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The risk of developing dementia rises exponentially with age and about a third of people will die with dementia. Palliative care is appropriate for many patients. Cognitive function may alter patients' perception of pain and communication difficulties can lead to under-recognition and undertreatment. In such patients, use of observational scales for assessing pain is recommended. Appropriate pain control can help to improve the holistic management of patients with dementia.

Neuropathic pain can arise from injury to the nervous system and can involve spontaneous dysthaesias, allodynia, or hyperaesthesia. An estimated 8% of the population are thought to live with neuropathic pain. Several types of drugs can be used to treat neuropathic pain, but many patients have no relief. Stimulating the spinal cord with implanted electrodes can be an effective treatment, especially for failed back surgery syndrome. NICE issued guidance in October 2008 recommending spinal-cord stimulation and complex regional pain syndrome.

Amyloidosis is a term used to describe a group of disorders consisting of abnormalities in and the accumulation of amyloid protein. This protein cannot be degraded and so collects in the tissues, interrupting both their structure and function. The disorder is progressive as amyloid increases and symptoms vary depending on the affected organs, which can be localised or systemic. We discuss diagnosis and management of amyloidosis with cardiac involvement and describe a case presenting in late life with rapid progression. 

Late onset schizophrenia presents differently from early onset schizophrenia and medication is complex. Treatment should be reviewed and guidelines should be followed. Awareness of  recent changes to legislation and its implications for management is also important.

There are multiple treatment options for patients with low-risk prostate cancer: active surveillance, surgery, external beam radiotherapy and low-dose rate brachytherapy.

In the past few years, the management of rheumatoid arthritis has changed considerably with the introduction of biological therapies. Older disease modifying treatments still have an important role since the newer treatments are relatively expensive and are used in patients who are refractory to standard drugs. In addition to these disease modifying drugs, that can improve function and delay deterioration, analgesics are useful for controlling pain.

More than $100 million is spent on research into Parkinson's disease each year. Where is thisresearch leading us? Can we expect a cure or prevention of the disease in the foreseeable future? Are new developments in research likely to change contemporary practice? Are there biomarkers for the disease and will these help us to diagnose the condition before symptoms are established? What of neuro-transplantation? These questions are addressed in the following article.

An ageing population and advances in the treatment of heart failure have led to greater numbers of elderly patients surviving withheart failure. This article discusses the current evidence base for the management of heart failure.

The Department of Health has recently announced the rollout of the NHS National Bowel Cancer Screening Programme (NBCSP). The following article outlines the principles of bowel cancer screening and examines the evidence supporting such a programme, including economic factors. In addition, the implications of colorectal cancer screening for individuals outside of the target age range of the NBCSP are considered.

This charity profile looks at the work of the British Lung Foundation in attempting to raise awareness of chronic obstructive pulmonary disease€”a condition that women are more susceptible to developing as their lung function worsens with less duration of smoking or intensity of smoking than that of men.

Osteoarthritis is the most common cause of disability in older people, and diseased hip and knee joints cause most difficulty for older individuals because activities of daily living are significantly affected. Verbal and numerical rating scales best quantify pain intensity in older patients, including those with mild-to-moderate cognitive impairment. Non-drug therapies include educating patients, occupational therapy, weight reduction, and exercise. Pharmacological strategies include simple analgesia, non-steroidal anti-inflammatory drugs, and topical agents, progressing to weak then strong opioid painkillers for chronic severe pain. Surgery is an option for some patients to avoid the chronic pain cycle.

Type 2 diabetes usually develops in people over the age of 40 years, and the risk of getting it increases with age. It is more common in men and hyperglycaemia caused by untreated type 2 diabetes can lead to a number of long-term complications. It confers a two to four-fold greater risk of coronary heart disease among men compared to a three to five-fold increased risk among women. This article looks at the latest guidance from NICE on management.

Generalised anxiety disorder is increasingly recognised as an important treatable clinical disorder. It has an overall prevalence of about 2€“5%, and twice as many women as men have this condition. This disorder can present with a variety of symptoms and some people present with mainly physical symptoms. Symptoms can be treated pharmacologically, but cognitivebehavioural therapy has an important role.

Stroke is the third leading cause of death in the world. The incidence of stroke approximately doubles each decade after the age of 45, with a 2% annual risk over 80 years of age and a 3€“7% annual risk over 95 years of age. Hypertension is also a major factor responsible for most deaths worldwide, nearly 50% more than cigarette smoking. The lifetime risk of developing hypertension is 90% in people surviving to 80€“85 years of age.

A study was undertaken to define the prevalence of nocturia and urgency in the hip fracture population immediately prior toadmission to hospital and to determine the frequency that urinary problems caused the fall leading to hip fracture.