From criminology to gerontology: Case studies of experiential authenticity in higher education

This article discusses two examples of higher education teaching interventions with evidence of high levels of student engagement resulting from experiential authenticity – the Prison: Learning Together module and an intergenerational module about ageing (NUAGE). The article outlines the aims and objectives of the two approaches and discusses the core findings from the module evaluations. The findings demonstrate that creating communities of practice using experiential authenticity enhances the learning journey for students, resulting in greater participation. Experiential authenticity has been identified as distinct from other forms of experiential learning with common features thought to result in sustained student engagement included collaboration with peers, an authentic experience of working with learners from outside the university, and reciprocal respect between members of diverse groups. We make suggestions as to how these engagement themes could be applied to other higher education settings whilst acknowledging the challenges involved.


Background
Internationally, academics express frustration with perceived lack of engagement by students and often seek to adapt their teaching strategies to improve the student experience by maximising engagement (Baron & Corbin, 2012). Similarly, as authors of this article based in two separate UK universities, we have persisting concerns about our students' levels of engagement. Lack of engagement may manifest as poor attendance, failure to complete preparatory reading, low grades and lack of enthusiasm about group work or communication with peers. The definition and understanding of student engagement as a concept continues to be debated (see Kahu, 2013), however, engagement persists as an academic and socio-political construct that is significant to individual students, higher education (HE) institutions and policy makers. Trowler's (2010) review assembled evidence correlating student engagement in HE with measures of success such as student satisfaction, academic achievement and improved self-esteem. Davis, Summers & Miller (2012) argue there are three dimensions to student engagement; cognitive, relational and behavioural. Cognitive engagement refers to the quality and depth to which students engage with their learning and the effort they put into developing their own understanding of course material. Relational engagement concerns how students interact with those in the learning environment, such as their peers or lecturers. Finally, behavioural engagement refers to the level of participation during sessions and with the education community. In all three of these dimensions, engagement is enhanced when students show a motivation to study, increase their participation in the learning environment and have a sense of belonging to the learning environment.
The dimensions of student engagement are complex but common factors that are argued to enhance engagement are evidenced in practices of social learning theories. Lave and Wenger's (1990;Wenger, 1998) models of situated/experiential learning and communities of practice suggest authentic communities enable students to participate more effectively in the learning process. An authentic learning community is one that aligns teaching with real-life setting and provides realistic problem-solving opportunities. Tasks should replicate real-world situations, whereby students don't just learn about a topic, but rather learn how to do it (Jonassen, 1999). It is argued that students need to be "encultured into the discipline" (Lombardi, 2007: 9) by gaining direct experience of discipline-specific culture through authentic learning. However, developing authentic communities of practice using experiential learning is not always possible in higher education, particularly in subjects such as criminology and gerontology. Criminology deals with social institutions, such as prisons and courts, that are largely inaccessible as spaces for learning. Gerontology concerns social, psychological and biological aspects of ageing. Gerontology and criminology teach students about populations that most student have little direct contact with, and who may be affected by social isolation, degenerative disorders, imprisonment, or addiction. This paper discusses two distinct modules that evidenced high levels of student engagement on all three dimensions. The case studies are unique because the approach to enhancing student engagement was to create diverse learning communities that brought together traditional (fee paying, formally enrolled and situated in HE) and non-traditional (non-fee paying, situated outside the university) learners. The findings from the case studies indicate that taking an innovative approach to authentic learning communities, what we have termed experiential authenticity, not only enhances student engagement during the modules but has impact beyond the modules. The two case studies discussed are, the Prison: Learning Together module run as a partnership between Leeds Beckett University and HMP Full Sutton, and Newcastle University Ageing Generations Education (NUAGE), a module for undergraduates at Newcastle University (Tullo, Greaves, & Wakeling, 2016). These were two entirely separate modules delivered at different universities in different academic disciplines, however they both set out with the same objective, which was to enhance student learning by diversifying the learning communities. The collective case study approach leads to more robust and reliable conclusions, offering a better insight than only using a single case (Yin, 2003). By bringing together two case studies from distinct academic disciplines, but with a shared goal of maximising engagement of diverse groups of learners, we aim to identify generic attributes leading to successful engagement that could be applied more broadly across academic disciplines.

