Dr Mashkur Khan, President of the RSM Geriatrics and Gerontology Section, is the lead physician for the care of the older person team at Epsom Hospital in Surrey. Specialising in Parkinson's disease, syncope (fainting) and memory loss, he is also an honorary senior lecturer for the University of London. Here he talks about the work of the Section, his plans for cross-section work at the RSM and current hot topics for geriatricians.
Are there particular topics or themes that the Section's education programme is focused on this year? Are you planning to work with other sections to co-host events?
On Thursday 23 March 2023, we have the second part of Biology of Ageing. In part one we covered topics like periodontology and dental health, a marker of systemic disease often overlooked, the ageing endocrine system, balance and gait disorder. In March we’ll be hearing Dr Shruthi Konda, Linacre Fellow at the Royal College of Physicians, talk about lung diseases for the geriatrician, and also hear expert presentations on the ageing liver and the ageing eyes.
Then on Wednesday 21 June, we are very excited that Professor Craig Ritchie from Edinburgh will be coming to talk to us about the landmark studies in dementia at our meeting focusing on new advances in gerontology.
I’m also in the process of arranging a meeting with our RSM Digital Health Section to run a programme about dementia. Loneliness and depression is an important aspect of geriatric care. Digital technology such as robots, artificial pets, avatars and so on offer some potentially exciting solutions in that area.
Looking ahead, I’m hoping to forge closer ties with our GP and primary care colleagues and, further afield, work on growing our partnerships with the Royal College of Physicians and the British Geriatrics Society.
How is the Geriatrics & Gerontology Section supporting trainee geriatricians?
Our education programmes are designed to help the development of all grades of doctors but monitoring how our trainees are progressing and how we can enhance their learning is a particularly important aspect of the Section’s work.
Our prizes, such as the President’s essay prize, the A C Comfort prize and the clinical audit and governance prize, offer trainees opportunities to submit posters and oral presentations. Our audit prize, for example, allows trainees to carry out a clinical audit focusing on the common causes of a specific condition among the elderly. The Section Council chooses three or four people to judge the entries and the winners then have the chance to come and present their work at one of our Section meetings. It’s a good way of stimulating their appetites to build on and develop their work.
Which 'hot topics' are of particular interest to geriatricians and their patients currently?
New and exciting developments in dementia care are particularly important. Two new drugs, Aducanumab and Lercanimab, are the first new groups of drugs which can actually reverse the progress of dementia.
Thirty or forty years ago people were dying of heart disease, but statins and blood pressure control have made an enormous impact. Stroke care has become much better managed than twenty years ago too, thanks to surgical and neuro-radiological procedures. But there have been no developments in dementia care for almost thirty years and it’s almost an epidemic.
The fact that researchers have come up with two fabulously promising dementia drugs is very exciting and we are looking forward to them being licensed for use in the UK, hopefully in the next 18-24 months.
The second very important development concerns Parkinson's disease. Thankfully it’s no longer a taboo subject, with famous people such as TV presenter Jeremy Paxman and comedian Billy Connolly talking about living with Parkinson's.
For the first time, we're beginning to understand more about this neurodegenerative disorder and its overlap with dementia. In my clinics I see dementia patients with tremor and it’s clear that both diseases are on the same neurodegenerative spectrum, with wear and tear of the brain likely to be the main cause. There is big potential for research on this overlap.
The other hot topic is how we manage the care of our elderly patients. In my career as a geriatrician, we’ve seen long term and intermediate care disappear and we’re paying the price now. There’s nowhere for very disabled, very dependent elderly patients to go. Again and again, they end up back in hospital because there’s nowhere else to go.
How do health inequalities exacerbate care for the elderly?
I’m concerned about the huge disparities between the rich and the poor. Some of my elderly patients are not heating their flats, some are only having one meal a day. Many are extremely anxious about their future with the cost-of-living crisis. A lot of them are relying on food banks and even those are running low on supplies. I feel there is a silent majority who have no voice.
We need to think outside the box and consider innovative models, such as the dementia villages in the Netherlands where patients are living in their own community, with shopkeeper, bus driver and so on working in dual roles as dementia nurses.
How do you see geriatric care developing in the future? Are there potential advances in treatment and care that are going to make big differences to patients?
I see geriatric medicine moving in a different direction because one of the reasons why geriatrics as a specialty has survived is that we are able to reinvent ourselves. There was a time when geriatrics was practised solely in the community. Then we moved into the hospital and then into acute medicine where we started doing acute on calls and helping with the on- call rota. Stroke care was our next move and now, if you look at stroke physicians, about 70% are geriatricians.
I see geriatrics moving with the needs of the community and the population. That could be very well mean having one foot in the hospital and another foot in the community where I think we would be best placed to offer our expertise, working with GPs, specialist nurses, therapists and social services.
How long have you been a member of the RSM and how has your relationship with the Society helped in your career development?
I’ve been a member of the RSM since 2004. It’s a unique organisation and represents a very important part of my clinical work. It’s a place where I learn, grow and develop and get the intellectual stimulation and excitement about being a doctor.
There isn’t anywhere else where over 50 medical and surgical specialties come together under the same roof. That allows a lot of cross-fertilisation between specialties. For example, I sometimes attend ENT meetings hosted by the RSM Laryngology & Rhinology and Otology Sections because they are relevant to my specialty which is balance and dizziness.
I also find it helpful to exchange ideas and interact with retired consultants when I visit the RSM. Quite often you’ll find former presidents or senior officers of other medical royal colleges working in the RSM library or socialising in the bar.