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Dysphagia, or swallowing difficulties, is a prevalent disorder associated with certain neurological, obstructive and muscular conditions; stroke is the most recognised neurological cause. Swallowing difficulties are known to adversely affect all aspects of quality of life. Early identification and management is essential. Prognosis is variable and is improved with multidisciplinary management.

Neuropathic pain differs from inflammatory pain both in terms of its symptoms and its management. This article outlines these differences and highlights some neuropathic pain conditions found in older patients with reference to pharmacological and non-pharmacological treatment options.

The use of fracture prediction tools in osteoporosis has improved the management of patients by empowering risk factors other than bone mineral density to be considered, thereby improving fracture prediction. The FRAX tool is the most popular tool worldwide. One limitation is that it lacks the facility of incorporating falls risk, which is an independent risk factor for fractures.

The importance of exercise for older people is great. Exercise delays the onset of a variety of diseases, increases performance and quality of life, reduces dependency and prolongs life. There is a dose€“response relationship between the amount of exercise taken and the benefits which accrue. Unfortunately, although a higher level of exercise produces greater benefits it is less likely to be maintained.

A number of new antidiabetic medications have been launched in recent years. However, these are more expensive than standard treatments until they come off patent. Doctors are under pressure to keep costs down and this is reflected in the current NICE guidelines. This article examines the issue of cost-effectiveness when treating the elderly patient with diabetes.

There have been substantial changes in dementia research over the last 20 years. For example, we have gone from basic science to licensed treatments for Alzheimer's disease. But, more needs to be done if we are ever to get to the point of having a cure. Professor Clive Ballard, Director of Research at the Alzheimer's Society, talks to Dawn Powell about where we have been and where we need to go next.

In March this year, the National Institute for Health and Clinical Excellence published a new guideline for the pharmacological management of neuropathic pain. This article outlines four reasons why both primary and secondary care doctors should welcome the guideline.

Diabetes is a leading cause of premature death in elderly populations, often indirectly due to microvascular and macrovascular complications. Treatment is aimed at improving glycaemic control, whilst simultaneously managing associated comorbid factors to reduce complications and prolong life.

Due to the increased prevalence of dementia with increasing age, people presenting with cognitive impairment and dementia, either as a main problem or as part of general comorbidity, will be more common. Pain is also more prevalent in older people as they suffer from chronic conditions. This is no different in people with dementia. Here, we discuss the differences that may lie in the detection and management of that pain and in some specific issues around management.

In 2006, the Leicestershire, Northamptonshire and Rutland Deanery (now part of East Midlands Healthcare Workforce Deanery) and Northampton General Hospital NHS Trust were selected to jointly run a pilot project to meet the European working-time directive. Working hours for junior doctors had already reduced from a maximum working week of 72 hours to 56 hours as part of the new deal contract in 2004.

The prevalence of heart failure is increasing due to an ageing population and success in delaying coronary events through primary and secondary prevention. New-onset or acute chronic decompensation resulting in hospitalisation represents a significant and growing healthcare burden. Major precipitants of admission in the elderly include: dyspnoea, fluid retention, noncompliance with medication or indeed an ischaemic event.

The GM editorial team received two letters, in response to the article entitled €œUrinary incontinence€, published in the March 2010 issue (GM March 2010; 40(3): 147€“52). Two specialists in Urological Surgery and an experienced specialist in Geriatric Medicine wrote to us to add further insights into the management of the condition. Here, we present their views.

Amiodarone is a commonly prescribed medication that frequently causes thyroid dysfunction. Monitoring and treatment of this complication is therefore essential for patients taking long€‘term therapy.

The National Hip Fracture Database (NHFD) is a web-based, clinically-led national audit of hip fracture care in England, Wales and Northern Ireland. It seeks to improve the quality and costeffectiveness of hip fracture care and to improve secondary prevention by documenting casemix, process and outcomes.

Historically, COPD has been seen as a disease for which little could be done. However, more recently a surge of interest has led to significant advances in treatments, such as long-acting bronchodilators, noninvasive ventilation and pulmonary rehabilitation. This article outlines recent changes to the NICE guidance.