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Developments in pain assessment have led to a much greater understanding of the different types and definitions of pain. However, the definition of breakthrough pain is still unclear €” for some, breakthrough pain is transient pain on a background of treated pain; for others, it is a flare up of a previously treated pain or painful event. Therefore, breakthrough pain is an umbrella term that requires further definition.

The evidence for early supported discharge services is compelling, but progress towards widespread implementation is patchy even though the early rehabilitation of stroke patients at home has been a national priority since 2007. This article explores why this is the case.

A comprehensive report of GM's first annual conference The older patient: bridging the gap between primary and secondary care.

The sixth National Medicine for Old Age Psychiatrists conference took place, on the 8€“9th November 2010, at the Institute of Physics. This report is based on some of the key presentations of the conference.

Substance misuse in older people has received very little attention from clinicians and policy makers. Due to the ageing population and changing trends in substance misuse, we can no longer consider this clinical issue as a rare phenomenon. Older people with such problems can present with severe physical and psychological morbidity. In this review, important issues regarding the epidemiology, diagnosis and management of substance misuse in older people are discussed.

There has been considerable controversy over several years regarding the use of cholinesterase inhibitors and memantine for the treatment of Alzheimer's disease. In a recently published technology appraisal, NICE has reversed previous guidance on the use of these drugs in England and Wales. In this article, aspects of the diagnosis and management of Alzheimer's disease in the light of this guidance are reviewed.

The hospital has a vital and central role to play in the pattern of Geriatric Care. This article examines the multidisciplinary and many faced role of the geriatric unit in managing the patients social, medical and psychological needs.

Interstitial lung disease (ILD) is a general term for a number of diseases characterised by progressive pulmonary fibrosis or €œscarring€ of the lungs. The term fibrosis implies formation of abnormal connective tissue within the lung parenchyma. 

Gout is a common presentation in the elderly population; therefore, physicians need to be skilled at its diagnosis and treatment. This paper addresses the diagnosis and treatment of gout, with a particular focus on challenges in the elderly.

A caring role is performed by one in every eight adults in the UK at any one time€“ and on average lasts for four years, with 40% of carers providing care for less than one year and 25% for more than 10 years. The peak age range at which caring begins is in the fifth and sixth decades of life.

Cancer is a common problem, but an individual GP may only see about seven to eight new cases of cancer per annum (although they will see many more patients with symptoms that are associated with cancer but are actually due to a non-malignant cause). In an audit in NHS Greater Glasgow and Clyde, only 19.2% of referrals with suspected cancer actually had a diagnosis of malignancy.

Multiple sclerosis (MS) is the most common chronic disabling disease of the central nervous system in young adults. The late-onset MS (LOMS) variety, with clinical onset after 50 years old, is not a rare phenomenon. LOMS may present a diagnostic challenge because of the variability in its presentation. This article gives an overview of the clinical features of MS in older people, the diagnostic challenges and management lines.

Older people's health needs are recognised to be under-served. Telemedicine, delivered through a telephone or the internet, may be one potential approach to this shortfall. This article looks at some of the evidence of older people's use of these telemedical resources.

Evidence shows that pharmacological and non-pharmacological interventions for people with dementia and their carers all have modest effects and many studies are of poor quality. This article considers interventions to help maintain cognition, function and behaviour during and after the period of adjusting to the diagnosis. The article highlights some benefits of early intervention and the need for comprehensive care planning over a long period.

The NICE guidance Chronic heart failure: management of chronic heart failure in adults in primary and secondary care was published last year and replaces the 2003 version. New and updated recommendations are included on diagnosis, pharmacological treatment, monitoring and rehabilitation.