Prison: Learning Together
In 2016 Leeds Beckett University set up their Prison: Learning Together module in partnership with HMP (Her Majesty's Prison) Full Sutton, a category A prison (a prison classified as high security, housing those who have been determined a threat to the public, the police or national security) in North Yorkshire, and in 2017 the module ran for the first time. Prison: Learning Together is an accredited module delivered by Leeds Beckett University to students from both outside and inside the prison. The module was delivered at HMP Full Sutton and was taught to a group of students containing serving prisoners (N= 12) and Leeds Beckett undergraduate students (N=11). The module ran for 12 weeks and consisted of fortnightly classroom sessions (7 in total including an introductory lecture) that were held in HMP Full Sutton's educational department. The classroom sessions lasted 2.5 hours and consisted of a lecture, a short break and seminar activities. In each session a guest lecturer, who had written about prisons and punishment, would deliver a lecture on their subject area. This was followed by small group discussions, based on the reading the students had been allocated. The small groups consisted of two students from Leeds Beckett University, two students from HMP Full Sutton and one facilitator (experienced teaching assistants from Leeds Beckett University and the University of Leeds).
The independent evaluation (see Young, 2018) was a qualitative research project that sought to understand the experiences of the students who had undertaken the Prison: Learning Together module. Qualitative methods were deemed the most appropriate to enable the researchers to uncover the underlying rationales for undertaking the modules and discuss their experiences in depth. The preferred method for the evaluation was individual semi-structured interviews, whereby the key research questions could be addressed. Individual interviews were chosen over focus groups to ensure all students could speak openly and honestly about their experiences (Miller & Glassner, 1997;Davies, 2000). All of the Leeds Beckett students and 10 of the students from HMP Full Sutton participated in the interviews (one HMP Full Sutton student was unable to participate due to his other commitments when the interviews were taking place and one student had been released). The interviews were fully transcribed, imported to NVivo and a rigorous thematic analysis was undertaken. Initial deductive coding was undertaken using the research questions, followed by an inductive process of generating the key themes (see Guest, MacQueen and Namey, 2012;Silverman, 2005). Evaluation of Learning Together gained full ethical approval. Ethical approval was granted from the School of Social Science Ethics Committee at Leeds Beckett University. Approval to undertake the research at HMP Full Sutton was granted from the National Offender Management Service (NOMS).

Newcastle University Ageing Generations Education (NUAGE) module
In keeping with Newcastle University's commitment to improving the lives of older people through research and teaching, a module about ageing was developed for undergraduate students registered on any degree programme across the university. The aim was to approach the subject of ageing broadly, with content covering multidisciplinary aspects of gerontology such as health, innovation and social policy. NUAGE was developed as a supernumerary module for students electing to undertake additional credits beyond their degree programme. Adopting a collaborative approach to curriculum development, a small group of older volunteers were invited to a consultation meeting to review the aims of the module and refine a draft curriculum. Based on the input of older people in the planning meeting, a steering group of older people was convened, recruited through a university-based user group (Voice, 2018) to develop and pilot the module in 2014. Older people, working alongside faculty, took part in the design, delivery and evaluation of the NUAGE pilot (Tullo, Greaves & Wakeling, 2016). The evaluation of NUAGE received Faculty ethical approval from University of Newcastle Based on the outcomes of the pilot, the curriculum was refined for subsequent annual iterations of the NUAGE module. The team of older people (experts by experience -EXBEX) continue to collaborate on the design, delivery and evaluation of teaching for 30-35 undergraduate students annually. NUAGE evaluation data was collected iteratively across the life of the project. Methods of data collection from older participants and students varied and included quantitative and qualitative questionnaires, focus groups and interviews. Detailed accounts of data collection and analysis methods are available from previously published articles -focus group data with EXBEX members was analysed using an iterative coding process in keeping with a framework approach (Tullo, Elliott & Wakeling, 2019). Interviews with NUAGE students were not formally analysed but provided explanatory information that could be triangulated with data from qualitative questionnaires (Tullo, Wakeling & Pearse, 2018). The aim was to gather evidence of impact on students and older people and of reciprocal learning between participants.
The two case studies offered fee-paying university students the opportunity to learn alongside non fee-paying participants who had lived experience of the topics being covered. One module involved taking students off campus to learn within a high security prison and the other brought older people onto a university campus. On both these modules there was 100% overall student satisfaction (derived from the anonymous end of module evaluations of both modules) and 100% student participation in the classes (all students, in both case studies, attended the classes and took part in class activities). The following section discusses the overarching themes, inherent to both modules, to help explain why these modules were particularly successful.

