Spring Meeting: 28th February 2004, London.
Venue: National Hospital for Neurology and Neurosurgery, Queen Square, London.
Theme: Age Related Issues in the Aviation Environment.
Report: This excellent meeting, held in London, was organised by Jeremy Radcliffe with help from Sally-Ann. They did an superb job, as usual, and their hard work is greatly appreciated. Very favourable reports have been received from all who attended. These included comments on the educational content and the organisation of the day. The dinner went down a treat as well!
Some members have kindly shared their thoughts about the lectures at our winter meeting. My personal thanks go to all who agreed, at such short notice, to be reporters.
Other speakers not reported below, included, Mike Bagshaw, who told us about the aircraft cabin environment and passenger fitness to fly and Kevin Gibbin who guided us through the inner ear and its associated problems.
Peter Saundby. “Infancy to Senility”.
Peter Saundby got the day off to a flying start. He reviewed the seven ages of man (and woman), from the mewling and puking infant, through the whining schoolboy, the lover, the soldier, to those who are sans eyes, sans teeth, sans taste, sans everything. He skilfully illustrated each age by describing their physical and psychological features and their relevance to all aspects of the aviation environment. The likely effects of these characteristics on flying, whether as a fare-paying passenger, a student pilot or a qualified pilot were all described; the latter case included the recreational pilot as well as those in the civil or military fields of work. Peter’s well thought out talk and excellent presentation set the tone for the day and left us feeling wiser and better informed at the end of it.
Mr Graham Duguid. “The Aging Eye”.
The lens becomes sclerosed with the passage of time so that the lens cannot focus and the rays of light are brought into focus behind the eye. Thus, there is difficulty with near vision, otherwise known as the ‘short arm syndrome’. Smoking and hypoxia make matters worse and it can be difficult to set the altimeter. It was suggested a small magnifying glass in the area over the setting might help. Glasses help if they are the look-over or half-moon type, providing there is no distance vision problem. He emphasised that a spare pair must be available and on the person for immediate use.
It was pointed out that modem contact lenses do not have a halo effect and might prove useful. Contact lenses could be for distance with the ‘look-overs’ for near, or alternatively, bifocals or varifocals can be worn. Glasses are reliable but they can have an image size difference plus a blind-spot due to the frames and in addition vibration may affect the vision.
Contact lenses on the other hand offer better vision are stable and one does not lose two at a time so that one lens can temporary suffice. However one may become intolerant to them and also infection may set in. Refractive Surgery is at present useful only for a distance vision correction.
Lens opacity may occur early and some may even be present with normal vision. The symptoms are glare, reduced vision and monocular diplopia. Correction of the aphakia is by surgery and an implant, with return to flying after three months. But the patient should be monitored for capsular opacification.
Glaucoma is more likely with age but may be hereditary and it produces a visual field defect. Xalaton has mainly replaced beta-blockers to increase the outflow of aqueous humour and surgery may be indicated. Macular disease causes deterioration of central vision but certification may be possible if the other eye is normal and a safety pilot present.
Dr Raymond Johnston. “Increasing Sugar – a link with increasing age”.
Rising age, rising sugar was the theme for Dr Raymond Johnston who amongst other things is a clinical tutor to the CAA. Although diabetes of all sorts is present in 3% of the population, this rises to 4.3% between 45 and 54yrs and 10% over the age of 70. The aim in considering any individual’s medical certification is to base decisions on evidence. It is nevertheless accepted that as in all clinical medicine, judgement and therefore acumen will be required. Liaison between diabetologist and aviation medicine specialist should be de rigueur. Type 2 diabetics are prone to micro and macro vascular disease associated with functional decline, visual and cognitive impairment, depression, amputations, strokes, coronary events and iatrogenic hypoglycaemia amongst other things. The risks (probability that an event will occur) are polymorphic and need perception, analysis and management.
15% of men and 23% of women with type 2 DM have ECG evidence of coronary heart disease at diagnosis 40% have hypertension. Lowering the blood pressure by 10% over 8 years reduces the risk of stroke by half and of death by 1/3. Commercial pilots with type 2 are screened for coronary artery disease starting with an exercise ECG and going on if necessary to coronary angiography possibly via myocardial scintigraphy. The risk of complications can be ameliorated by good blood pressure sugar and lipid control. For most this will mean drug treatment for all three.
Mr Ian Sargeant. “Orthopaedic Issues”.
Mr Ian Sargeant, who works in Sellyoak, Birmingham and is an RAF Consultant Advisor in Orthopaedics, presented information that at first hearing was mostly relating to fitness for military flying, but now there are live ejector seats in civilian use in ex-military trainers, and of course many considerations cross over into fitness for civilian activities. My memories of his interesting talk include:
Fitness for ejection seat flying after internal fixation of fractures: RAF policy used to be to disallow any lower limb metal in situ for fast jet flying because of fears of possible increased liability to fracture or diminished control abilities. However this was reversed in a re-think not unrelated to representations from a grounded RAF man (with an intra medullary nail for fractured femur) where a USAF pilot was flying in the same unit who still had similar metalwork in his leg.
