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Stroke medicine is a rapidly evolving field. This commentary will summarise developments in the primary and secondary prevention of stroke in patients with atrial fibrillation, and the latest guidance on intravenous thrombolysis in acute ischaemic stroke.

The Mental Capacity Act 2005 came into effect (in part) in April 2007; all the outstanding provisions were introduced in October that year. Assessment of mental capacity is an important part of everyday practice and this Act gives guidance on both how to assess a patient and how to proceed if capacity is lacking. We highlight some important features of the Act, with reference to a clinical case.

Death with dementia accounts for 1 in 3 deaths in an average general practice. End of life, and death with dementia may be complicated by distress, which is difficult to interpret and resolve. A positive, proactive approach using palliative care principles helps the patient, their family, and professional carers. General practitioners attending nursing homes is the best method for coordinating this work. Support should be available from local services for old-age psychiatry and palliative care.

Back pain is a common symptom that can be the harbinger of serious disease, particularly in elderly patients. Separation of serious pathologies such as malignancy, infection, and cauda equina syndrome from benign axial back pain is a challenge. The red flags have clinical use for assisting in obtaining key features in the history and examination that may relate to sinister pathology. Knowing what and when to refer to a spinal specialist such as an orthopaedic surgeon or neurosurgeon is important. Cervical radiculopathy, myelopathy, and scoliosis may require specialist skills for discectomy, decompression, and reconstruction. This article deals with the assessment and treatment of cervical myelopathy and scoliosis.

Chronic pulmonary thromboembolic disease is one of the most underdiagnosed causes of chronic breathlessness and is not uncommon in elderly patients in hospital. About a quarter of cases of pulmonary thromboembolic disease result in pulmonary hypertension, which can be cured if referred to appropriate centres.

Alison Bloomer looks at the recent launch of the new GM Journal website which aims to help healthcare professionals interested in the management of older patients stay up-to-date on the latest news and clinical advances.

Care pathways are used to detail programmes of care for specific diagnostic conditions. In this article, Dr Adrian Jones sets out a new way of working and configuring services for older people's mental health services. The drivers for doing this are the future health challenges that arise through population projections, the burden of disease and the technological changes, such as telemedicine, that are anticipated over the next 20 years.

Exercise prescription is vital and a fundamental component in the management of all patients with rheumatoid arthritis (RA). There remains a lack of awareness by physicians and some physical therapists in relation to this important aspect of management, and hence recommendation of exercise by healthcare providers remains suboptimal. In this article, Dr Cathy Speed looks at the benefits of exercise in management of RA.

The UK's ageing population means an increasing proportion of people going on holiday abroad will be over 65. Although many elderly travellers will remain healthy while abroad, it is important to remember that this group as a whole are at increased risk of health problems. In this article, Dr Michael Townend reviews the potential health issues that the elderly traveller might face.

The accumulation of prescribed medicines is a recognised effect of ageing. Polypharmacy is an important issue when treating the elderly patient, as it is one of the main reasons why this age group have a higher frequency of adverse drug reactions compared with younger groups. Dr Richard Fitzgerald and Professor Munir Pirmohamed discuss how polypharmacy can occur and how to reduce the pill burden for the elderly patient.

Pain in the elderly is under-reported, under-recognised and untreated. This has significant potential consequences such as reduced quality of life, depression, social isolation and loss of function. Effective pain management in the elderly is complex and should include pharmacologic and non-pharmacologic strategies. In this article, Dr Dylan Harris discusses assessment and management. 

Women are smoking in increasing numbers both in the developed and the developing world, thus placing themselves at risk for chronic obstructive pulmonary disease (COPD). COPD now affects 13 per cent of women over the age of 65 years. Despite its high mortality rate, women do not find the prospect of this condition of major concern. Dr Richard Russell reviews the vital statistics, diagnosis and management of COPD in the elderly woman.

Non-motor symptoms such as depression, sleep disturbances or hallucinations are common in Parkinson's disease (PD), but often these are under-recognised and poorly treated. The frequency of non-motor symptoms usually increases with severity of disease and thus are more likely to affect older patients, many of whom may have had PD for 15 years or more. In this article, Drs Doug MacMahon and Simon McIntosh discuss the major non-motor symptoms.

Primary hyperparathyroidism is a common cause of hypercalcaemia in the elderly, which is seen in daily practice but is not always easily recognised since many patients are asymptomatic. Management of this condition raises valid questions of whether it should be treated surgically or medically. Drs Graham Sutton and Ali Ajaj review the current evidence for both approaches.

If diagnosed in the early stages, lung cancer is curable. However, most lung cancers are detected in the later stages of the disease €” when a cure is no longer possible. It is, therefore, not surprising that lung cancer is the leading cause of cancer death in the UK. Dawn Powell talks to lung cancer expert Professor Stephen Holgate about the disease and what needs to be done to ensure earlier diagnosis.