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In part two of his three part series on the National Service Framework for Older People, Professor Ian Philp reviews its development and how it is still possible to implement much of the NSF's aims.

Economically we are in very tough times in this country, public sector pay has been restricted and since most doctors are employed in the state system, this has a direct effect on a medic's take home pay. However, what has really hit home to public sector workers€”and doctors are no exception€”has been the focus on pensions.

Migraine is a common complaint in all age groups, but the diagnosis and treatment in an older population require special consideration.

Paget's disease of bone becomes increasingly more common with age with a prevalence of 10% at the age of 70 years. The diagnosis may be missed unless the clinician is vigilant, recognises the presenting features, and investigates further. This article reviews the presenting features, investigation and treatment of what can be a painful and debilitating disease.

The British Association of Parenteral and Enteral Nutrition (BAPEN) recommend that all hospital in-patients should have nutritional screening, and this also applies to those with bone fractures. Preventing and managing malnutrition is an important aspect of managing bone fractures and promoting healing. This study completed the audit cycle, assessing rate and type of nutritional screening in patients admitted to a district general hospital with bone fractures and comparing outcomes once the nationally recommended Malnutrition Universal Screening Tool (MUST) tool was brought in.

Joint disease accounts for over half of all chronic health problems in the over 65 years group. In Europe chronic neck pain afects between 10€“20% of the population. In North America about 5% of the general population of all ages is disabled because of neck pain.

This article discusses the current understanding of epidemiology, pathogenesis, clinical features, diferential diagnoses and diagnostic studies of post-stroke seizures and epilepsies with an emphasis on the current recommended treatments, prophylaxis and important considerations when using diferent medications for seizure control.

Leukaemia encompasses a group of malignant disorders of haemopoietic tissues associated with increased numbers of primitive white cells, initially within the bone marrow and then spilling into the peripheral circulation. This review will cover the incidence, presentation, diagnosis and a brief overview of management of the most common acute and chronic leukaemias seen in primary and non-specialist secondary care.

Elderly people can now be found exploring the Amazon, visiting polar regions, climbing to high altitude and adventuring into remote parts. They indulge in active leisure time activity and participate in white water rafing, para-gliding, snorkelling, horse riding and sailing while abroad. Moderate physical impairment does not deprive elderly people of the right to venture afar or indulge in active sports, but they should do so aware of potential risk to well-being.

Doctors are to strike for 24 hours in protest against the Government's controversial pension reforms on June 21. This will be the frst time since 1975 that doctors have striked and may be followed by further industrial action.

Doctors must cease protecting dignity, and strive to enhance it. Tis is critical amongst our elderly patients, who are the most vulnerable yet stand to gain the greatest beneft, both psychologically and physically. For too long the practical application of dignity has been lef to the nursing profession, yet without a collaborative approach elderly patients sufer unnecessarily. Improvements in both education and communication are essential.

Transient global amnesia is widely regarded as one of the most remarkable neurological conditions in terms of its history, symptoms and signs. It presents classically with a sudden onset of severe anterograde amnesia. We describe here the epidemiology, clinical features, and management of this poorly recognised condition.

Clinically the prevalence of signifcant lower urinary tract symptoms and/or poor flow rises from around 13% in the 5th decade of life to between 28€“43% by the 7th and 8th decades of life. Histologically, benign prostatic hypertrophy is seen on autopsy from the age of 30 years with 88% of those beyond 80 years old afected. The risk of urinary retention in the 8th decade of life is between 0.9€“3.4% per year for symptomatic men.

Chronic pain is a frequent health problem in the elderly and is not part of the normal ageing process. The prevalence levels range between 45% and 80% in line with an age-related increase in patient comorbidity.

The burden of musculoskeletal foot pathology in the general population is frequently trivialised but causes patients signifcant impairment. This article aims to give clinicians who don't specialise in the foot, a basic understanding of how to recognise and provide first line treatment for common musculoskeletal foot pathologies.