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Background Prediction models can identify fall-prone individuals. Prediction models can be based on either data from research cohorts (cohort-based) or routinely collected data (RCD-based). We review and compare cohort-based and RCD-based studies describing the development and/or validation of fall prediction models for community-dwelling older adults. Methods Medline and Embase were searched via Ovid until January 2023. We included studies describing the development or validation of multivariable prediction models of falls in older adults (60+). Both risk of bias and reporting quality were assessed using the PROBAST and TRIPOD, respectively. Results We included and reviewed 28 relevant studies, describing 30 prediction models (23 cohort-based and 7 RCD-based), and external validation of two existing models (one cohort-based and one RCD-based). The median sample sizes for cohort-based and RCD-based studies were 1365 [interquartile range (IQR) 426–2766] versus 90 441 (IQR 56 442–128 157), and the ranges of fall rates were 5.4% to 60.4% versus 1.6% to 13.1%, respectively. Discrimination performance was comparable between cohort-based and RCD-based models, with the respective area under the receiver operating characteristic curves ranging from 0.65 to 0.88 versus 0.71 to 0.81. The median number of predictors in cohort-based final models was 6 (IQR 5–11); for RCD-based models, it was 16 (IQR 11–26). All but one cohort-based model had high bias risks, primarily due to deficiencies in statistical analysis and outcome determination. Conclusions Cohort-based models to predict falls in older adults in the community are plentiful. RCD-based models are yet in their infancy but provide comparable predictive performance with no additional data collection efforts. Future studies should focus on methodological and reporting quality. [ABSTRACT FROM AUTHOR]

Background medical education must adapt to meet the challenges and demands of an ageing population, ensuring that graduates are equipped to look after older patients with complex health and social care needs. Recommended curricula in geriatric medicine in the United Kingdom and Europe offer guidance for optimal undergraduate education in ageing. The UK version, written by the British Geriatrics Society (BGS), requires updating to take account of innovations in the specialty, changing guidance from the General Medical Council (GMC), and the need to support medical schools preparing for the introduction of the national Medical Licensing Assessment (MLA). Methods the BGS recommended curriculum was mapped to the most recent European curriculum (2014) and the MLA content map, to compare and contrast between current recommendations and nationally mandated guidance. These maps were used to guide discussion through a virtual Nominal Group Technique (NGT), including 21 expert stakeholders, to agree consensus on the updated BGS curriculum. Results the curriculum has been re-structured into seven sections, each with 1–2 overarching learning outcomes (LOs) that are expanded in multiple sub-LOs. Crucially, the curriculum now reflects the updated GMC/MLA requirements, having incorporated items flagged as missing in the mapping stages. Conclusion the combined mapping exercise and NGT have enabled appropriate alignment and benchmarking of the UK national curriculum. These recommendations will help to standardise and enhance teaching and learning around the care of older persons with complexity. [ABSTRACT FROM AUTHOR]

Geriatric medicine has evolved to an accepted specialty in 23 European countries. Despite much heterogeneity of postgraduate geriatric curricula, European societies have succeeded in defining a common core curriculum with a list of minimum training requirements for obtaining the specialty title of geriatric medicine. Geriatricians play a leading role in finding solutions for the challenges of health care of multimorbid older patients. One of these challenges is the demographic shift with the number of adults aged 80 years and older in Europe expected to double by 2050. Although geriatric units will play a role in the care of frail older patients, new care models are needed to integrate the comprehensive geriatric assessment approach for the care of the vast majority of older patients admitted to non-geriatric hospital units. Over the last few years, co-management approaches have been developed to address this gap. Innovative models are also in progress for ambulatory care, prevention and health promotion programs, and long-term care. Efforts to implement geriatric learning objectives in undergraduate training, and the generation of practice guidelines for geriatric syndromes may help to improve the quality of care for older patients. [ABSTRACT FROM AUTHOR]

Two-thirds of the world's population aged 60 years and over will reside in lower and middle income countries (LMIC) by 2050. Many LMICs are experiencing rapid population ageing at a faster rate than in Western Europe and North America, but may not have the resources to respond to the World Health Organization's call to action. As population ageing is a global issue, effective and sustainable global solutions are much needed. Proposed strategies include stemming the outflow of trained healthcare workers to high-income nations where migrants from LMICs often contribute to the work force caring for older people. Public education, preventive measures and innovative approaches to training are additional proposed solutions. Higher income countries have a responsibility to contribute towards the development of healthcare services for older people in LMICs. [ABSTRACT FROM AUTHOR]

