August 2008

Dear Editor
What`s in a name?

With regard to discussions about the Society’s name, I would remind members that Nascher, a New York Physician, coined the word ’geriatrics’ in 1914. It derives from two Greek words, ’geron’ - an old man and ’iatros’ - a physician. So, literally, ’geriatrics’ means ’an old man who is a doctor’ or ’a doctor who is interested in old men!’ Those who don`t know Greek, reckon that the word means a doctor who is interested in older people.

Whatever, for almost 100 years, societies have lived with the term “geriatric”, sometimes as a music hall joke, a derogatory description or a positive approach to the medicine of old age. I recall the time when I was asked to make a pre-admission home assessment visit and the elderly lady who opened the door said. “Oh dear! They haven`t sent you – I`m not a geriatric yet.” Will it take another 100 years to get used to a new name?

Health in old age results from health in middle age, which is enhanced by health in the early years. The promotion of health throughout life should be the job of public health medicine and associated health professionals. The practice of geriatric medicine is to unravel the effects of physical, mental, social and economic problems which lead to disease and/or disability in later years. Disease requires medical or surgical treatment and disease requires rehabilitation. I suggest that this should be the main purpose of geriatric medicine.

The demise of NHS continuing-care beds, partly because of concern about the standards of care, has been replaced by private and voluntary care homes, with the same concern about the standards of care. Perhaps the profession should take a more active part in the care of this group of patients, to ensure a safe end to life as we ensure a safe beginning.

Dr C Cohen OBE. FRCP Ed. and Glas. Retired.

Naming names
While appreciating that the decision has been taken, pro tem, to retain the name of the “British Geriatrics Society”, I would like to add my support for those in the debate who say that we really do need to change the name of our Society. The ‘G’ word is one which conjures stereotyped images of old age and evokes predominantly negative reactions from members of the public. I come across this regularly at our scientific conferences when sharing a lift with other hotel guests. A glance at my British Geriatrics Society badge results in a mixture of eye rolling, nervous tittering and whispers to each other along the lines that “you’ll soon be a geriatric yourself”.

Of course we are a Society with a proud heritage. Most of us are proud to be geriatricians, and are indebted to our illustrious predecessors. But wishing to change the name of the Society to one that is more in step with our times implies no disrespect to our history.

Times change and how we are perceived by our patients, the public, charities, policy makers and politicians is increasingly important. To introduce yourself to a patient by announcing that you are from a Department of Geriatric Medicine can sometimes leave a mountain to climb in overcoming prejudices and low expectations. This is an unnecessarily difficult start to your relationship with a patient. I am aware that actions speak louder than words, but choosing the right words is easy. Doing the right thing, on the other hand, is a test we all face daily in our clinical lives.

We wrestled with a similar identity crisis in Dundee some years ago when there was a groundswell of opinion that we should drop “Geriatric Medicine” from the name of our academic department. So we did something radical – we asked our patients. In a survey of 100 older patients attending our NHS outpatient services, most rejected the term “geriatric” as offensive, and many were not that keen on “elderly” as an alternative. The option that won the day was “Ageing and Health”; a departmental name which I am pleased to note has been adopted by a number of other departments throughout the UK.

Our academic office in Ninewells Hospital is on the main medical ward thoroughfare, and I derive quiet pleasure from hearing the comments of visitors as they walk past the entrance. Lay people instinctively like the name, they like its positive ring, and the notion that the people in these offices are trying to promote health in old age. Is this not just the sort of response that our Society aspires to elicit?

What about “Ageing and Health (UK)” or Andrew Elder’s suggestion of “Healthy Ageing UK”? Any of these would convey to non-members what we are about as a Society.

Professor Marion McMurdo
Ninewells Hospital

As a UK geriatrician currently working in a Geriatric Medicine Research Unit in Halifax, Nova Scotia, I follow with interest the debate about the name of the Society.

In the November 2007 newsletter, you argued eloquently that the word “geriatrics” has “acquired negative connotations and might hamper our external image”. Perhaps our response to this should not be to abandon the term but to fight harder to dispel negative stereotypes of older people and to promote geriatric medicine as the dynamic and rewarding specialty we know it can be.

The heritage and international standing of the British Geriatrics Society would be undermined by any change in name. More importantly, the name reflects our role as advocates for frail and vulnerable older people. Changing to the British Society for Health in Ageing is perhaps analogous to the Association of Palliative Medicine changing its name to the Society for Serenity in Dying. The new name, depicting an idealized outcome of care, may be intended to allure but the construct of the title may, paradoxically, describe those least in need of the Society’s expertise.

Ruth E Hubbard
Dalhousie University and Queen Elizabeth Health Sciences Centre,
Canada

Change the reputation, not the name
I read with interest your editorial in the Dec 2007 BGS Newsletter, and would like to respond to your call for feedback on the Society’s name (“What’s in a name?”).