Collaborative learning communities
Both the Prison: Learning Together and NUAGE modules were designed using principles of collaborative learning. This involves learners taking responsibility for their own and their peers' learning by working together on tasks and assignments. There are numerous benefits of collaborative learning noted by authors (see Laal & Ghodsi, 2012;Tinto, 2003) that make it distinct from group work (Scheuermann, 2018). Prison: Learning Together students had to undertake collaborative learning during class activities and in the production of a group poster. All the students worked together and contributed to the discussions, tasks and poster, with no learners feeling as though the workload was unequal. The university students were able to offer their academic knowledge to the collaboration and the students in prison were able to contribute personal experience. In this model, the students had to work together because they were reliant on one another: [W]e said quite a bit in our presentations that we're sort of doing the more academic side whereas they were doing the lived experience side. So I think, they kind of even out quite nicely, we had academic and then like real life experience (Leeds Beckett student).
Similarly, NUAGE students worked collaboratively in multi-disciplinary groups on an innovation project with an EXBEX member as a mentor. The EXBEX mentors were able to work with the group to offer advice based on their experience of ageing, including knowledge of healthcare systems, retirement and pensions. In addition to the summative marks allocated by staff for the group projects, EXBEX members offered formative feedback comments including an assessment of how effectively groups had collaborated.
From the outset of the Prison: Learning Together module, the university students had a unique sense of identity because they had been the fortunate few to secure a place on the module. Each student had to apply for the module and, if shortlisted, were interviewed (the same process was put in place for the HMP Full Sutton students). Therefore, this was a group of students who had a desire to learn alongside each other; they possessed enthusiasm for the module and felt fortunate to be given this unique opportunity. NUAGE students did not have to compete for a place but were united by their interest in ageing above and beyond their parent degree programme. They were motivated to go above and beyond the minimum requirements of their degree, including dedicating time in the evening to attend the programme.
For a community to work effectively, there needs to be a shared common goal. The common goal for the Prison: Learning Together university students was the desire to learn, which was not evident in traditional learning settings, as noted here by one student: It was different like, with other modules with Uni, I find it so awkward because I want people to speak and somebody is asking a question, I don't want to be the only one putting my hand up and saying something. I want other people to speak with me, to have a debate or whatever it is. I love it when people do but then you get the awkward seminars where people don't speak at all and I feel so sorry for the lecturers that are taking them because they must feel really awkward waiting for somebody to speak up. Whereas with that, everyone was there, everyone did the application and they wanted to do it and, in that environment, you have got to speak up and voice your opinion and whatever it is that you know. They were willing to do that. NUAGE students made similar observations when asked to identify the 'most useful and enjoyable' aspects of the module: Working in a group to a common goal. Very enjoyable and a lot learned. Especially intergenerational aspect very important (2017 student -questionnaire).
For Prison: Learning Together, learning goals differed between the university and prison students, in that the university students wanted to learn about imprisonment from the perspective of people residing in prison, and the prison students wanted to learn about criminology and often used it to make sense of their own situations. Despite the difference in goals, there was still an overarching common goal that enhanced the collaborative learning and empowered students to take responsibility for their learning (see Gokhale, 1995). NUAGE students differed from EXBEX members as they were designated as the 'learners' -EXBEX members did not have an obligation to undertake assessment. However, feedback from all participants demonstrated comprehensively that reciprocal intergenerational learning was fundamental to the success of the course: Chatting with the Exbex members was very useful in terms of understanding the effects of ageing and the societal changes that they have witnessed over the years (2018 student -questionnaire).
I felt it important to be at the lectures, from a learning point of view to understand what the students had been taught or lectured about, so I would learn at the same time. (2016 EXBEX team member -focus group) Detailed analysis of data from focus groups with EXBEX demonstrated that 'learning' (from the students and each other) was the most pertinent outcome of participation in NUAGE for older people. For an account of the iterative coding process following a framework approach to qualitative analysis data collection please see Tullo, Elliott & Wakeling, (2019).
