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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.

A quarter of all new patients diagnosed with coeliac disease are in their seventh decade or older. Coeliac disease presents with a wide range of symptoms. It is under diagnosed, especially in the elderly who may present with only iron deficiency anaemia. The mean delay in diagnosis in elderly patients is around 17 years. Early treatment is necessary to avoid potential associated complications.

The NHS Health Check programme aims to help prevent heart disease, stroke, diabetes and kidney disease. Everyone between the ages of 40 and 74 years, who has not already been diagnosed with one of these conditions, will be invited (once every five years) to have a check to assess their risk of heart disease, stroke, kidney disease and diabetes and will be given support and advice to help them reduce or manage that risk.

The prevalence of type 2 diabetes is rising in the UK. The number of people with diabetes recorded on practice diabetes registers for the Quality and Outcomes framework (QoF) payments rose from 3.4% in 2004/5 to 3.9% in 2007/8.1 Figures based on a model of prevalence suggest that in 2010 there were 3.1 million people with diabetes in the UK, aged 16 and over, a prevalence rate of 7.4% and that 27% had yet to be diagnosed.2 Diabetes prevalence rises with age, so the majority of people with diagnosed diabetes in the UK are over 50 years of age.

Palliative care aims to improve the outcome of patients, especially in life threatening conditions. This is usually provided through prevention and relieving of suffering by a holistic approach; considering the physical, psychosocial and spiritual modes of treatment. The chronic diseases are insidious in onset and are preventable; they contribute to a high mortality and morbidity in the developed world. In part two of this article we review the evidence base for palliative care for stroke patients.

The law concerning advance decisions, otherwise known as €œLiving Wills€, has been formalisedby the Mental Capacity Act. These documents can be used by patients to refuse treatment andcan be legally binding on clinicians. This article looks at the background to advance decisionsand provides an example contained in a survey questionnaire to demonstrate and discuss thecriteria used to determine if an advance decision is legally binding or not.

Palliative care aims to improve the outcome of patients, especially in life threatening conditions. This is usually provided through prevention and relieving of suffering by a holistic approach; considering the physical, psychosocial and spiritual modes of treatment. The chronic diseases are insidious in onset and are preventable; they contribute to a high mortality and morbidity in the developed world.1 In this two part review, we look at palliative care in stroke.

Tinnitus is a common symptom with 7% of the UK adult population attending their GP specifically about tinnitus. The prevalence increases with age and hearing loss although it can also be present at any age and with normal hearing. Tinnitus is a symptom of many disorders and, in terms of treatment, what works for one may not necessarily work for another. Therefore, effort should be made to understand the mechanism of each individual's tinnitus to enable us to prescribe the most effective treatment plan Whilst it can be annoying for some, and there is usually no definitive cure, the symptom can usually be managed effectively with modern treatments.

Rheumatoid arthritis (RA) is a disease of unknown cause that leads to widespread infammation, predominantly manifesting itself in the joints, with pain, swelling and stiffness. Uncontrolled, it is a progressive disease that damages joints and can lead to joint deformity and difficulties with daily functioning.

Coronary heart disease (CHD) incorporates a range of conditions including chronic stable angina, acute coronary syndromes and myocardial infarction. Chronic stable angina pectoris is a common problem in the UK, with a prevalence of just under two million and an annual incidence of 28,000.

Depression kills people through suicide, self neglect and its negative impact on the outcome of other diseases, especially cardiovascular disease and stroke. It is often not taken seriously enough because it is not recognised. Depression is also a major cause of unnecessary disability.

This report is based on presentations given at the satellite symposium Chronic Stable Angina in the Elderly, which took place at the 2012 Spring meeting of the British Geriatrics Society, 16€“18 May 2012, Llandudno.