I have written on this topic in an editorial of the Journal of the Hong Kong Geriatrics Society in 1996. (Kong TK. Packing Geriatrics. Journal of the Hong Kong Geriatrics Society 1996; 7(1):7-8). My view point remains unchanged since then: “it is better to change the fame of geriatrics rather than to change the name of the profession:.

TK Kong
Consultant Geriatrician
Princess Margaret Hospital, Hong Kong

Geriatrics is okay, but time to change
I am an SpR in Geriatric Medicine in Manchester...this was how I introduced myself at a recent PCT funding meeting that I attended. The RMN and social worker there seemed to be very offended by my use of the word geriatrics and it made me think again about the issue of the name of our Society. I asked my mom (who does after all have a free bus pass) what she felt about the word “geriatric” and she replied that she doesn't really mind what she's called as she gets older as long as she is respected and treated well. My 96 year old Aunt, when I asked her if she would be offended if admitted to a "geriatric" ward said definitely not...although in fact I think by “geriatric” she thought I meant a gynaecology ward! However I can see that use of the word “geriatrics” will become less and less viable with time. Picking up on the suggestion by Andrew Elder I wondered whether 'Better Ageing UK' could be an option? After all, everybody involved in the BGS is in the business of improvement and it probably encapsulates the needs and wishes of the elderly population that we serve. In addition it would possibly facilitate the society's role in campaigning, as it makes clear that we are about a better level of care for the ageing population.

Susan Powell (SpR Geriatric Medicine)

Change the attitude, not the name
I have read with interest, the March 2008 edition of the BGS Newsletter. I note the letter from Dr Andrew Elder who suggests that by re-naming the BGS, “Healthy Ageing UK” , it gets away from the “G-word”.

This sounds as if we should be ashamed of the word “Geriatrics”.

Words change their significance with usage. Any dislike of the word “geriatrics” covers a dislike of the whole subject of the care of the elderly. This dislike would soon be transferred to any new term chosen.

Two examples from general literature may be given where words originally meant to be disparaging have acquired respect, because the subject they described acquired respect.

The Goths and the Vandals were Northern tribes who ravaged Northern Europe at the time of the fall of the Roman Empire. Bot names indicated savage barbarians. At the time of the Classic Revival, medieval architecture was despised and called “gothic”. Medieval architecture is now deeply appreciated and “gothic” is a term of respect. The name “vandal” retains its original significance.

At the time of the first world war in 1914, German Military Authorities described the British Expeditionary Force sent to Flanders as the “contemptible little army”. Those who took part in that campaign deemed it a great honour to have been one of the “old contemptibles”.

Rather than getting away from the “G-word”, we should aim to inspire respect for the term by emphasising the insight and vision of Dr Marjory Warren, who saw just how much could be done for the elderly, how important it all was, and how much appreciated by the patients and their families.

Dr R G Miller

I write as a long-term supporter of change, with a suggestion for a new name. Why not....... "Ageing UK" or "Ageing Britain". It
a) ties in with the name of our journal.
b) describes a real demographic fact.
c) permits simple devolution to e.g. "Ageing Mersey" or "Ageing Scotland".
d) gets us away from the G word.
e) lets people immediately know what we are about.

Diabetes UK did it. Why can't we?
- Andrew Elder

What’s in a name? Everything and nothing
If the purpose of a name is to identify our role as geriatricians, then I think that the use of geriatrics is entirely appropriate. Most people know what geriatrics means, more or less – something to do with advanced age, frailty and proximity to death. Even the TV shows that Martin Curtice reviewed for us have a fairly good idea about geriatrics, even if some of the themes were negative. So if the purpose of the name is to define, then geriatrics does it well.

But if, on the other hand, it is about image and attitude, then maybe there is still some work to do. Whilst big business can change its name, re-brand and create a new image, we cannot really do the same. Our core ‘product’ – the frail older person is fixed. Whilst it is true that some geriatric subspecialties have successfully rebranded to some extent – such as stroke medicine, they have changed attitudes rather than the product. Stroke is now ‘sexy’; the same can be said about cancer care, and increasingly, end of life care.

Therein lies the bigger challenge – changing society’s attitude to frailty. The key to this is in ensuring that opinion is well-informed. This is slowly happening – whether it is the older people’s tsar appearing on day time TV, or increased media coverage generated by debate, we are hearing more and more about issues relevant to the frail older person. Some of you may have seen the secret millionaire series, in which millionaires go undercover to find a worthy cause for their benevolence. I was particularly struck by one programme (28th November 2007) in which the millionaire worked in a care home. His initial experience was predictably negative, with complaints about the smell of urine and lack of appeal. But the programme ended positively, with him giving a large donation to one of the young, underpaid but very caring assistants. It was a good example of how exposure to frail older people (and hence informed opinion) influences attitudes. But we are also reminded that the exposure needs to be deep and not superficial, if it is going to be successful in changing negative attitudes.

I am increasingly convinced that attitudes is the battle that we need to win if we are going to get our colleagues to look after the growing number of frail older people properly. - Simon Conroy