A notable feature of most medical specialties is close joint working between patient advocacy groups and specialist societies in furthering improvements in policy and services. While growing old is not a disease, nor too is being a child, and the engagement of advocacy and international bodies such as UNICEF with paediatricians is well established and recognised. Yet almost eight decades after the founding of geriatric medicine, it is clear that this type of relationship does not hold for the advocacy bodies representing those we serve, as well as the wider constituency of older people. Geriatricians are an extraordinary resourceful and imaginative group, and a more effective promotion of our role as guardians of the longevity dividend is vital to a more positive and mutually beneficial relationship with older people and society. This will require a redirection of our focus to a more critical stance on our origins as a discipline, our relationship with ageing across the lifespan and with older people and a fuller engagement with the broader concepts of gerontology in training and research to develop a refreshed articulacy for, the opportunities arising from gerontologically attuned healthcare. [ABSTRACT FROM AUTHOR]

Aged care coverage in Australia is universal but fragmented and has been challenged by government policy to deregulate aged care and open it up to market forces. A recent inquiry into aged care (Royal Commission into Aged Care Quality and Safety) documented the outcome of this policy—substandard care at most levels. The provision of services to older Aboriginal and Torres Strait Islander peoples, who have high prevalence of frailty and cognitive impairment, was also identified as inadequate. The effects of yet to be implemented changes in policy and funding in response to this report remain to be seen. Despite this policy backdrop, geriatricians have contributed to a steady growth in medical services and interventions focussed on specific geriatric issues such as dementia, falls, polypharmacy and orthogeriatrics. These are often driven by, or in collaboration with researchers, and aim to generate research data as well as provide patient care. The numbers of academic geriatricians and other aged care health professionals is increasing, and the training of specialist geriatricians now includes a significant research component. [ABSTRACT FROM AUTHOR]

Background The global population is ageing, and rates of multimorbidity and chronic illness are rapidly rising. Given specialist palliative care has been shown to improve overall care and reduce health care costs, how best to provide this care to older people is internationally significant. Aim To examine the knowledge, attitudes and practices of geriatricians in providing palliative care and working with specialist palliative care services. We also aimed to capture self-reported barriers, confidence and satisfaction in providing palliative care. Design A prospective cross-sectional study surveying Australasian geriatricians was conducted. Setting/Participants This was a voluntary anonymous online survey, distributed to all full members of the Australian and New Zealand Society of Geriatric Medicine. Results A total of 168 completed responses were received; 58.3% were female and 36.6% had over 20 years of clinical experience. Most geriatricians (85%) reported caring for patients in their last 12 months of life represented a substantial aspect or most of their practice. Geriatricians overwhelmingly believed they should coordinate care (84%) and derived satisfaction from providing palliative care (95%). The majority (69%) believed all patients with advanced illness should receive concurrent specialist palliative care. Regarding knowledge, participants scored an average of 13.5 correct answers out of 18 in a Modified Palliative Care Knowledge Test. Conclusions Geriatricians find reward in providing generalist palliative care to their patients; however, potential exists for improved collaborations with specialist palliative care services. An evidence base for geriatric patients who benefit most from specialist palliative care services is needed to improve resourcing, collaborative practice and ultimately palliative care delivery. [ABSTRACT FROM AUTHOR]

Healthcare aims to help older people to live well, but ultimately must also support them to die well. Most people die in old age, but predicting death in both short- and long-term is impossible for many, although not all, older people. Frail older people live with hope and pride in coping, and often anticipate recovery when ill. Key objectives of healthcare for older people are to maintain independence, minimise suffering and preserve dignity, which requires active medical, mental health and rehabilitation management, even when extending life is not the main goal. Thorough medical diagnosis and appropriate treatment and rehabilitation minimise disability, physical and mental distress and problems resulting from acute illness and crises. In these terms, 'health gain' can be achieved from medical intervention, even when life expectancy is short. Assumptions derived from cancer care about lack of reversibility with medical interventions are sometimes unwarranted. This has to be balanced against investigation- and treatment-burden, including that associated with hospital admission and the adverse effects of drugs and therapy interventions, and the need to respect the identity and autonomy of individuals. The resolution of these tensions requires anticipation of care options, multi-professional assessment, judicious and targeted treatment, good communication with patients and stakeholders and rigorous shared decision-making. In this commentary, we compare geriatric and palliative medicine, and describe how the geriatric medical approach can deliver appropriate healthcare towards the end of life. This is well supported by the broad knowledge, skill-set, flexibility and professional values displayed by geriatricians working in multi-professional teams. [ABSTRACT FROM AUTHOR]