A further aspect that has contributed to the creation of both of these successful communities of practice is what we have termed 'positive peer pressure'. The evaluation explored why the process of learning for the university students had changed, particularly in relation to their dedication to undertake pre-set readings, attend all classes and participate equally. Prison: Learning Together students discussed how they felt pressure to engage with the material, knowing that the other learners were relying on them. In the interview extract below, one student explains why this mode of learning encouraged them to engage with the learning resources and how this contributed to developing a community of practice.
INT: Why is it that you felt that you had to do the reading and you had to sit in group discussions when it doesn't happen like that in other modules? Student: I think it's the sense of they're relying on us and we're relying on them and I think that came through quite a lot in the assessment, like when we did the whole poster and stuff like that. I knew that if I don't sit and do the reading, we're all going to have to talk in the room at some point, we're all going to have to talk to someone, if I don't do it they're going to find out I haven't done it and I don't really want the guys who are in maximum security prison to be angry with me. That's not what I'm here for. But yes, it was more a sense of they were counting on us and when it come to the group presentation, we felt like we were counting on them and I think that balanced it out quite well. We all needed each other. And yes, it brought a whole sense of like a class, a proper class, how it would have been at school rather than at uni. Because at uni it's so self-study, everyone for themselves and this wasn't like that at all. It was a really group environment, group mentality and we all knew that we had to do it all for each other, it wasn't just for our own grades, we knew that we wanted the best for them as well.
For the NUAGE module group project, a proportion of the grade relied on peer-marking to ensure that proportional effort was duly rewarded. In both case studies it is evident that creating a diverse learning environment encourages students to develop a community of practice whereby all those participating in the learning feel empowered to offer something. They also feel a sense of obligation to their peers because they are relying on one another in order to create and sustain this learning community.

Diversifying the learning communities
The evaluations of both modules demonstrate that these approaches to learning resulted in a positive social impact whereby students learned to appreciate the knowledge and experience of people who they would not normally study alongside or meet socially. On the Prison: Learning Together module, the university students were able to break down social barriers and see those often labelled as 'evil', 'dangerous' and 'outcasts' as people, and importantly as co-learners (Young, 2018). The students spoke openly about viewing people differently who had been convicted of crimes and the greatest impact of the module was to challenge their preconceptions about people in prison. Similarly, data analysis in relation to NUAGE students' perceptions of ageing provided evidence that students' expectations about growing older were more positive following the module (Tullo, Wakeling & Pearce, 2018).
A further benefit of the diversification is the sharing of skills. On Prison: Learning Together saw the university and prison students bring different skills to the sessions. The university students were able to share their academic referencing and writing skills and knowledge of criminology with the prison students. The prison students enhanced the university students' communication skills by increasing their confidence to ask questions, challenge the readings and verbally present information. The collaborative nature of the learning communities resulted in university students having to participate in their small groups, communicate their reflections on academic scholarship and, in some cases, assist the prison students with the academic skills.
We note that university students today can struggle communicating effectively in face-to-face and group interactions, leading to many educators adopting technology enhanced approaches to overcome some of these difficulties (see Young & Nichols, 2017). Diversifying the learning communities enables university students to feel empowered by their ability to contribute to ideas and discussions, whereby they don't feel that they are in competition with their peers, they are all equal learners. NUAGE students complete a reflective essay concentrating on what they have gained from participation. Improved communication is a common theme: I decided to undertake this course to gain much wiser insight firstly into having contact with elderly people to be able to communicate in a common language, to debate their ideas and understanding of how communities work socially or break down more.
[NUAGE] helped me learn how to communicate with older people and to also be more sensitive

Impact beyond the modules
The greatest impact of the Prison: Learning Together and NUAGE modules on the university students went beyond the core learning outcomes of the module. There is evidence of a social impact, whereby students were able to break down social barriers with a population of people with whom they would most likely have limited or no contact. This impact has enabled the students to reconsider their preconceptions and develop a more open-minded approach and see people for who they are, rather than only for the crimes they have committed or the age that they are.
