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Report of British Geriatrics Society Scotland Autumn Scientific Meeting (Aberdeen, 1-2 Nov 2017)

Download the powerpoint files supporting the presentations here.

The meeting opened on the evening of 1st November with a session about Realistic Medicine.  Professor Chris Burton of the University of Sheffield talked about patients with ‘unexplained persistent physical symptoms’ (formerly often called ‘medically unexplained symptoms’), providing a master class in managing these.  Next was an excellent talk by Mr Terence O’Reilly, Consultant Surgeon in Aberdeen and a Senior Medical Officer with the Chief Medical Officer’s team in Edinburgh, talking about Realistic Medicine 2 years from launch – emphasising the importance of giving patients enough information and also ensuring they understood it; it’s vital to check that you have addressed what the patient wants and what is important to them.  We went on to have a very enjoyable dinner, well attended by delegates and their guests, with post dinner chat long into the evening.

On 2nd November the meeting opened with a talk entitled “Good Conversations” by Dr Margaret Hannah, Director of Public Health NHS Fife: this was a fascinating review of the need for transformational change in how we provide healthcare and included the opportunity for delegates to chat to people sitting next to them about conversations important to them; a key message was the need to attend to patients’ social relationships, exploring their meaning and purpose – she advocates a good quality conversation as a health intervention.  A fascinating talk which provoked much discussion.

After two scientific talks we moved on to a session on collaborative working between primary and secondary care, with  joint presentations from Geriatric Medicine consultants and GPs, talking about developments in the community which have produced impressive improvements in the care of older patients across Grampian, Highland and Tayside.  Delegates asked numerous questions and there were multiple Tweets – an inspiring session.

The final section, ‘Adapting for the future’, had 2 more scientific talks  : one was the winner of this year’s Evidence Based Medicine Day prize, ‘Reduced Level of Arousal and Increased Mortality in Acute Medical Admissions’, presented by Dr Sam Blackley and Dr Amy Todd.  The last event was the  launch of the Scottish Care of Older People (SCoOP) national audit of comprehensive geriatric assessment.  The background to this and the plans for the audit were outlined by Professor Phyo Myint and Dr Graham Ellis (our new Specialty Adviser to the CMO for Geriatric Medicine in Scotland) then there was encouragement  by me  to volunteer to assist with this work.  We hope that this audit will take place throughout Scotland.

The Kate Johnson prize for the best oral presentation from the submitted abstracts was won by Andrew Ablett, a medical student at Aberdeen University, and the prize for the best poster was won by Dr Claire Muir and colleagues from Aberdeen.

We are very grateful to the team in Aberdeen, particularly the lead organiser Dr Bob Caslake, ably supported by Dr Graeme Hoyle and colleagues, who went to considerable trouble to provide an excellent meeting.  It was notable that we comfortably exceeded the original estimated attendance, with more than 80 delegates present from across Scotland.

I look forward to seeing you in Lanarkshire on 27 April 2018 for our Spring meeting.

Christine McAlpine
Chair, BGS Scotland Council

Scottish Care of Older People Audit

The evidence base for specialist led coordinated organised services is stronger than ever with an update of the Cochrane review expected imminently to conform that some benefits (avoidance of Nursing Home) may start as early as the point of discharge.

In other specialties such as Stroke or Orthopaedics (Hip Fracture), national audits and benchmarking of services have led directly or indirectly to a focus on improvement.  Often this has resulted in improved services.

In a partnership between the University of Aberdeen, Healthcare Improvement Scotland and BGS Scotland, we are announcing the development of a national benchmarking of CGA services.  This will be developed in an interactive fashion and we are not naïve to the scale and complexity of the challenge!  A similar (voluntary) exercise was undertaken in England and can be found here.

Longer term our hope is that this might also prove the springboard to investigate correlations between process and outcome in service delivery.

In the meantime however we plan to establish the metrics.  Whilst we would aim to make this as undemanding as possible for boards, we are likely to need close cooperation with colleagues at board level to collect data.

Meanwhile watch this space!  We hope to have a website available shortly to give updates on the development and progress of the initiative.

Graham Ellis
Phyo Myint

BGS Scotland

BGS Scotland is the professional organisation of doctors who specialise in the medicine of old age in Scotland. The branch has 280 or so members and is affiliated to the main British Geriatrics Society in London (BGS).

We welcome suggestions and input from members of BGS Scotland or from representatives of organisations sharing the interests of the Society. Contact the Web Editor, Dr Allan MacDonald of Belford Hospital.

Hospital at Home Forum at the BGS Autumn Meeting

Dr Graham Ellis is an Associate Medical Director and Older Peoples Services Consultant Geriatrician for NHS Lanarkshire. He is also one of the key speakers at the Hospital at Home UK Forum at the BGS Autumn Meeting on Wednesday 23rd November in Glasgow. 

home-heartOlder people are presenting to acute hospitals in greater numbers year on year. Predictions of the future demographic raise serious questions about the sustainability of hospital based services. The Future Hospitals Commission recommended the development of specialist hospital services in the community delivering new and innovative services closer to the point of need.

Older people’s services in particular are challenged to meet existing and predicted demand. Recent headlines have highlighted inadequate alternatives to admission for older people. Yet older people should receive high quality, safe and effective care best suited to their needs that includes Comprehensive Geriatric Assessment. Services need to be designed from a patient centred perspective, but they must also be high-quality, safe and affordable. (more…)

Why do older people get less palliative care than younger people?

A paper written by Anna Lloyd and her colleagues, and published in the European Journal of Palliative Care analysed data from four studies into the end-of-life experiences of people with glioma, bowel cancer, liver failure and frailty. They found that patients aged 70 and over received less palliative care.

In summary, the team found that:

  • A secondary analysis of data from four studies on the end-of-life experiences of people with glioma, bowel cancer, liver failure and frailty suggests that older patients (aged 70 and over) have more untreated pain, less access to generalist and specialist palliative care, and greater information needs than younger patients
  • In older people, there are less clear early signs indicating that they need, and triggering their referral to, palliative care. The lack of a clear diagnosis of dying and the association of palliative care with cancer also hinders older people’s access to good end-of-life care.
  • More efforts should be made to identify older patients who would benefit from a palliative care approach in all settings.

Read the full paper here