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Difficulty swallowing (dysphagia) imposes a heavy burden on the NHS and patients, and can undermine nutrition, result in aspiration pneumonia, compromise quality of life, and hinder administration of solid medications. 

Stroke is the leading cause of adult disability in the UK. 70% of strokes occur in adults older than 65 years of age. Oral health and mouth care are usually forgotten, but are important aspects of care. Studies have highlighted the poor state of oral health in patients after stroke and poor knowledge of oral-care procedures among nursing staff throughout the UK. Despite previous evidence linking poor mouth care with risk of carotid stenosis, stroke-related functional disability, and aspiration pneumonia, oral care is still not perceived as a priority. This review aims to address the importance of mouth care after stroke in preventing infectious complications, and to highlight the current poor knowledge among nursing staff in providing adequate oral care and the need for high quality trials to evaluate effectiveness of oral healthcare interventions.

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 polyarticular pain. This 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.

Cardiopulmonary resuscitation is undoubtedly an important form of medical therapy that has saved many lives. However, as clinicians we come across situations in which resuscitation would clearly not benefit the patient. Therefore, in the patient's best interest, we make a decision not to attempt resucitation. By best interest, we mean protecting the dignity of the patient by avoiding futile resuscitation attempts.

In May, NICE issued updated treatment guidelines for type-2 diabetes. This advice gives doctors the option of using thiazolidinediones or dipeptidyl peptidase-4 inhibitors in patients whose blood-glucose control is inadequate. However, evidence suggests that rosiglitazone may increase the risk of myocardial infarction and heart failure. Pioglitazone has not been shown to have such an effect, but since few data are available to prove pioglitazone's cardiovascular safety, NICE recommends that neither thiazolidinedione should be given to patients with heart failure.

Nocturnal leg cramps are very common in elderly people. Diagnosis and treatment of any underlying causes such as myositis is important. Physiological treatments such as massage and exercise have not been thoroughly investigated, and the main drug treatment is quinine.

Practitioners working in dementia care are commonly involved with patients who reside, or will require placement, in a residential or nursing home. Recent legislation sets out rigorous safeguards to protect patients in this regard. Topics covered in this article include the use of guardianship and the safeguards against deprivation of liberty.

It is hard to believe that 12 months have passed since the last World Alzheimer's Day, but it has certainly proven to be an exciting year for dementia and all those involved with this disease. After years of campaigning or dementia to be given the recognition that it deserves, we welcomed both the publication of the Government's National Dementia Strategy for England in February 2009, and the news that similar plans are afoot for Northern Ireland and Wales. The English Strategy is a 5-year plan setting out how to improve quality of life for people with dementia, and it provides the opportunity of a generation to transform the lives of people living with dementia.

Towards the end of 2009, the Association of British Neurologists revealed its updated guidelines for MS diagnosis and treatment. This article reviews how they have moved forward from the first edition in 2001 and the impact this now has for the prescriber.

This brief review addresses some factors clinicians should consider when treating older depressed patients.

Weight loss and cholesterol lowering in the elderly remains a controversial issue. Obesity is considered to be problematic as a result of associated dyslipidaemia, cardiovascular disease and mortality. Diet, exercise, medication and laparoscopic gastric banding all demonstrate important potential for achieving safe weight loss and cholesterol lowering in older people. This evidence, however, remains minimal and a case specific approach is recommended until more robust guidelines can be developed.

Smoking accounts for 18% of all deaths in adults aged 35 or older and costs the NHS £5‹…2 billion a year (5% of the total health-care costs). Health-care professionals are ideally placed to help reduce these figures by encouraging patients who smoke to quit. Older patients should not be excluded from receiving smoking cessation support because, regardless of their age or length of habit, they can still benefit from giving up.

Chronic heart failure (CHF) is a common condition, particularly among older patients, and is associated with a high rate of mortality and morbidity. In the first part of this article, we reviewed the diagnostic tools and medical therapies used in the management of CHF. In part two, we provide guidance on when patients should be referred for more intensive management and focus on device therapies.

Asthma in elderly patients is poorly studied, increasingly common, and often under-recognised and undertreated. Elderly patients have largely been excluded from clinical trials because of age and comorbidity.

Parkinson's disease is gradually and inevitably progressive over several decades and it has serious motor and non-motor complications. Although the clinical manifestations of PD remain similar to those described by Parkinson in 1817, our knowledge of the associated findings has increased dramatically. This article discusses the non-motor problems of PD.