rehabilitation

Geriatric medicine in Britain was born in the setting of a former poor law workhouse in London. Its early pioneers developed models of geriatric services and instigated research into the diseases pertinent to older people. Government initiatives championed the establishment of geriatric units but denied geriatric medicine the status of a clinical medical specialty. Despite an unfavourable image within the medical profession, medical services for older people flourished under the National Health Service to become one of the largest groups of medical specialties.

Soon after qualification, Fortescue Fox (1858–1940) began practice in a Scottish spa where he acquired a lifelong interest in chronic disorders, especially arthritis. He worked to improve the status of spa medicine, recasting it as medical hydrology. At the start of the First World War, his interests turned to the handling of war casualties and a seminal work on physical treatment and rehabilitation was published in 1916. He set up a physical treatment clinic for damaged soldiers and co-founded a residential community where such treatment could be coupled with paid work in rural crafts.

Background Physical fitness is impaired after stroke, yet fitness training after stroke reduces disability. Several international guidelines recommend that fitness training be incorporated as part of stroke rehabilitation. However, information about cost-effectiveness is limited.

This symposium covered a wide range of conditions of interest to the geriatrician, the general physician and the general practitioner, including demographic shift, the epidemiology of ageing, diabetes in older people, investigation and management of falls, an update on stroke (including the role of neurovascular clinics, stroke thrombolysis and rehabilitation) and the management of coronary heart disease in the elderly.

A 55-year-old woman with a history of excess alcohol intake presented to the acute medical unit following concerns regarding her electrolyte disturbances. During correction of the electrolytes, the patient developed central pontine myelinolysis. The unusual features in the case were the absence of hyponatraemia which is usually associated with central pontine myelinolysis and also the good recovery that the patient made. Looking at the electrolyte changes, we suspect there may be a link to the rapid osmotic shifts occurring during refeeding and central pontine myelinolysis.