Kunschner nails down the femur were used to treat fractured femurs in Germany in the Second World War, and some returning ex-POWs had theirs removed after return to Britain, such was the suspicion or worry about what was then a new and revolutionary technique. However now Professional Racing Motor Cyclists frequently have them in their legs, as do Rugby Players, without obvious problems. Do they diminish ability to control the aircraft? In reality usually no.
Do they alter the risk of injury during ejection or landing by causing stress concentrations? This depends very much on the exact nature of the metalwork.
Further questions included: Do they alter the future injury pattern? What is the risk of ejection with the particular metalwork in situ?
Why is metalwork removed? Fears of possible pathological effects of metal: local osteoporosis, peri-implant failure, corrosion and ion release, local or distant malignancy. Other causes for removal include; prominence, pain, exercise pain, barometric change pain.
What are the risks of removal? Not zero: e.g. re-fracture, infection, nerve injury, scarring. About 1 in 10 removals produces a new problem of some sort.
The blanket ban on flying with remaining internal fixation and insistence on its often unnecessary removal was therefore changed to become a case by case consideration of the issues.
Joint replacement and resurfacing. These issues include function, stability, distracting or intrusive pain, peri-implant failure. Is getting in or out and emergency exit impaired?
South Manchester prospective back pain study: 10% increase in back pain per year de novo.
My apologies to Mr Sargeant and those reading this if I am mistaken, corrections may be suggested by correspondence to the editor of this journal or the next time we meet at a BMPA meeting.
Prof Michael Joy. “Concerns of Cardiology, an age old risk”.
After an unexpected delay with his laptop in stubborn asystole, Professor Michael Joy, consultant cardiologist and advisor to the CAA, proceeded to regale us with some fascinating facts figures and anecdotes in equal measure. He emphasised that of all the risk factors leading to cardiac disease, ironically age is by far the most important and unalterable one. 25-30% of all males will die of coronary disease and half will expire in the first 15 minutes. It would appear that your chances of survival are greater if you have your coronary at one of Prof Joy’s lectures. Cardiac events in pilots are rare, but by necessity, usually catastrophic. In the last 10 years there have been three deaths in class one holders and six in PPLs (age range 22- 73). Over the last 40 years, of accidents in the RAF, cardiac causes were responsible for 22 out of a 1000. The ‘AGE 60’ project showed that accident rates are related to lack of recent and overall experience and age. The commonest cause of licence loss is cardiac related. The risk of having a coronary between a normotensive 50yr-old and a hypertensive 89yr-old increases by a factor of 128 and likewise, a stroke by a factor of 60. Sobering reading!
Mr Peter Thorn. “Professional and Instructional issues”.
Peter Thorn had been present for the whole day and his delivery belied his age which I had been reliably informed had reached 7,163,352 hours – or 82 years. He had been involved in instruction with, initially, the Royal Air Force and then with Oxford in the civilian world. He described how the more mature learner differed from the young aggressive male in being less dare devil. He felt the older student was usually from a background where he had been giving instruction and orders and now had to learn again to be the recipient of the same. He described the fear of failure phenomenon in the older student particularly with use of VHF communications where the open mouth failed to receive any connection with the brain in case the incorrect messages were transmitted. He also felt that the managerial level older student had a different learning curve and success was more likely with the continuity of basic training and exposure to the same instructors. We would agree that many FIs are dedicated to hour building but there are very few GA flying schools which are robust enough to give a pilot wages and a secure future.
Peter also touched on his involvement with handicapped flyers through the International Air tattoo. He had a nice anecdote relating teaching a thalidomide victim involving a Velcro strap on the yoke. Furthermore, when demonstrating straight and level at different air speeds the usual order of power, attitude and then trim was replaced by first use of the trim wheel to lower the nose and then the appropriate application of power was added which worked better for the pilot.
The talk was linked in much the same way as the whole day had been. Peter had words of advice about a certain small ruddered aircraft and those who have tried them will attest to their “sportiness”. In the aviation magazine that Peter Saundby had left for us, the same manufacturer gets a mention. Polly Vacher, one of his well known students, was mentioned also in the magazine and had just been turned back on a cross Antarctica expedition.
Mature students may be less common in the flying population but they go on to buy aircraft (and motor bikes etc.) and aviation toys. Peter had warnings about the use of GPS and the cost of failure to use the equipment professionally. If an aircraft is fitted with navigation or other avionics and they are serviceable and turned on, then the older student needs to learn how to use them – pressing “go to” can have serious consequences.
Now that is a problem we older people can share with the youngsters!
Summer Meeting: 9th-11th July 2004, Shenington.
The Summer meeting returned to its usual home of Shenington Gliding club for the informal and relaxed feast of gliding, flying, food and fellowship.
Autumn Meeting: 3rd-5th September 2004, Nottingham.
The meeting was organised by Kevin Gibbin. Members flew into Nottingham East Midlands Airport (EGNX) where Donington Aviation provided parking and reception facilities courtesy of Eric and Erica Bannister. Accommodation for the weekend was in the Holiday Inn at Castle Marina, Nottingham, situated on a basin of the Nottingham canal.
On the Friday evening members took a a trip on the River Trent in the ‘Nottingham Princess’, with a barbecue and disco. On the Saturday morning there was a visit to the National Space Centre in Leicester followed in the afternoon by a visit to Wollaton Hall, and its deer park.