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Medicine of the Older Person: Now the drugs don't work: challenging polypharmacy

RCPE Symposium Royal College of Physicians of Edinburgh

Date: Thursday, 21 March 2019


Royal College of Physicians of Edinburgh
9 Queen Street



The numbers of people simultaneously prescribed 10 or more medications has almost quadrupled in the last decade. This is fuelled by a ‘perfect storm’ of an ever-ageing population, growing multi-morbidity, the increasing super-specialisation of medicine, a proliferation of single-disease-centric guidelines, publication bias and profit-driven marketing of new therapeutic agents. In contrast, there is remarkably little guidance on how and when medications can safely be stopped. Older people are much more likely to experience polypharmacy, but there are still numerous reports of unjustified under-treatment of common conditions in old age, such as depression or pain. What is a prescriber to do?

This symposium will provide much needed balance and advice on prescribing and therapeutics in common conditions of old age. It will explore the state of the art in medical optimisation, non-drug therapies and common therapeutic challenges in the care of older people.

Top experts in the field will deliver an entertaining and stimulating interactive programme using a range of formats to appeal to all clinicians and allied health professionals in hospital or community settings. Anyone who works with older people but does not think the programme is particularly interesting or relevant to them is especially encouraged to attend!   




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Thursday 21 March 2019


Registration and Coffee


Welcome and Introductory Remarks
by President, Royal College of Physicians of Edinburgh

Session 1 - Turning prescriptions into recipes for health

Chair: Dr Victoria Henderson, Consultant Geriatrician, Dr Gray's Hospital, Elgin


The burden of treatment for patients
Professor Frances Mair, Professor of Primary Care Research, University of Glasgow
* the hidden impact * what can go wrong? * how to minimize burdensome expectations    


De-prescribing to minimise polypharmacy
* how safe is de-prescribing? * who can benefit? * how to achieve it? 


Action against prescribing errors: an update on medication safety
* the epidemiology of prescribing errors and adverse drug effects *how to improve prescribing for older people? * systems and innovations that optimize medication safety

Session 2 - Non-pharmacological therapies - just say 'no' to drugs?

Chair: Professor Miles Witham, Geriatrician and Professor of Trials for Older People, Newcastle University 


Break-out sessions: best practice for everyday challenges
(tea/coffee will be served in each room at start of session)

Shared learning around the best way to keep older people active and healthy in both hospital and community setting.

A - Sit less, move more: tips for encouraging physical activity to increase resilience in frailer older people, Prof Dawn Skelton, Glasgow

B - Ending pyjama paralysis, Mrs Sam Stirling, Edinburgh

C - Reversing the cascade to dependency, Mrs Laura Hay, Aberdeen

D - Non-pharmacological management of delirium, Dr Dearbhail Lewis, Belfast

E - Nutrition in old age, Ms Jane Fletcher, Birmingham

F - Rehabilitation after stroke, Prof Peter Langhorne, Glasgow  


Chair: President, Royal College of Physicians of Edinburgh

Evidence-based non-pharmacological therapies for common geriatric syndromes
Professor Antonio Cherubini, Instituto Nazionale di Ricovero e Cura per Anziani, Ancona, Italy 



Session 3 - Prescribing in practice

Chair: Professor Angela Timoney, Director of Pharmacy, NHS Lothian, Edinburgh 


Making best use of your practice pharmacists
Ms Jacqueline Kelland and Ms Ruth Campbell, Medicines Management for Care at Home Pharmacist, Primary Care, NHS Lanarkshire
* what are practice pharmacists? * medication management in community settings * the future of multi-disciplinary medications management


Dispensing aids: for who, when and why?
Professor Derek Stewart, Professor of Pharmacy Practice, School of Pharmacy & Life Sciences,  Robert Gordon University, Aberdeen
* epidemiology of dispensing aid use, regulation and oversight  * do dispensing aids improve patient outcomes


Update on pharmacological treatment of delirium
Dr Ajay V Macharouthu, Consultant in Liaison Psychiatry, NHS Ayrshire & Arran
* SIGN guideline for delirium * effective prescribing  * promising new treatments