Background/Objectives Sarcopenia is defined as the gradual age-associated loss of both muscle quantity and strength in older adults, and is associated with increased mortality, falls, fractures and hospitalisations. Current sarcopenia criteria use dual-energy X-ray absorptiometry (DXA) measures of muscle mass, a test that cannot be performed at the bedside, unlike point-of-care ultrasound (PoCUS). We examined the association between ultrasonic measures of muscle thickness (MT, vastus medialis muscle thickness) and measures of muscle quantity and strength in older adults. Methods A total of 150 older adults (age ≥ 65; mean age 80.0 ± 0.5 years, 66 women, 84 men) were recruited sequentially from geriatric medicine clinics. Each subject had lean body mass (LBM, by bioimpedance assay), grip strength, mid-arm biceps circumference (MABC), gait speed and MT measured. All initial models were adjusted for biological sex. Results In our final parsimonious models, MT showed a strong significant correlation with all measures of muscle mass, including LBM (Standardised β = 0.204 ± 0.058, R2 = 0.577, P  < 0.001) and MABC (Standardised β = 0.141 ± 0.067, R2 = 0.417, P  = 0.038). With respect to measures of muscle quality, there was a strong significant correlation with grip strength (Standardised β = 0.118 ± 0.115, R2 = 0.511, P  < 0.001) but not with subject performance (gait speed). Conclusions MT showed strong correlations with both measures of muscle mass (LBM and MABC) and with muscle strength (grip strength). Although more work needs to be done, PoCUS shows potential as a screening tool for sarcopenia in older adults. [ABSTRACT FROM AUTHOR]

Background two common anti-diabetic treatments used are sitagliptin and sulphonylureas however evidence examining their comparative effectiveness in older people is limited. Objective to evaluate effectiveness of sitagliptin vs sulphonylureas when added to metformin in older (aged ≥75) vs younger people (18–75). Design retrospective cohort study. Setting UK Primary Care. Subjects 2,904 individuals prescribed sitagliptin (223 aged≥75) and 13,683 prescribed sulphonylureas (1,725 aged ≥75). Methods multivariable regression to analyse difference in HbA1c and weight, 12 months after add-on initiation and proportion achieving different glycaemic targets. Results after multivariate adjustment to remove baseline differences, the HbA1c after 12 months of treatment was on average 1 mmol/mol (95%CI −0.7 to 2.8) higher with sitagliptin vs sulphonylureas in older people though this was not statistically significant. The weight however, was significantly lower −1.4 kg (95%CI −2.1 to −0.7) with sitagliptin vs sulphonylureas. A lower proportion prescribed sitagliptin vs sulphonylureas recorded HbA1c < 48 mmol/mol by study end: Odds Ratio 0.63 (95%CI 0.42–0.95). In younger people, similar HbA1c reductions were also observed with both treatments, however weight after 12 months was even lower with sitagliptin vs sulphonylureas: −2.3 kg (95%CI −2.5 to −2.0). Conclusions similar HbA1c reduction was observed when sitagliptin or sulphonylureas were added to metformin in older and younger age-groups. Sitagliptin use led to modest comparative weight loss. There may be greater risk of over-treatment with sulphonylureas evidenced by greater proportion recording HbA1c < 48 mmol/mol by study end. This evidence supporting use of sitagliptin when add-on therapy is selected in older adults should be considered alongside the wider evidence-base and patient-preference. [ABSTRACT FROM AUTHOR]

