BGS Scotland

British Geriatrics Society Scottish Branch

Academic Centre: Aberdeen

University of Aberdeen
Department of Medicine for the Elderly

AIMS

To promote general well being and health amongst older people through research and the implementation of evidence-based medicine to enable them to lead independent healthy lives.

TEACHING

The department actively undertakes teaching of undergraduates throughout their five year programme from introductory visits in first year to final year attachments. The department also welcomes both local and visiting elective students wanting to have a more experience in medicine for the elderly. Formal teaching of doctors also occurs on a regular basis in preparation for their postgraduate exams.

Postgraduate medical education aims to ensure that all staff working in the department from Foundation Year doctors to Specialist Trainees have a myriad range of experience in the principles and practice of Geriatric Medicine. Training days amongst the various levels range from weekly teaching sessions to monthly educational sessions ensuring that all are kept up to date with the latest developments in the treatment and management of elderly people.

RESEARCH

Research in the Department of Medicine for the Elderly in Aberdeen divides roughly into the following groups:

Current research projects fall under five headings:

I. Applied Clinical Research

• Non-invasive measurement of endothelial function using Pulse Wave Analysis (PWA).

In collaboration with colleagues from Department of Medicine and Therapeutics and Public Health, Dr Soiza has embarked on a number of studies involving PWA both in patients and in a population-based cohort of older people born in 1936 (please refer to Section 2 below).

• Musculoskeletal and hormonal effects of whole body vibration in older patients

Whole body vibration was originally devised for use in younger people and very little in known about its uses in older people. However, vibration exercises are particularly suited to frail people who cannot undertake conventional exercise therapy and following successful pilot studies a number of further investigations are planned. This work involves collaboration with physiologists as well as researchers from the Musculoskeletal and Bone Research Theme based at the University of Aberdeen.

• Falls and Fragility Fractures

Recent collaboration with our colleagues in the Musculoskeletal and Bone Research Theme will result in the department developing new projects in this important area including the effect of computer-assisted exercise regimes in later life (EXCELL study).

• Quality of Life measurement (please refer to Section 3 below)

• Hyponatraemia

Following a successful pilot study, endowment funding has supported a Specialist Registrar led project studying the applicability and validity of bioelectrical impedance analysis (BIA) in the assessment of volaemic status in older patients.

• Casemix measurement.

ACMEplus is a prototype casemix tool for evaluating older medical patients soon after emergency hospital admission. Our department led an 8-centre ACMEplus project financed by the European Union. There is considerable scope for further refining the case-mix instrument which could find a day-to-day clinical role in the fields of risk prediction and audit.

• Nutrition

The Institute of Applied Health Sciences (IAHS) the Institute of Medical Sciences (IMS) and the Health Services Research Unit (all based on the Foresterhill site) have a strong Nutritional research interest, and co-operation also takes place with the Aberdeen-based Rowett Research Institute. Professor Seymour was one of the team of researchers looking at a randomised controlled trial of the physical and cognitive effects of vitamins and multivitamins in older people, and a Specialist Registrar project is currently underway looking at flavanoid consumption. There is considerable scope locally for research into both over and under-nutrition in older people.

• Care Home –Prescribing Practice and Pain Control

Two separate projects involving the Department of General Practice and Pharmacy and Nursing colleagues are ongoing. Both are leading towards major grant submissions. The Pharmacy project has successfully completed a CSO funded study into Psychotropic Prescribing and the opportunities of intervention in improving management and the opportunity of a separate study involving pain assessment and control for a care home population.

• Effect of Hearing Augmentation on Cognitive Assessment.

A Specialist Registrar project supported by Endowment funds.

