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Urinary retention after stroke is common and the mechanism is multifactorial. The management issimilar to its that of any other cause. In the majority of patients, it resolves with time and the overallprognosis seems favourable.

Age-related macular degeneration (AMD) is a progressive disorder of the retina in older adults. DryAMD, characterised by deposits in the fundus, does not cause significant vision loss. But if it progressesto advanced AMD, it can cause severe vision loss if left untreated. Laser therapy, which itself candamage the retina, was standard therapy during 1980 and 90s. However, a class of drugs that inhibitvascular endothelial growth factor has revolutionised outcomes for many patients

The lifetime risk for the development of ovarian cancer is one in 48 (2·1%) and according to recent statistics epithelial ovarian cancer is now the most commonly diagnosed form of gynaecological cancer in women.

Guidelines for treating osteoporosis issued by NICE in October 2008 were controversial throughout the consultation process and legally challenged early in 2009. The National Osteoporosis Guideline Group released an alternative set of guidelines giving doctors more choice in prescribing and including treatment for men. While experts in the UK argued about treatment choices, the American College of Physicians released guidance for US practice. The USA is often seen as an early adopter of new treatments€”does this translate into its guidance for doctors?

Coronary artery disease remains one of the leading causes of mortality in the UK, accounting for more than one in four of all deaths. Since the prevalence of coronary artery disease increases with age, as our population grows older a larger number of people face living with this disease and its consequences.

Clinicians should recognise that older patients are often sexually active and, therefore, at risk of sexually transmitted infections. Syphilis and HIV are two such infections with particular relevance in an older population, since the morbitity of other infections mainly affects fertility, which is of little worry in older patients. Since 1998, diagnoses of syphilis have been increasing in the UK, and late effects of earlier epidemics may be seen as untreated, latent, or symptomatic syphilis. In the case of HIV, effective antiviral treatment has increased the lifespan of patients and an increasing number of new diagnoses are made in older patients

Pain in older patients is often poorly treated. Some patients have a tendency to under-report their symptoms or are unable to communicate their pain. Clinicians do not always adequately investigate pain or are unaware of non-verbal cues of pain in cognitively impaired patients. We describe assessment and management of pain from a patient's fi rst interaction with the health-care team using psychological, non-pharmacological, and pharmacological strategies. WHO's analgesic ladder is a good basis for treatment of pain and allows for use of adjuvants to complement standard analgesics. Drug side-effects are more common in elderly patients and often inhibit dose increases. A low-dose, slow-titration regimen is advocated, combined with appropriate support of patients for optimum management and to limit adverse events.

An Englishman's home is said to be his castle€”the same is, of course, true for an Englishwoman too. I would say one's home is more than a castle, particularly for older people who want to live and die in their own home. The home that one makes over the years is unique and irreplaceable, and the comforts of familiar furniture and bed, kitchen, bathroom, and toilet, may not be matched by modern accommodation. The house may be cluttered, which is common in both young and old. It may be dirty and squalid to some people, but to the owner it provides 5-star luxury. Favourite pictures might be displayed on the walls, and a pet might give company.

Coronary heart disease and cerebrovascular disease are the two main forms of cardiovascular disease. In 2003 there was a totalof 58,420 deaths in Scotland. Cardiovascular disease accounted for 38% and cancer for 26%.This article discusses management ofcardiovascular risk factors and looks at how initiatives such as the Keep Well programme in Scotland can help.

Polyarthralgia is a common presentation in primary care. Because chronic arthritides may present abruptly, they need to be considered in patients who present with acute polyarticularpain. This condition pain poses a diagnostic challenge because of extensive differential diagnoses. Many classic rheumatological laboratory tests are non-specific and radiographs can be normal or show only non-specific changes early in the disease process. A thorough history and a complete physical examination are essential for accurate diagnosis.

When reading the article on management of trigeminal neuralgia in GM December 2008, I was surprised that it did not mention use of tricyclic antidepressants. The authors recommend carbamazepine as treatment of first choice. Locally, I do not think it is even second or third choice. I have seen very few patients ever prescribed carbamazepine, including for diagnoses other than trigeminal neuralgia. As the authors mention, carbamazepine is known to cause side-effects more often in elderly patients, exactly the age group most likely to have post herpetic pain or trigeminal neuralgia.

The management of pain for older people with cancer is complex and multimodal. Older individuals are more likely than younger people to have other medical problems and disabilities; comorbidities may be a predictor of poorer pain control, greater symptom burden, greater functional impairment, increased use of healthcare services, and mortality.

Parkinson's disease remains a clinical diagnosis and a reminder of the UK brain bank criteria can help ensure that our clinicaldiagnoses maintain a reasonable level of specificity. DaTSCANs„¢ can be helpful where diagnostic uncertainty remains, particularly indistinguishing Parkinson's disease from drug induced parkinsonism, but are of no use in distinguishing from the Parkinson-plus disorders.New evidence is driving increasing numbers of Parkinson's disease specialists to recommend earlier treatment for Parkinson's disease;however, the choice of medication to initiate should still be tailored to the individual patient according to their disability.

In spite of overwhelming clinical evidence to support the cardiovascular benefits of antihypertensive treatments, less than half oftreated hypertensive individuals achieve good blood pressure control. Poor concordance remains one of the major obstacles inpreventing adequate control. It is estimated that between 50% and 80% of hypertensive patients do not take all of their prescribedmedication, resulting in potentially major adverse consequences. Involvement of patients in decisions about their treatment, adaptingconsultation style to meet patients' needs, simplification of treatment regimens using combination therapy with flexible dosingcomponents are just some of the ways that may enhance concordance.

The physical environment and design of a ward or care setting for people with dementia can have a profound effect on patients' quality of life as well as improving symptoms of the disorder. We discuss good practice in the design of such environments.