Background the European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed considerably since then and it has therefore become necessary to update these recommendations. Methods under the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators. Results the final recommendations include four different domains: 'General Considerations' on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), 'Knowledge in patient care' (36 sub-items), 'Additional Skills and Attitude required for a Geriatrician' (9 sub-items) and a domain on 'Assessment of postgraduate education: which items are important for the transnational comparison process' (1 item). Conclusion the current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states. [ABSTRACT FROM AUTHOR]

Background: there is concern that there are insufficient numbers of geriatricians to meet the needs of the ageing population. A 2005 survey described factors that influenced why UK geriatricians had chosen to specialise in the field--in the decade since, UK postgraduate training has undergone a fundamental restructure. Objective: to explore whether the reasons for choosing a career in geriatric medicine in the UK had changed over time, with the goal of using this knowledge to inform recruitment and training initiatives. Design: an online survey was sent to all UK higher medical trainees in geriatric medicine. Methods: survey questions that produced categorical data were analysed with simple descriptive statistics. For the survey questions that produced free-text responses, an inductive, iterative approach to analysis, in keeping with the principles of framework analysis, was employed. Results: two hundred and sixty-nine responses were received out of 641 eligible respondents. Compared with the previous survey, a substantially larger number of respondents regarded geriatric medicine to be their first-choice specialty and a smaller number regretted their career decision. A greater number chose geriatric medicine early in their medical careers. Commitments to the general medical rota and the burden of service provision were considered important downsides to the specialty. Conclusions: there are reasons to be optimistic about recruitment to geriatric medicine. Future attempts to drive up recruitment might legitimately focus on the role of the medical registrar and perceptions that geriatricians shoulder a disproportionate burden of service commitments and obligations to the acute medical take. [ABSTRACT FROM AUTHOR]

There is currently wide variation in the structure and content of higher medical training in geriatric medicine across Europe and no common framework within which existing efforts can be compared. We set out to develop an audit tool to compare training between countries. An initial review of indexed and grey literature was used to develop an audit tool which was used as the basis of an Internet-based modified Delphi process incorporating the views of 14 expert geriatricians from across Europe. Items in the audit tool were included or excluded when supported by ≥75% or <50% of respondents, respectively. Items supported by 50-74% of respondents were carried forward with additional suggestions and modifications included following Round 1. Thirteen experts representing 12 countries responded to both rounds. 40/45 items were supported at Round 1. Five items were carried forward. A further 13 elements were introduced for consideration at Round 2. Consensus was gained after the second round. The final tool describes 52 items across four domains: general considerations, topics referring to knowledge in patient care, different roles that should be considered in medical training and topics regarding assessment. The resulting tool can be used as a basis for comparing higher medical training programmes in geriatric medicine between countries. Individual countries can use this to audit current practice. At an European Union level, the insights gained through such audit will form the basis of future work to develop an agreed postgraduate curriculum in the specialty. [ABSTRACT FROM AUTHOR]

Aims: to describe contribution of geriatric medicine to the development of integrated care for older people and to suggest future directions for the further development of integrated care for older people.Methods: literature review and case studies.Results: geriatricians have made a significant contribution to the development of integrated care for older people. The feasibility of this approach has been shown in demonstration projects. Although there is only limited evidence from randomised controlled trials, integrated care seems likely to be beneficial. There is an opportunity to develop new approaches to integrated care for older people in prevention and provision of community alternatives to hospital care.Conclusion: the principles and practice of geriatric medicine have been shown to underpin the successful development of integrated care for older people and should continue to do so as new challenges emerge. [ABSTRACT FROM PUBLISHER]

Background: delirium is common and serious, yet frequently missed by medical staff. It is known that delirium is widely taught and examined in UK medical schools; however, what is taught, and how such teaching is delivered, remains unknown. The primary aim of this study was to determine the content of UK undergraduate medical education about delirium and establish how it is delivered. A secondary aim was to highlight and share examples of gold-standard teaching on delirium.Methods: all UK undergraduate medical schools were invited to complete a survey. Schools were asked to describe how delirium was taught and to provide delirium-related learning outcomes. Learning outcomes were mapped to the three overarching themes outlined in Tomorrow's Doctors (knowledge, skills and attitudes).Results: 24/31 schools (77%) provided responses. In line with previous work, delirium was widely taught and examined. 18/24 schools reported at least one learning outcome that mapped to the knowledge domain, 19/24 for the skills domain and 2/24 for the attitudes domain. 4/24 evaluated the impact of sessions and 3/24 involved patients and the public in teaching. 13/24 schools were confident that exposure to delirium was guaranteed. Innovative teaching methods were reported by a number of schools; weblinks to examples are provided.Discussion: there was widespread failure to address attitudes on delirium within teaching, to evaluate the impact of sessions, to involve patients and the public in teaching and to guarantee exposure to delirium. Future teaching interventions should be directed at attitudinal outcomes, using a synthesis of clinical experience with multidisciplinary interaction and supportive technologies. [ABSTRACT FROM PUBLISHER]