II. Research - Aberdeen Birth Cohorts from 1921 (ABC1921) and 1936 (ABC1936)

All Scottish schoolchildren born in 1921 and 1936 underwent IQ testing at the age of 11, although little was done with the information at the time. Since 1997, beginning with the 1921 cohort, Professor Lawrence Whalley (Professor of Psychiatry at Aberdeen) and colleagues have painstakingly traced surviving individuals in Grampian and established two cohort studies namely the ABC1921 and ABC1936. In recent years, individuals in the ABC1921 and, more recently the ABC1936, have been evaluated in a number of “waves” of investigation using a battery of psychometric, physiological, genetic, clinical and neuro-imaging tests. Formal research links from Medicine for the Elderly were established for the 5 th Wave of the ABC1921, with particular emphasis on examining determinants of Quality of Life and “successful aging” in octogenarians, while a more recent ongoing collaboration with the ABC1936 cohort has focused on associations between endothelial function, cognitive function and neuro-imaging. There is considerable scope for further collaborative research, particularly in the ABC1936 individuals who are now in early old age. The existing datasets also provide many opportunities for further statistical evaluation.

III. Evaluation of Quality of Life (QoL) in older patients

Despite extensive theoretical work by psychologists among healthy young adults, there has been only limited use of QoL measurement techniques in older people. Using an interesting new individualised QoL measure (the SEIQoL-DW) alongside a more established Health Status Questionnaire, Professor Seymour and colleagues have looked at QoL in hospitalised older patients and community-based octogenarians from the ABC1921. The former study raised the potential of QoL measures in day-to-day clinical care, particularly in patients with complex rehabilitation needs, while the latter pointed to interesting interrelationships between QoL, cognitive impairment, depression and physical impairment. Future research could involve (a) the further application of existing instruments in specific circumstances (eg planning therapy or evaluating interventions in specific patient groups such as patients with Parkinson's disease, stroke, multiple disabilities or frailty) and (b) work on the development of the instruments themselves to make them more feasible for clinical and population use.

IV. Educational Research (Specialist Registrars' Group)

Taking advantage of the fact that that the clinical Department of Medicine for the Elderly is heavily involved with MBChB teaching at all stages of the course, our Specialist Registrars have carried out a series of surveys at different stages of the undergraduate medical course, looking at attitudes to the medical treatment of older people, both in Aberdeen and in a multicentre study.

V. Parkinsonism .

A recent review of potential research developments in the department identified patients with parkinsonism as a group of particular interest. Patients with parkinsonism form an important part of the department's clinical work, ranging from early cases to advanced cases with complex neurological/functional/cognitive problems. A clinic run by Drs Primrose, Foy and Rochow has been established to look at complex problems and in addition, there are local epidemiological studies of incidence [Parkinsonism Incidence in the North East (PINE) led by Dr C Counsell, Senior Lecturer in Neurology and currently involves a research Specialist Registrar from the Department of Medicine for the Elderly] and local / European survey of environmental influences.

RECENT PUBLICATIONS

Cardinale M, Soiza RL , Leiper JB, Gibson A, Primrose WR. Hormonal responses to a single session of whole body vibration exercise in elderly individuals. Br J Sports Med 2008 (In press)

Bhat Y, Rochow S, Bal AM, Gould IM. An unusual case of Corynebacterium striatum endocarditis and a review of the literature. Int J Infectious Dis 2008 (In press)

Hoyle GE, Sharma V, MacLullich A, Seymour DG. Clinical aspects of delirium. RCPE-CME Journal 2008 (In Press)

Seymour DG, Starr J, Fox H, Lemmon H, Deary IJ, Prescott G, Whalley LJ. Quality of Life and its Correlates in Octogenarians: use of SEIQoL-DW in Wave 5 of the Aberdeen Birth Cohort 1921 study (ABC1921). Quality of Life Research 17:11-20, 2008

Hughes NJ, Soiza RL, Chua MPW, Hoyle GE, MacDonald A, Primrose WR, Seymour DG. Medical student attitudes toward older people and willingness to consider a career in geriatric medicine. J Am Geriatr Soc. 56(2):334-8, 2008 Feb

Soiza RL. Postgraduate performance: Study was flawed. BMJ 2008;336:462 Feb

Espallargues MP, Seymour DG, Campbell SE, Primrose WR et al. Measuring case-mix and outcome for older people in acute hospital care across Europe: The development and potential of the ACME plus instrument. QJM. 101(2): 99-109 2008 Feb

Chua MPW, Hoyle GE, Soiza RL. Prognostic implications of hyponatremia in elderly hospitalized patients. Arch Gerontol Geriatr. 45(3):253-8, 2007 Nov-Dec.