Most of it's personal, that I'm going to take away. It really opened my eyes to the complexity of society and how we have this, kind of, one scheme fits all and actually it doesn't work like that. Everybody in that prison, from students to prisoners, all had different lives and different life experiences and it was quite clear to see that you can't take a one approach fits all with everybody. Whereas in my previous jobs or even during uni, that's a kind of one approach fits all. Whereas it brought into reality, when I was in there, you can't go through life that blinkered because it just won't work for anyone. (Leeds Beckett Student) Coming to understand that there is no archetypal 'old person' meant that I could not describe one single process of ageing that could be deemed universal. I would now simply define it as 'chronological progression throughout life'. Progression in this sense is not synonymous with maturity, and to me only means that we are gradually moving forward in time. However I firmly believe that ageing varies so richly between people, cultures and communities, to the end that it would be only foolish to make assumptions about an individual's experience of moving through their life. (2017 student -reflective essay) There is also evidence of the modules having an impact on students' future aspirations having completed the modules. For the Prison: Learning Together students, the experience of learning alongside serving prisoners inspired them to pursue careers working within prisons or working with people in the community who had been in prison. Five of the Leeds Beckett students decided to pursue careers working with either prisons or probation (two of who have now secured employment in prison education) and two decided to undertake further education to learn more about the criminal justice system. Other students, like Tracey, were encouraged to undertake some form of work to help people who were, or had been, in prison: Meeting them has made me want to fight their corner a little bit more because even though I was quite open minded going into it, it has made me more passionate for wanting to help people like that.
An evaluation of the trajectories of NUAGE students following participation in the module is underway. Students' reflective essays noted a series of aspirations to use their new knowledge and skills in future: The communication skills I have worked on as part of this course and the awareness of the central importance of communication in the lives of people with neurodegenerative diseases has given me a firm foundation to build selfawareness to influence the way I treat and the way I care for my future SLT clients (2016 student -reflective essay).
I am looking forward to implementing a refreshed view of the older generation in my work as a Care Assistant (2017 student -reflective essay).

Discussion
The bringing together of non-traditional learners with traditional learners highlights the importance of diversifying the learning communities to enhance the learning experience for university students. For both case studies a crucial component of this diversification was the authenticity of learning. Students studying the Prison: Learning Together and the NUAGE modules found the learning process more engaging because of the authentic experiences of their peers. Herrington & Herrington (2006) discuss authentic learning environments as those that enable real-world problem-solving activities. They argue that the physical environment plays an important role in this authenticity and this was evident in the Prison: Learning Together module. Learning about imprisonment, whilst being in prison, enabled students to see first-hand how the concepts, theories and empirical research studies were applied in the real-world setting. This led to what Nichols (2018) has termed sensory authenticity, whereby students could get a sense of what it was like to be in prison. For the NUAGE students, participation in a seminar when they wore equipment to simulate the symptoms of common age-related conditions such as arthritis and visual impairment was a further example of the importance of sensory authenticity. This type of sensory simulation has been used elsewhere with evidence of student satisfaction and development of empathy (Qureshi, Jones, Adamson & Ogundipe,, 2017;Koblar, Cranwell, Koblar, Carnell, & Galletly, 2018).
The pedagogical approach of both case studies differs from other community-based learning approaches such as servicelearning, whereby students go into the community and learn through the experience of participating in an existing health or social care service (Cronley, Madden, & Davis, 2015;Madden, 2000). Whilst service learning is an effective way of achieving experiential learning, this approach designates the students as service-providers acting in a different role to those members of the public that they serve. Both of the case studies align more closely with situated learning theory and communities of practice, where the traditionally registered university students' roles overlap and complement those of learners from outside of the university (Lave & Wenger, 1990;Wenger, 1999). Using Wenger's (1999) theory of communities of practice, the findings demonstrate that this form of learning can be understood as people engaging in collective learning. They share their experiences and help each other through the learning process and they care about each other's successes. It is evident from the case studies that creating communities of learners with common aspirations and positive peer pressure rely on reciprocal respect. The university registered students felt a sense of responsibility because the learners from outside the university were relying on them to fully participate. The university students also knew that the discussion topics were personal to the outside learners and felt obliged to engage with materials to be able to better understand those from outside the university. The learners from outside were respectful that the modules were part of the university students' degree programme and felt a sense of responsibility to share their experiences in order to benefit the students' learning process. Sadler (2012) highlights that engagement requires a buy-in from students, whereby they take ownership of their learning. These case studies have shown that creating positive peer pressure enables students to take responsibility for their learning and the learning of others.