Introduction: the rise in the number of older, frail adults necessitates that future doctors are adequately trained in the skills of geriatric medicine. Few countries have dedicated curricula in geriatric medicine at the undergraduate level. The aim of this project was to develop a consensus among geriatricians on a curriculum with the minimal requirements that a medical student should achieve by the end of medical school.Methods: a modified Delphi process was used. First, educational experts and geriatricians proposed a set of learning objectives based on a literature review. Second, three Delphi rounds involving a panel with 49 experts representing 29 countries affiliated to the European Union of Medical Specialists (UEMS) was used to gain consensus for a final curriculum.Results: the number of disagreements following Delphi Rounds 1 and 2 were 81 and 53, respectively. Complete agreement was reached following the third round. The final curriculum consisted of detailed objectives grouped under 10 overarching learning outcomes.Discussion: a consensus on the minimum requirements of geriatric learning objectives for medical students has been agreed by European geriatricians. Major efforts will be needed to implement these requirements, given the large variation in the quality of geriatric teaching in medical schools. This curriculum is a first step to help improve teaching of geriatrics in medical schools, and will also serve as a basis for advancing postgraduate training in geriatrics across Europe. [ABSTRACT FROM AUTHOR]

Geriatric medicine has an encyclopaedic sweep, reflecting the complexity of both the ageing process and of our patient group. Keeping up with, and making sense of, the relevant scientific literature is challenging, especially as ageing has increased in prominence as a focus of research across many branches of the sciences and the humanities. This review of research published in 2012 in generalist, geriatric medicine and gerontology journals has been compiled with a view to extracting those aspects of research into ageing which could be considered relevant not only to the practice of geriatric medicine, but also to our understanding of the ageing process and the relationship of geriatric medicine to other medical specialties and public health. The research discussed includes new insights into global ageing and the compression of morbidity; nosological, clinical and therapeutic aspects of dementia; an innovative study on the microbiome and ageing; epidemiological perspectives into multi-morbidity; an overview of the impact of the first waves of Baby Boomers; fresh thinking on geriatric syndromes such as orthostatic hypotension, kyphosis, urinary incontinence after stroke, frailty and elder abuse; an update of the Beers criteria and the first stirrings of recognition of the longevity dividend in the biomedical literature. [ABSTRACT FROM AUTHOR]

Background: the population is ageing globally and developing countries are experiencing the most rapid increase in the number of older persons. By 2045 the United Nations estimate that for the first time in history more people will be over 65, than under 15, years of age. The World Health Organization predicts that deaths from non-communicable diseases will rise by 24% in Africa in the next decade. The aim of this survey was to determine the specialist medical services available for older persons and the undergraduate and postgraduate training systems in place for geriatrics in each African country.Methods: a short survey was developed and sent to representatives from every country. Where appropriate, French and Portuguese translations were available.Results: responses were received from 40/54 countries (74%). Data were obtained via an internet search for a further three countries. Out of 43, 25 countries had no geriatricians. Out of 40, 35 countries had no formal undergraduate training for medical students on geriatrics and 33 of 40 countries reported no national postgraduate training scheme for geriatrics. Having at least one geriatrician in the country was associated with a World Bank upper middle-income status (P = 0.04), but there was no significant association with the population size (P = 0.395).Conclusion: despite increasing numbers of older people and the increasing burden of chronic disease there are few geriatricians in Africa. Without undergraduate training, even general medical physicians will have limited knowledge of specialist geriatric needs. This is an area that will require development and investment in the future. [ABSTRACT FROM AUTHOR]

