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Leg discomfort is a common presentation among the elderly and can be a manifestation of many different disease processes. One key issue is how to differentiate between the benign and the more serious causes. This article will explore the main differential diagnoses including the most common causes and management of these, and the recognition of potentially life or limb threatening causes with an overview of red flag signs and symptoms.

Aortic stenosis (AS) is a narrowing or obstruction of the aortic valve and is the third most prevalent form of cardiovascular disease in the Western world after hypertension and coronary artery disease. AS is a potentially life-threatening condition that may present with symptoms related to valve obstruction or heart failure or may be diagnosed incidentally on €œroutine€ clinical examination.

Doctors have a very important role in public safety by ensuring that patients understand their medical condition may impair their ability to drive. The aim of our study was to determine whether appropriate driving advice based on national guidelines was given to patients admitted with TIA or acute stroke.

There is a lack of literature specifically exploring the management of fractured neck of femur patients who may have palliative care needs for illnesses besides malignancy such as those with end stage dementia. Patients with dementia are not considered to have a terminal illness and consequently receive suboptimal palliative care.

The number of older people having surgery is increasing and geriatrician involvement is being increasingly sought. This article uses guidance from the European Society of Cardiology1 and the American College of Cardiology to provide a practical guide for geriatricians advising on preoperative cardiac optimisation in older people. Preoperative investigations should be justified according to risk. These include blood tests, electrocardiograms (ECGs), echocardiograms, stress tests and angiography. Optimising and initiating treatment for cardiac disease reduces adverse postoperative outcomes.

The SPECAL (Specialised Early Care for Alzheimer's) method aims to give patients with dementia a feeling of being in control and being able to make decisions which are carried out. It incorporates a number of core tools and best practice techniques including validation therapy, life history work, distraction techniques, orientation strategies, communication skills and reminiscence therapy.

Metastatic bone disease is a common cause of pain and disability for patients with advanced cancer. Early detection and appropriate management can limit pain, reduce disability and prevent complications such as hypercalcaemia, pathological fracture and spinal cord compression. In specific cases surgical resection of an isolated bone metastasis may improve survival. This article provides an evidence-based overview of the investigation and management of patients with metastatic bone disease.

The benefits of strict glycaemic control in delaying the onset and progression of micro and macrovascular complications in diabetes are undisputed but determining appropriate HbA1c targets remains controversial. This is a particular dilemma when treating patients who have coronary heart disease, particularly the very elderly, many of whom are frail and have several comorbid medical disorders.

A significant proportion of older mental health patients will need to be transferred to a district general hospital for assessment and treatment of comorbid physical conditions. What is the best way to do this?

Coronary heart disease peaks in the older age groups and cholesterol lowering can help reduce the risk. The aim of treating hyperlipidaemia is to prevent or reduce the risk and complications of CVD. Such risk reduction includes nondrug measures (such as addressing lifestyle factors) and drug treatment using lipid-lowering therapy.

Social care/domiciliary care is purchased by or on behalf of thousands of elderly people in the UK who wish to remain living in their own home. The majority of social care is delivered on an hourly basis from early in the morning to later in the evening and the services provided are regulated, efficient and safer for both individuals and their care staff. The care staff are trained with care plans and risk assessments are carried out .

Charles Bonnet Syndrome (CBS) may be defined as the presence of visual hallucinations in the absence of mental illness, associated with deterioration in visual acuity. The underlying pathophysiology of CBS is poorly understood; partly due to the multifactorial nature of the syndrome with its ophthalmological, neurological and psychiatric components.

In response to the needs and demands of an ageing population, the specialty of Geriatric Medicine has evolved rapidly in recent decades. But has it evolved enough to attract new doctors to the field?

Pain can be broadly grouped into four categories namely nociceptive, neuropathic, mixed and pain of unknown origin. Mixed pain is a combination of nociceptive and neuropathic pain. This article serves to highlight the presence of mixed pain syndromes and their diagnosis and management.

Many patients with dementia will in the later stages develop distressing behavioural symptoms. Antipsychotics are commonly used to treat this; however, as a class have been associated with serious adverse events in this vulnerable population. In this article we provide an overview of alternative medications.