Research-active members of the BGS
The British Geriatrics Society continues to look for active researchers among its membership - of any discipline - who are willing to talk about how they found their way into research, the obstacles on that path, the stage that their research is at presently, and their advice to others considering following in their footsteps. Here, James Frith writes of his experience.
My interest in research first began when I was an SHO working on a Geriatric Medicine ward. My supervisor at that time had done a PhD and I very much liked his style of working. It was only then that I discovered that research was not limited to laboratory experiments or drug companies. Shortly afterwards, I heard about a research post which was coming up with one of the Geriatricians in Newcastle. Anyone who has ever met Julia Newton, knows that one needs only pass within twenty yards of her and she has one writing five research papers; ten yards - a research thesis; or five yards - a lifetime committed to a clinical academic career.
My PhD was based in Newcastle University and the Falls and Syncope Service in Newcastle Hospitals NHS Foundation Trust. Following my PhD I took up a post as an NIHR Academic Clinical Lecturer, which allowed me to complete my clinical training while also continuing my research in a fifty-fifty split post. This post was crucial for me, as I knew I wanted to pursue a clinical academic career. It provided me with the time and training I needed to develop and write a robust intermediate fellowship application.
In February 2015 I gained my CCT and was awarded the prestigious National Institute for Health Research (NIHR) Clinician Scientist award.
The NIHR Clinician Scientist award is predominantly a training fellowship, providing five years of funding to develop as a research leader, continue clinical practice and deliver a research programme.
My interest is in falls and syncope, but particularly in orthostatic hypotension, the type which is associated with frailty and ageing rather than with autonomic failure. My research aims and objectives were defined in collaboration with older people who have OH and consist of:
- Identifying which non-pharmacological therapies are effective at treating OH in older people
- Determining whether these therapies are acceptable to older people and the clinicians prescribing/delivering them
- Developing strategies to improve adherence to these interventions
- Designing a clinical trial to evaluate non-drug therapies and their adherence strategies
Research programme in context
Mrs Johnson, an 82-year-old lady, has been having postural dizziness and falls for several months and has now been diagnosed with postural hypotension. She is keen to avoid further medication and hopes to maintain her independence. The treatments offered to her were:
- Stop one of her anti-hypertensive medications
- To stand up slowly
- Squeeze her leg and abdominal muscles immediately after standing
- Increase her fluid intake
- Eat small frequent meals, rather than three large meals
- Wear full-leg length compression stockings
- Wear an abdominal binder
- Exercise to keep her leg and abdominal muscles strong
- Sleep with the head of the bed elevated
- Avoid excess caffeine and alcohol
How many of these have a strong evidence base in older people? How many will Mrs Johnson be able to maintain? How many will she find unacceptable and so not even consider? How many will she remember?