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Men gradually reduce their levels of testosterone as they age. Many of the signs and symptoms of testosterone deficiency were previously believed to be part of the normal ageing process, and only recently has treatment of low testosterone in the ageing male been shown to provide long-term physical and mental improvement. There is an estimated UK incidence of 8% of men aged 50€“79 years with testosterone deficiency syndrome, also known as hypogonadism.

The majority of older people want to exercise their right to vote, but being in hospital while elections are being held can prevent some older people from voting. Healthcare professionals should make every effort to enable such patients to express their political views.

Cough is one of the commonest symptoms presenting to the primary care clinician. Manycoughs are benign and self limiting. However the varied aetiologies of cough and the possibilityof an underlying sinister diagnosis can make cough a challenging symptom to manage inprimary and secondary care.

Dupuytren's disease is a common condition of the hand particularly affecting the older population. The cardinal presentation of Dupuytren's disease, is a permanent digital flexion caused by the shortening, thickening and fibrosis of the palmar fascia. The fingers are drawn into the palm, preventing extension of the digits so that simple everyday tasks such as shaking hands or washing oneself become problematic. The restriction in hand function can be very debilitating for the patient and severely impact on their quality of life. There are currently several therapies available for Dupuytren's disease that aim to improve hand function but there remains no cure and it often recurs.

Age UK is currently campaigning for digital inclusion of older people and with the introduction of Silver Surfers' week, older patients are benefitting from technological change. Online health information is one such technology being embraced, but young and old are vulnerable to the dangers that lurk on the internet.

As a result of the ageing population and improved medical care causing people to survivepreviously fatal conditions (eg, myocardial infarction), heart failure occurs more and more ofenin the elderly population. Despite intensive medical therapy, people with heart failure ofenhave a reduced quality of life and poor prognosis €” a large proportion of people die within oneyear of diagnosis. Cardiac resynchronisation therapy (CRT) by means of biventricular pacingis a fairly new procedure that improves patient quality of life (based on the Minnesota Livingwith Heart Failure Quality of Life Questionnaire), increases distance walked in six minutes,improves oxygen uptake, lowers New York Heart Association classification, decreases QRSduration, increases left ventricular ejection fraction, and increases peak oxygen consumption.

Undiagnosed diabetes is common in older people. Early diagnosis is important to manage risk factors, control hyperglycaemia, reduce complications and improve quality of life. Symptoms of diabetes in the elderly may be atypical so more than one screening test may be required for diagnosis.

Despite classically appearing in a younger age group, Ménière's disease remains a significant cause of dizziness in the elderly population. The non-specific pattern of symptoms can make the disease difficult to diagnose and no firm consensus exists on the most effective treatment.

Falls and urinary incontinence are major problems among older people. Both are associated with significant morbidity and consumption of healthcare resources, and a consistent relationship between falls, urinary incontinence and some lower urinary tract symptoms (LUTS) has been established. Unfortunately, despite the link between LUTS and falls, few intervention studies to reduce falls have included addressing potentially remediable urinary symptoms as part of a management strategy. This review examines the evidence for the association, looks at supportive evidence and suggests a way ahead given the lack of evidence in this area.

This report is based on presentations given at the satellite symposium A new option for your high risk patients with aortic stenosis, which took place at the 2011 Spring meeting of the British Geriatrics Society, Liverpool.

The end-goal of any good doctor's work should be the diagnosis of a patient to enable effective management and treatment but also to give the patient a possible prognosis. In a personal view in the BMJ last year, Gordon Caldwell, a consultant physician working in acute medicine, said that the time taken to reach the correct diagnosis may be crucial for the patient's chance of survival. He added that over his career, he has seen many errors in the working diagnosis causing harm to patients and even death.

This review article looks at identifying late-life depression, which is a common presentation in primary care, and to identify hidden signs and symptoms. It also reviews pharmacological and non pharmacological approaches in treating depressive illness in the elderly population.

Nocturia is a common and ofen distressing condition with increasing incidence in the elderly. It has multiple causes and a focused history taking and physical examination will help to establish the underlying diagnosis. A voiding chart is a useful tool in investigation and also for assessing response to treatment. A multifaceted management approach can help to reduce the number of episodes of nocturia resulting in a significant improvement in quality of life.

A significant number of men with prostate cancer will be elderly. Although some of the issues they face will be the same as their younger counterparts, they will also have their own unique set of issues such as concerns about the practical aspects of their disease.

Acute chest pain is a common presenting complaint in hospital practice. The differentialdiagnosis of chest pain is broad and includes life threatening conditions such as theacute coronary syndromes (ACS). ACS include ST elevation, myocardial infarctions(STEMI), non ST MI (NSTEMI) and unstable angina. Elderly patients can present inatypical ways making the diagnosis challenging. In this review we address some of thekey issues facing clinicians when managing the elderly patient with chest pain. Focusingon the ACS, we discuss the possible differentials, pit falls and the key informationincluding investigations required to formulate the diagnosis.