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Editorial

It’s been a busy few months in BGS-land. In August I represented the Society at a Guardian New Media event where I was asked to speak on preparing for an ageing population.

I presented on the importance of the emerging frailty narrative, with the possibility that changes in early- and mid-life behaviours might ameliorate later-life vulnerability. I considered the increasing body of evidence that early frailty states might be reversible in the face of improving exercise- and nutrition-based interventions. I outlined the role of Comprehensive Geriatric Assessment in delivering better outcomes for those patients with more advanced frailty states. The audience – comprising a mixture of colleagues from the third sector, social care, NHS management and policy bodies – was warm. They asked me, however, what I was going to do to get “the rest of the medical profession” to fall in line with geriatricians given that we, as a specialty, seem to speak such sense. The profession as a whole was viewed less charitably. I was left wondering what we, as humble geriatricians, could do to deliver such a change. An answer, of sorts, came over the next two months as I travelled around the country meeting inspirational colleagues who might have shown me “the way”.

Frailsafe Launched
The Health Foundation-funded Frailsafe Improvement Collaborative (www.frailsafe.org.uk) finally got up and running in Sheffield in September. Twelve teams of clinicians and managers from around the UK came together to consider how this safety checklist might help to ensure that safe care is delivered more consistently to older patients with frailty presenting as part of the acute take.  It was useful to reflect on the hazards of hospitalisation for our core constituency and consider how simple measures – removing cannulae and catheters, early mobilisation, timely assessment of falls and pressure risk, prompt medicine reconciliation – can make dramatic differences - if only we can do them all the time, or nearly all the time. It was also inspirational to learn about Quality Improvement from Tom Downes and his team at the Sheffield Microsystems Coaching Academy. I finally worked out what all those pathway exercises that I’ve been asked to participate in over the past few years, involving management consultants and Post-it notes, have been all about. If only I’d known at the time…

At our October conference in Brighton, Nigel Edwards, in a barnstorming keynote speech, revisited the old chestnut of integrated care. He eloquently highlighted the implementation challenges associated with patient-centred, multi-disciplinary working to deliver co-ordinated care across the primary, secondary, health and social care continuum. I had the impression that some colleagues left the session feeling fired-up and ready to take on the world – and well they might – but they should not underestimate the challenges posed by such a reformation in the NHS.  This is an organisation which, Nigel reminded us, still prints out letters to fax them, to type them into a different computer at the other end, before printing them out again and faxing back a copy as confirmation of receipt!

Leadership in Geriatric Medicine
Also in Brighton, I found myself participating in an “all-share all-learn” session focusing on leadership in geriatric medicine. We discussed last year’s BGS leadership and management course for Specialty Trainees and what we’d learned from that as we prepare for this year’s programme in Birmingham. We learned from the scars on the back of the heroic and inspirational Sarah Brice as she leads her geriatric medicine service in a major London teaching hospital. We considered the lessons from Sarah Stonely, of Leicester teaching hospitals, as she moved from being a geriatrician within a service, to leading one. We concluded that leadership and management are separate, if complementary, skill-sets. We considered whether leadership skills were needed for effective followership.  At the close of the session, we concluded that we need to recognise and foster skills in leadership and management if we’re to meet the challenges that I highlighted at the head of this editorial.

The scientific meetings remain relatively “research-lite” affairs.  This is less by design than as a consequence of the fact that the meetings have to fulfill multiple remits, with a focus squarely on CPD. Gordon Wilcock and the Academic Affairs Committee, with the support of the Association of Academics in Geriatric Medicine, are working on a strategy to attract more primary research to the events.  Meanwhile, though, what was on show was of a very high standard. A group of colleagues presented high-level epidemiological research considering the association between grip strength and ageing, establishing normative foundations for meaningful clinical translational research around sarcopenia. Elsewhere, more clinical research focused upon the possible association between allopurinol use and hip fracture.  Another study considered overdiagnosis (and potentially, therefore, overtreatment) of pneumonia in older cohorts.  What all of these studies had in common was the reminder of the important role that academic geriatricians have to play in anchoring high-level research to real-world scenarios where they can make a difference to patient-care.

What does all of this mean? Well the public, or at least the educated non-medical campaigners who attend Guardian New Media events, don’t take much persuasion to see that geriatric medicine has a lot to offer as we move to a world where much of the discourse around health and wellbeing will be dominated by discussions of healthy ageing.  But if we’re to get on and deliver to our full potential, we’ll need both to recognise existing expertise within the specialty and develop further skills. We need experts in quality improvement, implementation science, research and leadership to lead the charge – all whilst continuing to deliver the best frontline care to older patients possible.  These are not things we can afford to be amateurish about, such are the important opportunities at stake. We, as humble geriatricians, can achieve a lot.  To do so, we’ll have to equip ourselves with the skills to deliver transformational change of the sort we want to see.

Adam Gordon

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