Objectives: to evaluate specialist geriatric input and medication review in patients in high-dependency continuing care.Design: prospective, randomised, controlled trial.Setting: two residential continuing care hospitals.Participants: two hundred and twenty-five permanent patients.Intervention: patients were randomised to either specialist geriatric input or regular input. The specialist group had a medical assessment by a geriatrician and medication review by a multidisciplinary expert panel. Regular input consisted of review as required by a medical officer attached to each ward. Reassessment occurred after 6 months.Results: one hundred and ten patients were randomised to specialist input and 115 to regular input. These were comparable for age, gender, dependency levels and cognition. After 6 months, the total number of medications per patient per day fell from 11.64 to 11.09 in the specialist group (P = 0.0364) and increased from 11.07 to 11.5 in the regular group (P = 0.094). There was no significant difference in mortality or frequency of acute hospital transfers (11 versus 6 in the specialist versus regular group, P = 0.213). Conclusion: specialist geriatric assessment and medication review in hospital continuing care resulted in a reduction in medication use, but at a significant cost. No benefits in hard clinical outcomes were demonstrated. However, qualitative benefits and lower costs may become evident over longer periods. [ABSTRACT FROM AUTHOR]

Objective: the organisation of long-term medicine and geriatric medicine has undergone many changes during the last 15 years. The aim of this study is to gain an overall perspective of the present organisation of geriatric medicine in Sweden. Design: questionnaire survey. Methods: The Swedish Society for Geriatric Medicine and Gerontology, in collaboration with the Federation of County Councils and the Swedish Association of Local Authorities, sent out a survey to people in all county councils in Sweden. The subject of the survey was the speciality of geriatric medicine in the Swedish healthcare system, with regard to healthcare organisation, staffing and care production in 2000/2001. Results: there were 52 separate geriatric units, 41 independent 'clinics' and 11 'sections' within other departments. There were a total of 3,101 geriatric inpatient beds. On average, there was one geriatric bed for every 799 individuals within the local population aged 65 years and over, with a 10-fold variation between counties. Four counties had no geriatric provision. The 'geriatric clinics' were mainly located in university towns and averaged 85 beds per clinic, again with a 10-fold variation. There were 604 established positions for doctors within geriatrics, of which 63% were at geriatric clinics. On average, the clinics had 16 positions each (of which 75% were filled with geriatric specialists) with 7 beds per doctor. The corresponding averages for nurses and paramedics could not be summarised due to organisational differences between the county councils. In general, there were very few nurses with specialist training in geriatric medicine. Conclusions: the field of geriatric medicine in Sweden is very heterogeneous regarding terminology, designations, structure, staffing and care production. There is no overall structural plan for the role of geriatric medicine in Swedish healthcare, with the desired close connection between content and dimensioning of geriatric speciali... [ABSTRACT FROM AUTHOR]

The internet and world wide web make it easier for professionals, patients and carers to access medical expertise and technology. Websites providing information about geriatric medicine and gerontology include those of general and specialized journals and textbooks—including publications on geriatric psychiatry, geriatric emergency medicine, nutrition, ethics and law and geriatric nursing—and those of professional and research organisations. Also of use are sites related to allied branches of medicine—particularly dementia, stroke, Parkinson's disease, pain and geriatric rehabilitation. Topic‐based mailing lists facilitate discussion; in addition, some websites include discussions areas. Information specifically targeted at patients and carers is available at sites created by research charities and patient information and support groups. [ABSTRACT FROM PUBLISHER]

The article reflects on the declining place of the teaching of geriatric medicine in British medical schools. It cites the importance of students learning about the special problems associated with older people's health according to the "Tomorrow's Doctors" document released by the General Medical Council. It details the implications of the decreasing number of medical schools with separate departments or divisions of geriatric medicine.

Lord Amulree was unique amongst UK geriatricians in having a 'wide angled' view of the care of elderly people. This resulted from his work at the Ministry of Health, his clinical commitments and his position in the House of Lords, which enabled him to bring the problems of old age, elderly people and infirmity before a much wider audience. It can be argued that his joint Parliamentary Presentation in 1946 stimulated a surge in publications relating to the care of older people. He will be remembered for his maxim 'Adding Life to Years'. [ABSTRACT FROM AUTHOR]