Soiza RL, Williams DJP, Crilly MA. Use of pulse wave analysis to measure arterial stiffness in old age. Age Ageing 2007;36:475-476 Jul

Chua MPW, Mclaughlin KM, Rochow SB. Hypomagnesaemia induced parkinsonism? J R Coll Physicians Edinb 37:202–204, 2007

Carpenter IG, Bobby J, Kulinskaya E, Seymour DG. People admitted to hospital with physical disability have increased length of stay: implications for diagnosis related group re-imbursement in England. Age and Ageing 36:73-78, 2007

Krska J, Hansford D, Seymour DG, Farquharson J. Is hospital admission a sufficiently sensitive outcome measure for evaluating medication review services? - A descriptive analysis of admissions within a randomised controlled trial. International Journal of Pharmacy Practice 15:85-91, 2007

McNeill G, Avenell A, Campbell MK, Cook JA, Hannaford PC, Kilonzo MM, Milne AC, Ramsay CR, Seymour DG, Stephen AI, Vale LD. Effect of multivitamin and multimineral supplementation on cognitive function in men and women aged 65 years and over: a randomised controlled trial. Nutrition Journal 6:10, 2007

Foy JM, Primrose WR, Mckenzie JM. Primary Cerebral Lymphoma presenting as Parkinsonism. Scot Med J. 52(1):55 2006

Hoyle GE, Chua MPW, Soiza RL. Prevalence of hyponatraemia in elderly patients. J Am Geriatr Soc 54(9): 1473-1473 2006 Sep

Hameed MF, Hoyle GE, Muir Z. A mysterious case of normalising blood sugar: insulinoma in a long-standing diabetic patient. Age Ageing. 35(3):317-8, 2006 May.

Soiza RL, Hughes NJ, Leslie SJ, Peden NR, Hargreaves AD. TIMI Risk Score predicts early readmission International Journal of Cardiology. 111(2):324-325 2006 Aug

Soiza RL, Leslie SJ. Prior clopidogrel use and outcome of acute coronary syndrome.

International Journal of Cardiology 111(2):313-314 2006 Aug

Soiza RL, Leslie SJ, Williamson P, Wai S, Harrild K, Peden NR, Hargreaves AD. Risk stratification in acute coronary syndromes - does the TIMI risk score work in unselected cases? QJM 99(2):81-87, 2006 Feb

Soiza RL, Leslie SJ, Harrild K, Peden NR, Hargreaves AD. Age dependent differences in presentation, risk factor profile and outcome of suspected acute coronary syndromes. J Am Geriatr Soc. 53 (11):1961-1965, 2005 Nov

Soiza RL, Ghosh S, McAlpine JK, Vickers MA. Non-fatal haemophagocytic syndrome in an elderly patient. Age and Ageing. 34(5):522-4, 2005 Sep.

Soiza RL. Evidence of ageism in the management of acute coronary syndromes. Age and Ageing. 34(4): 413 2005 Jul

Leiper JB, Primrose SC, Primrose WR, Phillimore J, Maughan RJ. A comparison of water turnover in older people in community and institutional settings. J Nut Health Aging. 9(3): 189-193 2005

Campbell SE, Seymour DG, Primrose WR et al. A multi-centre European study of factors affecting the discharge destination of older people admitted to hospital. Analysis of in-hospital data from the ACME plus project Age and Ageing 2005 34 467-475

Leiper JB, Seonaid Primrose C, Primrose WR, Phillimore J, Maughan RJ A comparison of water turnover in older people in community and institutional settings. Journal of Nutrition, Health and Aging. 9(3): 189-193 2005

CONTACTS

Professor of Medicine

Professor D G Seymour

email me

Head of Department

Dr D M Newnham

donald.newnham@arh.grampian.scot.nhs.uk

Regional Specialty Advisor

Dr W R Primrose

willie.primrose@arh.grampian.scot.nhs.uk

Clinical Lecturer

Dr R L Soiza