Coffee / tea

Session 4 - Ethical dilemmas in optimising treatment

Chair: TBA


Case based learning – (i) a nutritional conundrum (ii) end of life decisions

Interactive session covering challenging ethical dilemmas run with support and collaboration from the Law & Ethics Special Interest Group of the British Geriatrics Society

Dr Premila Fade, Consultant Geriatrician, Northwick Park Hospital, London

Dr Andrew Stanners, Consultant in Stroke Medicine, Mid Yorkshire Hospitals NHS Trust


Debate: “This House believes older people are routinely over-medicated”

For the Motion:
Dr Graeme Hoyle, Consultant Geriatrician, Aberdeen Royal Infirmary

Against the Motion:
Professor Carmel Hughes, Professor of Primary Care Pharmacy, Queen’s University, Belfast  






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Online booking for this event closes on Tuesday 19 March 2019 but places may still be available after that date - please contact the Education Co-ordinator for further information.

An early bird discount applies until Wednesday 20 February 2019.

Registration fees


Early Bird fee
until Wednesday 20 February 2019

from Thursday 21 February 2019

Standard fee



RCPE Fellow



RCPE Collegiate / Associate / Foundation Member



Nurse / AHP / Pharmacist / Postgraduate student



Retired FRCPE, including lunch



Retired FRCPE, no lunch



Medical student



Long term / other leave – Fellows and Members, please contact the Education Co-ordinator as some discretion may be available.

Collegiate and Associate Members of the RCPE in clinical research posts may be eligible for funding - please contact the Event Co-ordinator for further information.

Trainees – Scotland Deanery medical specialty trainees can attend any number of eligible symposia for a one-off payment from their study leave budget (block grant scheme).

Further details can be obtained from the Education Co-ordinator.

Free places

Unpaid post – Nil, if confirmation of status provided – please contact the Education Co-ordinator.

Refugee doctors – free places are available to refugee doctors who are Associate Members of the College. Associate Membership for refugee doctors is available free of charge. Please visit our website for instructions on how to join, and then apply to the Event Co-ordinator for your free place.

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Further Info

This event is open to all grades of medical, health care and scientific staff and to students. If you are unsure about eligibility, or the correct fee category, please contact the RCPE member of staff responsible for the event .

All relevant events are approved for Continuing Professional Development (CPD). A certificate of attendance with CPD information will be issued electronically to individual delegates via email. Please note - certificates can only be issued to attendees who have signed against their name on the CPD Register/Delegate List available at each event and completed feedback forms have been received.

Please note that on occasion event programmes may be subject to change due to unforeseen circumstances.

A professional photographer may be in attendance at this event. Photographs may be used by the College in digital and printed publicity material. If you do not wish to be photographed, please let a member of staff know at the registration desk.


As a listed building, the College has restricted disabled access. A wheelchair lift is provided at the rear of the College giving access to the main historic rooms. For further information and assistance please contact the RCPE Co-ordinator responsible for the event.

An induction loop system is available in the Great Hall.

Accommodation and Directions to the College

The College has negotiated special rates with a number of local hotels.

Parking is available on street (metered) or at the Omni Centre car park, 10 minute's walk from the College.

Download pdf map and directions

Bicycle racks are available for cyclists at the door to 8 Queen Street. For access to further bicycle racks, please ask at reception.

Local walking routes

Three short walks can be enjoyed from the College. So if you are visiting us, why not explore the local area. Details can be found at Medal Routes.

Commercial Sponsorship

Many events are supported by commercial companies taking stand space. Health professionals and NHS managers are invited to visit the company stands during the breaks. Companies interested in sponsoring this, or other events listed on the Calendar, should contact the Co-ordinator responsible for the event.

Exhibitors/sponsors play no part in the planning or delivery of the event and the College has developed an Ethical Sponsorship Policy to support organising committees and committee chairs in their negotiations with potential commercial partners for education and other events.

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