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Part of the role of the Clinical Practice Evaluation Committee (CPEC) is to develop and endorse clinical guidelines for treatment and management of the health of older people.

One of the aims of CPEC is to develop proposals for guidelines in the light of the national agenda and the interests of the Society. Collaboration with other national organisations and specialist societies is encouraged. The guideline development groups producing guidelines tailored to older patients have used critical appraisal of the relevant literature and have used Scottish Intercollegiate Guidelines Network (SIGN) criteria for levels of evidence and grades of recommendations. Good practice points are also added where appropriate. Our guidelines are circulated widely for comment before publication. Currently we have been successful in three particular areas.

The first area in which we published guidelines “Concise Guidance for the use of anti-depressant medication in adults undergoing recovery or rehabilitation following acquired brain injury” was a joint venture with the British Society for Rehabilitation. It was published in 2005. I co-chaired the development group with Prof Lynne Turner-Stokes. Depression after a stroke or other brain injury is under-detected and the guideline addresses this area with advice, even on detecting depression in aphasic patients. Treatment for depression after stroke and brain injury has been sub-optimal, so the guideline addresses this also. It makes it clear that antidepressant drugs should be used rationally and be prescribed and monitored carefully. Appropriate scales should be used to diagnose and monitor depression. Appropriate training is emphasised. The guideline development group included Prof John Gladman, Prof Allan House, and a number of other professionals with a particular interest in the field -including representatives from Headway, the British Psychological Society, The Encephalitis Society and primary care.

The second area is in the area of delirium. The guideline is entitled “Guidelines for the prevention, diagnosis and management of delirium in older people in hospital” and has just been issued to all members with the July Newsletter. This updated a previous guideline prepared by Dr Lesley Young and Dr Jim George in 1997 based on the work of a RCP (London) multidisciplinary working party.
The guideline emphasises the importance of testing the cognitive status of every elderly patient admitted to hospital. Delirium should be accurately diagnosed and should be prevented where possible in those at risk. The cause of the delirium must be identified accurately and appropriately treated. Once again appropriate staff training and development is emphasised in this guideline. Jim George, Lesley Young, Duncan Forsyth and Jonathan Potter represented the BGS on the multidisciplinary development team which included representatives from Age Concern and the Royal College of Psychiatry, Royal College of Nursing with help from RCP (London).

The third area is in the recognition of pain in older people. Often misinterpreted, the clinical signs of pain need to be assessed accurately and in an informed way so that the symptoms of pain can be dealt with effectively, by physical or pharmacological means. This guideline entitled, “Guidance on: The assessment of pain in older people” will be published later in the year. Sinead O’Mahony, with Jonathan Potter and Danielle Harari have represented the BGS with this project and there are representatives including those from nursing, pain medicine, physiotherapy and psychology.

CPEC is aware that clinical guidelines are really only useful if they are relevant and succinct and easily accessible, easy to read, understand and use. Through the BGS website the current guidelines can be accessed, browsed and download for local use. On the BGS website there are also links to the SIGN website where a number of relevant guidelines for use in the management of older patients are available. CPEC hopes to be able to endorse other relevant guidelines issued both by other specialist societies and to link to these on the website in the future. For the dwindling number of you who do not have internet connections, the BGS guidelines are also currently published in Clinical Medicine, the journal of the Royal College of Physicians (London).

CPEC has been fortunate in putting forward a business case to the BGS Management Committee, to have funding available for developing guidelines in the future. We realise it is a time and labour intensive activity, and one that requires the correct level of support. This includes doing literature searches, appraising the relevant literature, and formulating evidence tables. CPEC currently is developing a number of themes for future guidelines including ambitious plans to develop Trans-Atlantic guidelines with our counterparts in the American Geriatrics Society. We do, however, wish to encourage your support in CPEC’s endeavours. We would like to hear from you if you have local guidelines which you feel are particularly useful in your clinical practice, which could be developed into national guidelines with help of the BGS through CPEC. We would also like to hear from you if you have any novel ideas for guidelines that might be usefully developed or if you can spot a gap that should be addressed!.

Finally I have to pay tribute to the hard work that has been done by the individuals who have developed the current guidelines for the BGS. We are committed to clinical excellence for our patients and guidelines go a way to helping us achieve this goal.

Ron MacWalter
Chairman, CPEC
Clinical Practice Evaluation Committee (CPEC)
of the British Geriatrics Society