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August 2014 Editorial

The launch of Fit for Frailty in June was a very important event. It represented the culmination of over a year’s work for the BGS Quality Group under Dr Gill Turner’s leadership.

It saw our campaigning emphasis shift from Health Care in Care Homes (last year’s big push) to a concerted campaign to put geriatricians at the heart of the discussion about how clinical services designed for older adults with frailty should be commissioned, designed and delivered. 

It comes at an important time. The Department of Health document on Transforming Primary Care has sent clinical commissioners around England and Wales into a flurry of activity as they try to work out how to find their “top two per cent” of patients and decide how to meet their needs. Frailty has understandably featured prominently in many such discussions but perhaps not with the sophistication, nuance or recognition of scientific evidence-base that many geriatricians would seek to impose. Once again, as geriatricians, we need to be doing what we can to influence these discussions and the Fit for Frailty document represents a useful calling card to get us face-to-face meetings with those who influence local and regional policy.  I hope that you, the membership, will use it as such. 

But it’s not just commissioners and managers we need to be engaging if we’re going to get our health service Fit for Frailty. Less than a week after the launch of the BGS document, I found myself involved in a heated debate with a radiologist colleague about whether “frailty” was acceptable grounds for declining an investigation. I was told that frailty was a “commonly used term throughout medicine” and that my colleague did not need to be “patronised  about its application”. Quite what she was using frailty as a proxy for in the discussion never  became clear – she was adamant that the rejection of the scanning request was not based around age. It was clear, however, that she wasn’t using frailty to describe a measurable, quantifiable dimension with a significant underpinning scientific literature – she wasn’t using it in the way that we have done throughout Fit-for-Frailty. The same week, I encountered a patient with multiple severe electrolyte derangements and pneumonia. The junior doctor had entered one word under diagnosis: “senescence”. The management plan started with, “Do not attempt resuscitation.” 

If the profession, let alone the health services in which they work, are going to get Fit for Frailty, they’ll need training. It was encouraging, therefore, to see the Independent on Sunday run a full page spread AND an editorial based around the BGS’s campaign to improve undergraduate teaching on ageing on Sunday 13th July.  We’re soon to meet with representatives of the Medical Schools Council regarding this. It all fits into a broader programme of work described by Paul Knight in his President’s Column below. The articles in the Independent and the New Horizons article in Age and Ageing which it drew from are, once again, important calling cards and you should consider using them, where you work, to get to meet the people you need to in order to make things better. 

So far I’ve discussed commissioning, service delivery and education for doctors. An important final component to getting the service and profession fit for purpose is by ensuring that medical research focuses ever more firmly on older patients with frailty and what we can do to help them. In June I attended an international symposium on Ageing and Sleep in Lyon and found chronobiologists, geneticists, molecular biologists, pharmacologists, architects and health and safety experts all trying to disentangle the complex cause-and-effect relationships between ageing and sleep. Geriatricians were, with a few exceptions, conspicuous by their absence. I think we sometimes assume, either out of a mantra of clinical pragmatism or the geriatricians’ humility complex, that we have little to contribute to such debates. Our basic science colleagues are, though, hungry for our input. In the past few weeks the Association of Academics in Geriatric Medicine have been considering a new academic strategy put before them by the Research and Academic Development Committee (RADC) of the BGS. The society is indebted to Dr Steve Parry and Prof Gordon Wilcock for leading the work to develop the strategy and we hope to be able to share the finalised version soon. It should place before us an ambitious but achievable plan to build academic capacity within the specialty going forward. Once ready, delivering the strategy should be seen as core business for all geriatricians - since it will give us the capability to ensure that the focus of scientific enquiry is on the needs of the older patients with frailty.   

Adam Gordon

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