reassuringly at the lady, sitting on the bed next to her and asking how she was. She in turn smiled back, moved her arm forward and silently gripped my nose between her thumb and first finger and twisted it sharply to the right. Impassively, fighting back the tears of pain, I agreed that this was likely to be a delirium, though the trainees felt it was equally likely to be 360 degree patient feedback. There’s no room for a big ego in geriatric medicine.

Demoralised
Notwithstanding Sally Briggs’ finding that we geriatricians are a happy bunch Harrogate report, a specialist registrar recently wrote to me to say that he was leaving his post to change specialty because he felt that the General Internal medicine component of training had lost its way. The suggestion was that the combination of European Working time directive, Hospital at Night, Foundation programme, and night shifts had led to the situation where inexperienced and possibly unmotivated junior trainees were referring increasing numbers of decisions up to the medical registrar on call, from a variety of specialties. This is leading to widespread stress and disillusionment amongst his peers. Even worse, he perceived the increasing involvement of consultants in the acute take could only lead to this situation moving upwards to involve consultants, which represented an unattractive vision for a future career. I wonder if anyone else has come across similar views, or whether any trainees reading this would like to comment.

David Beaumont