In both case studies student engagement was enhanced through experiential authenticity as a form of situated learning (Lave & Wenger, 1990). We have identified two key components for this model of learning. Firstly, students learn with and from those who have experiences directly related to the learning material. And secondly, communities of practice are created by diversifying the learner cohorts. The authenticity of the learning environments came from more than just the physical environment; students were also learning from the lived experiences of participants from outside the university. The Prison: Learning Together students reported that the best people to learn from about prison are those who have experienced it. The students were also able to engage in the required reading in more depth because the experience enabled them to apply the academic writing to the lived realities of those it related to. The application of theories, concepts and policies to the lived realities of those who experience it was an impactful approach to learning. This goes beyond the use of experienced guest lecturers by creating communities of learners sharing experiences and using them to make sense of the academic content. There were key differences in the two modules with regards to the environment. For The Prison: Learning Together module, authenticity was enriched by the physical prison environment. This is a unique institution normally inaccessible to the public for university students studying penology; the environment itself enhances the understanding of academic writing on imprisonment. We suggest that incorporating experiential authenticity into learning practices will enhance students' understanding of academic work, encourage their critical thinking and appreciation of the value of academic work to everyday life. We recognise that creating authenticity in learning can be difficult to achieve, particularly in non-vocational courses. Our studies indicate that experiential authenticity can be just as effective as sensory and simulated authenticity and worked particularly well in these cases whereby other forms of authentic learning were not possible. Authenticity can be adopted in a range of different courses whereby curriculum design can create opportunities for students to learn alongside non-traditional learners who can bring direct experience to the learning communities. Where it is difficult to bring learners together in physical proximity at the same time, there may be a role for online group interaction that can happen asynchronously across locations.
Developing critical thinking is one of the most fundamental components of higher education and we argue that this can be achieved by enabling students to learn alongside those with direct life experience of what is being taught. The university students could not bring their own experiences to the Prison: Learning Together module, because they had never been in prison. Similarly, the NUAGE students would not experience older age until a much later stage of their life. Thus, experiential learning is not always possible for certain topics taught at university, but what we have demonstrated is that experiential authenticity is an approach that offers a means to bring experience into the learning environment. It is common for modules to invite guest lecturers to speak to students, but the difference is that they do not longitudinally integrate with the group to build a rapport and learn reciprocally. Learning alongside non-traditional learners with direct experience of the topic of discussion is a key lesson learned from both case studies. Whilst it is not always possible (or practical) to do this for every degree programme, we argue that efforts should be made to embed this more often.
Student engagement can be enhanced when educators create respectful learning environments. This process is achieved by identifying the common goals among participants and designing learning activities and assessments that require group members to learn from one another. In both case studies successful communities were established due to students' interest in participating and desire to learn from their peers. Furthermore, an effective community is created when students identify the value of their own contributions and what they can offer the learning community. Setting out core goals and learning objectives with students at the start of a programme of study can help to establish a community of learners, who feel empowered with the knowledge and experience they can contribute. Respecting the experiences and knowledge of other learners was fundamental in these case studies. We argue that creating tasks and assessments that require learners to rely on one other in a collaborative approach creates positive peer pressure. This pressure encourages greater engagement with the learning process and the desire to be part of the learning community.

Conclusion
This paper has provided cross-disciplinary case studies to highlight the benefit of incorporating non-traditional learners to improve student engagement by adopting experiential authenticity in higher education. The involvement of learners from non-university communities in teaching and learning is highly valuable to enrich learning experiences, develop critical thinking and break down social barriers. Learning alongside those with direct experience of the academic content being taught transforms university students from passive recipients of knowledge to active agents who participate in the learning process. This paper recommends that courses consider incorporating experiential authenticity, when experiential learning is not plausible, to enhance the learning experience for students. Encapsulating experience can be achieved by; including nontraditional learners; exploring alternative venues outside of formal university teaching spaces; introducing collaborative learning activities with a shared goal that allow learners to use their diverse skills and experience; encouraging positive peer pressure; and maintaining a respectful learning environment.

Biographies
Suzanne Young is a lecturer in Criminal Justice and programme leader for the BA Criminal Justice and Criminology at the University of Leeds. Suzanne is a Senior Fellow of the HEA and the deputy chair of the British Society of Criminology's Learning and Teaching Network.
Ellen Tullo is Academic training lead at NIHR Newcastle BRC in ageing and long-term conditions and a practising geriatrician in the NHS.