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The 19th World Congress of Gerontology and Geriatrics conference, held in Paris in July, attracted over 5,000 delegates from all around the world and was probably the largest ever gathering of geriatricians and gerontologists.

It proved to be a superb meeting. The designated themes ‘Longevity, Health and Wealth’ attracted 4,416 accepted abstracts. Held in the magnificent Palais des Congrès with a view of the Arc de Triomphe, the programme covered geriatric medicine, social gerontology and the biology and psychology of ageing. There was a rich diet of symposia, workshops, oral and poster presentations as well as satellite sponsored meetings. While it was only possible to sample a tiny proportion of the presentations on offer, it was an opportunity to gain a sense of the important current research areas and the growing importance of geriatric medicine internationally.

The UK was the fourth best represented nation out of the 91 nations sending delegates. Our academic contributions put us further down the international league table and particularly disappointing was the lack of a single UK geriatrician amongst the ten keynote lectures - the only UK representative being the cardiologist, John Camm, whose lecture on Atrial Fibrillation attracted a full house.

Of bats, whales and land mammalians
One of the strengths of the Congress was the opportunity for geriatric medicine and gerontology to mix. Geriatric medicine is only loosely associated with its gerontological scientific base, unlike organ based specialties which are firmly anchored in physiology. One of the outstanding symposia was, ‘Ageing is no longer an unsolved biological problem’. The legendary Leonard Hayflick, who arguably made the most significant discovery in gerontology when he described the limited number of cell divisions available to diploid cells (the Hayflick factor), made an impassioned plea for gerontological research, claiming that although only a fraction of the money spent on biomedical research is directed to gerontology, its achievements have great explanatory power, removing the mystery of the finitude of life. He redefined entropy in biological terms. After the reproductive phase of the life cycle, repair mechanisms deteriorate due to the accumulation of dysfunctional molecules. Ageing simply increases the vulnerability to age-associated diseases and is not in itself a pathological process.

Robin Holliday and Tom Kirkwood, who proposed the disposable soma theory 30 years ago, elaborated the biological theory of ageing and its implications. Tom Kirkwood, professor of medicine at Newcastle university and leader of the UK’s most important research institute for ageing, gave a typically elegant exposition of the complexity of ageing, exploring the value of systems-biology in understanding how best to intervene to prevent degenerative processes. Finally, Steve Austad from Texas explored mammalian ageing, looking at species such as bats, whales and large land mammals who have adapted to protective environments with increased longevity. All four speakers have written excellent, popular books on gerontology and it was a unique opportunity to see four of the world’s greatest gerontologists share ideas on the same platform.

Frailty
Frailty is rapidly becoming the unifying concept of geriatric medicine and it received enormous attention at this conference. The symposium which captured my imagination was ‘Psychology of Frailty’, led by Howard Fillit and Robert Butler, both eminent North American geriatricians. The symposium centred on a debate between arguably the world’s two greatest academic geriatricians, Linda Fried and Ken Rockwood. Fried believes frailty is an observable clinical syndrome that can be characterised and measured. It results from the dysregulation of physiological systems and may be triggered by factors which we can influence but, once established, is irreversible and represents a pre-death phase of life. Rockwood believes that frailty is simply an accumulation of health adverse deficits and becomes defined once a threshold number of deficits is reached, psychological deficits contributing rather than resulting from physical frailty. There are implications to how one practises geriatric medicine, according to which model one accepts and I expect the arguments on frailty to run and run.

Vaccines
Healthy ageing figured prominently at the conference, which was welcome to me as a retired third ager! Two sponsored symposia from Sanofi Pasteur MSD were of particular interest at the time of a flu pandemic. ‘How does the intradermal route represent an attractive opportunity for flu vaccination in the elderly?’ made a strong case for intradermal immunisation producing a better response in older people, together with the advantage of using new technology to deliver INTANZA, which was both easier for the patient and safer for the person giving the vaccine. The second symposium on preventing herpes zoster and post herpetic neuralgia was particularly relevant to me as I had just recovered from shingles. A new vaccine ZOSTAVAX, available in October, promises to prevent this disease in the over 50’s. Janet McElhaney a professor of geriatrics at the University of British Columbia looked at the impact of post herpetic neuralgia on the quality of life in patients, relatives and caregivers and left little doubt of the benefits of vaccination. The pioneering work of Steve Allsop and Margot Gosney on vaccination in older patients needs now to be followed up by the Society to encourage the benefits of these advances.

I returned from Paris, encouraged by the progress that is being made internationally in both understanding ageing and coping with its consequences. Although Great Britain no longer leads the world in this field, we remain important contributors to research and practice. It was good to see Ian Philp, Alan Sinclair and Ian Hastie making important contributions to the Congress. There were many other equally important UK contributions but the parallel sessions meant it was impossible to get round to see everyone. For those of you who couldn’t get to this meeting, the EUGMS meets in Dublin next year. It is very valuable for British geriatricians to broaden their horizons and be influenced by international opinion and science.

Jeremy Playfer
Retired Geriatrician and Past President
Liverpool

BGS Newsletter, September 2009
Issue 23 ISSN 1748-634000 23