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From the Department of Health to Dementia Action Alliance the knives have been out fordoctors who prescribe antipsychotics in dementia. But has the voice of pragmatism been lost inthe din of righteous indignation? While good care can make antipsychotics largely redundantthere will always be occasions when sedation is in the patient's best interests. What are needed,therefore, are expert guidelines informed by experience.

Geriatrics grew out of long term institutional care of the sick and infirm during the late 1940s and 1950s. The importance of comprehensive multidisciplinary assessment and the effectiveness of rehabilitation allowing both appropriate care and discharge, freed up resources and allowed geriatricians to move into much wider interactions with care problems in old age.

A fragility fracture is ofen the first sign that someone has osteoporosis, as there are no associated signs or symptoms, and this has lead to the condition being called the €œsilent epidemic.€ For the past 25 years, the National Osteoporosis Society have been anything but silent about osteoporosis. The charity's CEO Claire Severgnini talks to Dawn Powell about the past, present and future management of osteoporosis.

The NICE Guideline Development Group has spent 18 months reviewing every aspect of blood pressure care, from initial diagnosis to its long term management in patients of different ages and races and with the condition at different stages. High blood pressure is the single biggest risk factor for heart attack and stroke claiming thousands of lives each year. Unchecked, it can also result in kidney disease and dementia.

I have been a GP for nearly a quarter of a century and I have witnessed many changes in the way that general practice is run in this country. These administrative changes seem to be ongoing and it is not always easy to keep up-to-date with them.

Dementia is defined as a progressive decline in cognitive function, with memory being especially affected. It is associated with a progressive decrease in the patient's intellect accompanied by reduced emotional control and a deterioration of social functioning. The acquired cognitive and behavioural impairment will eventually become of sufficient severity that it interferes with social and occupational functioning of the patient.

Transient ischaemic attack affects approximately 35 people per 100,000 of the population per year and is associated with a high risk of stroke in the first month of the event and up to a year aferwards. There is now considerable debate regarding how the life of a patient is affected afer a TIA diagnosis.

As healthcare practitioners, we should all quite rightly remain focused on the effective delivery of care. This includes concentrating on the small proprtion of people who consume a relatively high proprotion of healthcare, but this should be productive. Care of people with chronic conditions such as asthma/chronic obstructive pulmonary disease (COPD), heart failure, diabetes, kidney disease and stroke costs the NHS about £7 of ever £10 spent on patient care.

Influenza is a common respiratory disease. It is spread by the respiratory route only by droplet spread and affects people of all ages. Influenza is highly infectious with a transmission rate of 20€“90%. Even when an epidemic is not present some 3000 to 4000 deaths may be attributed to influenza each winter.

There is a high prevalence of anaemia in the elderly population. Anaemia signifies an underlying disease and is associated with increased morbidity and mortality. It can be underdiagnosed in this age group as the symptoms of anaemia can be attributed to the ageing process. In part two of this review, diagnosis and treatment are discussed.

NICE was heavily criticised when it ruled that patients with rheumatoid arthritis who had failed on one TNF- inhibitor could not use an alternative TNF- inhibitor. However in August 2010, NICE published guidelines that reversed this decision. Dawn Powell summarises the guidelines' recommendations and Professor Paul Emery talks to Cher Tornhill about the management of rheumatoid arthritis.

Pacemaker therapy has become an important therapeutic option for patients with heart rhythm conditions worldwide. The number of elderly patients needing pacemakers is on the increase due to an ageing population worldwide. Pacemaker syndrome consists of the cardiovascular signs and symptoms of heart failure and hypotension induced by right ventricular (RV) pacing.

NICE was established by the former Health Minister, Frank Dobson in 1999. Its website quotes its remit as €œan independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health.€ It was to €œensure everyone has equal access to medical treatments and high quality care from the NHS€”regardless of where they live in England and Wales€. It was hoped that the post-code lottery would be consigned to the dustbin of history!

The coalition Government's announcement last year that it planned to radically change the NHS came as a major surprise to both healthcare professionals and the general public as neither the Conservatives nor the Liberal Democrats had mentioned such dramatic changes to the NHS in their manifestos.

Aortic stenosis (AS) is the most frequent heart valve disease in developed countries and prevalence sharply increases with age. Aortic valve replacement is the reference treatment for severe symptomatic AS. However decision making regarding surgery is often difficult in older patients. The literature below discusses the feasibility of doing aortic valve replacement in older people in the light of current evidence.