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Delirium is a common disorder in the elderly, particularly those with previous cognitive impairment, and is associated with adverse outcomes. Early recognition and adequate management is essential but prevention is a highly effective strategy.

It has been five years since NICE published its guidance for Parkinson's disease. There have been several new developments since the publication of this guidance, including new drugs, new formulations and some controversial changes in strategy. The fundamental principles of managing Parkinson's disease have not changed but in the light of these developments, some aspects of care may need to be re-thought.

The prevalence of type-2 diabetes is rapidly increasing with up to a quarter of people over 60 years of age affected by it. To reduce the risk of the associated microvascular and macrovascular complications, national guidelines for glycaemic control recommend HbA1c targets of between 6.5€“7·5%. In recent years two novel GLP 1 receptor agonists exenatide and liraglutide have become available for clinical use.

Diabetic ketoacidosis is a presenting feature of both type 1 and type 2 diabetes mellitus in the elderly. The diagnosis and management of new onset diabetes is discussed along with the challenges in an older age group. It is important that symptoms associated with new onset in the elderly are not limited to those associated with hyperosmolar hyperglycaemic states.

Optimal care of older patients is a challenge for evidence-based medicine. In the past, older patients have tended to be under represented in clinical trials and are more vulnerable to harm from their medications. As age increases, patients tend to have difficulty participating in treatment decisions and concordance can be poor.

As new therapies become available for type-2 diabetes, healthcare professionals will not only have to make difficult clinical decisions but also cope with the demands from patients for these treatments.

Syncope in the elderly population is a complex and often ill understood entity. Therefore, its diagnosis and management can prove to be challenging. This challenge is of particular relevance for the general practitioner, who is frequently called upon to initiate management of patients in the community presenting with €œcollapse; query cause€. This article is a review of the epidemiology, aetiology, pathophysiology and diagnostic pitfalls of syncope in the elderly.

First part of a reprint of an article first published in 1971. Part two was published in February.

Cerebrovascular disease has a major impact on people's physical, social and mental well-being, and is a major financial burden on the NHS. In recent times, the management of acute stroke has changed significantly. Thrombolysis is being used to reduce the disability from stroke and to avoid other devastating complications. In this article,we review the need and evidence for thrombolysis in acute stroke.

Part two of a reprint of an article first published in 1971 (part one was published in the January issue).

The first part of this article (published December 2010) reviewed the clinical features and differential diagnosis of superficial thrombophlebitis and deep vein thrombosis. This second part discusses how these conditions are managed.

Sexuality in older people is affected by various factors including, sexual physiology in old age, physical illness, medication and mental illness; therefore, a thorough sexual history should form part of a comprehensive psychiatric assessment. Also, several sexual problems arise in people suffering from dementia, which range from decreased sexual activity to inappropriate sexual behaviours. Management of inappropriate sexual behaviours include psychological and pharmacological interventions.

Temporary transvenous pacing (TTVP) is an emergency procedure frequently performed in the elderly. An apparent decline in its use, which appears to be multifactorial, has led to its role in a district general hospital (DGH) to be questioned. We present data from six years of procedures performed on patients over 50 years of age at a DGH without onsite permanent pacing facilities.

The elderly smoker can suffer numerous diseases as a result of long-term tobacco use but evidence demonstrates that smoking cessation is beneficial. Self-help material, counselling, group therapy and medications are all useful, although the elderly can present unique challenges and require special considerations. Clinician encouragement and support remain important.

Osteoporosis is a chronic disease affecting the whole skeleton, causing bones to become more fragile, and increasing the risk of fracture. Having one fracture increases the risk of future fractures, so patients who have had a fracture need assessment and many need therapy. Both the National Institute for Health and Clinical Excellence (NICE) and the National Osteoporosis Guideline Group (NOGG) recommend generic alendronic acid (AA) as first-line therapy due to cost effectiveness.