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It is with some trepidation that I step, as editor, into the rather large boots of David Oliver. David has been a tireless advocate for the Society and for frail older people during his time in office.
He has published several excellent articles on ageism, many in the BMJ1-7, conveying important messages about older people to a wide audience.
Having demitted as Hon Secretary of the Society, and editor of this newsletter, David continues to lead in the area of falls and is now working closely with the Department of Health (DH) to influence the national agenda on falls and other issues relating to older people, and he serves as BGS Lead on Age Discrimination and Patient Safety. It is reassuring to know that we have a stalwart geriatrician such as David campaigning right at the heart of government, setting the agenda at the highest level to ensure high quality care for the most vulnerable in our society. David has been a fantastic contributor at BGS meetings at Marjory Warren House, providing sensible, grounded and evidence based commentary on a wide range of issues. I am sure he will continue to play an active role and I hope that I can get close to the high benchmark that he has set.
I am looking forward to getting to know something about what you, my fellow BGS members, think about the BGS and what more we can be doing to help you.
BGS Topic Leads
We have recently identified a panel of ‘instant experts’, who have a special interest in areas relevant to geriatric practice, including generic issues such as revalidation, leadership and commissioning, but also in clinical issues such as care home medicine and intermediate care (see here for a complete list). I am hoping that we can get our experts to provide a short article on their respective topics for this newsletter which will be helpful to members. The experts will also be available to provide media commentary, an increasingly important part of national BGS activity, as a means of raising the profile of geriatric medicine and older people’s issues. I am optimistic that we will see the BGS having much more of a media presence, thanks to our experts, supported by Iona-Jane Harris, our Press, PR and Parliamentary Affairs Officer. If you have expertise in any of the listed topics and are interested in contributing, we would love to hear from you – please contact Graham Mulley through the editor at the link at the top of this page.
Who am I?
Don’t worry, the question does not constitute a manifestation of an identity crisis and I am not waxing philosophical, but for those who do not know me, let me set out my credentials. I have not been around very long, having been appointed as a senior lecturer and consultant at Leicester Royal Infirmary in March 2008. Most of my clinical training has been in the East Midlands, with a brief spell in Cambridge and Bedford. I then worked with John Gladman in Nottingham, where I embarked on an academic career, working as John’s lecturer from 2004-2008. My main clinical interests are the acute care of frail older people, in particular the interface with primary care. This stems from my time in Nottingham, when I was doing medical registrar in-call duties combined with community geriatrics. It became obvious that there was a dysfunctional relationship between primary and secondary care, and I believe that geriatricians are well placed to help, given the history of geriatrics and our natural affinity with primary care – for example, care home medicine.
In terms of academic activities, I am interested mainly in falls, frailty, acute care and end of life care, but I am open to offers! I am conscious that geriatric research needs to be closely aligned to clinical priorities, and that some of the best research comes from people at the ‘coalface’, so hopefully we can harness the combined force of the British Geriatrics Society to ensure that research into older people’s health remains grounded in reality.
Around the time I started in Nottingham, I also became more involved with the BGS, as trainee representative on the England council and Policy Committee. My experience as a trainee working with the BGS was inspiring and led to me accept the role of Honorary Deputy Secretary in 2007. Zoe Wyrko, who I have asked to introduce herself here, will take on that role now that I am Honorary Secretary. Zoe has recently accepted a post as consultant geriatrician and has been replaced as Trainee Chair by Thomas Jackson who also introduces himself . It is crucial for the Society to hear the voice of all its members, not just those that get involved at Marjory Warren house.
I look forward to meeting as many of you as possible over the coming years, and would welcome your thoughts and suggestions as to how we move forwards. I can be contacted at through the editor's email address link at the top of this page.
Is the NHS doomed?
In the first of our new series of articles written by BGS Topic Leads, Mehool Patel and Dave Beaumont provide a most helpful synopsis of the recent King’s Fund review on the likely impact of the recession on NHS funding. With the general election looming, it is impossible to know how things will work out, but it does look likely that there will be stringent budgetary control over the next 4-5 years. Some of you may have noticed this already. Whilst we have to be vigilant in protecting services for frail older patients and continue our role as advocates, we do also need to be open to new ideas. Perhaps most concerning in Mehool and Dave’s article, is the comment that NHS productivity has been falling by 0.4 per cent per annum over recent years. This damning statistic (however derived) does rather support the notion that we need to do things differently. For example, the article refers to the loss of geriatricians to acute medicine as a potential threat. This may also be an opportunity. It is well known that most acute physician training schemes contain relatively little dedicated training in geriatric medicine - this despite the fact that around two-thirds of the patients seen on acute medical units will be older people, and that geriatric syndromes make up at least a quarter of the ‘top 20’ presenting complaints. So, I would argue that in order to improve patient care in acute medicine, a geriatric presence is essential. Ideally, this would be specialist input, rather than just another consultant ‘hacking the take’, focussing on providing high quality geriatric care right at the front door. But there is another agenda – by having a robust geriatric presence at the heart of medicine, we have an opportunity to educate and to influence attitudes towards older people through role modelling. I suspect that for the most part, geriatricians deliver better care to frail older people, and by having more geriatricians in acute care, we should improve outcomes, both for the patient and the service – through avoiding inappropriate admissions and preventing readmission. Ideally, front door geriatricians should also have a presence in community settings – so called ‘interface geriatrics’. For more on this, see here.
And finally...
The rest of the world has finally come to realise that there is something ever so slightly different about care home medicine. A recent NEJM article has described the poor prognosis of patients with advanced dementia8. Is this evidence of ‘green shoots - signs that the medical fraternity is starting to take frail older people seriously?
Simon Conroy
References
1. Oliver D. Age based discrimination in health and social care services. BMJ 2009;339(aug25_1):b3400-.
2. Oliver D. Older people are undertreated as much as they are overtreated. BMJ 2009;338(mar23_2):b1200-.
3. Oliver D. QOF and public health priorities don't improve care in ageing. BMJ 2008;337(aug27_1):a1403-.
4. Oliver D. Geriatric syndromes continue to be poorly managed and recognised. BMJ 2008;337(jul22_1):a892-.
5. Oliver D. Well, if you are old and frail. BMJ 2007;335(7629):1059-.
6. Oliver D. Government should have respected evidence. BMJ 2007;334(7585):109-.
7. Morris J, Beaumont D, Oliver D. Decent health care for older people. BMJ 2006;332(7551):1166-1168.
8. Mitchell SL, Teno JM, Kiely DK, et al. The Clinical Course of Advanced Dementia. N Engl J Med 2009;361(16):1529-1538.
BGS Newsletter, November 2009
Issue 24 ISSN 1748-634000 24