Polymyalgia rheumatica and giant cell arteritis are closely related conditions, considered by many to represent opposite poles of a single disease spectrum. They can occur together or separately.

Polymyalgia rheumatica is characterized by pain and morning stiffness in the shoulder girdle and sometimes the pelvic girdle. The symptoms are felt to be related to synovitis of proximal joints and extra-articular synovial structures. Giant cell arteritis displays a frank vasculitis affecting the regions supplied by the temporal artery to give visual loss and scalp tenderness but is increasingly recognized to also affect the aorta and its extra-cranial branches. For this reason the term ‘giant cell arteritis’, which is descriptive of the pathology, is used instead of the alternative term ‘temporal arteritis’, which gives a misleading impression of localization but which was the term used in previous reviews for this journal, the most recent in 2003.

Urinary tract infection is the most common bacterial infection in older populations. It is an important clinical problem across the full spectrum – from elderly persons who are well and living in the community to highly functionally impaired residents of long-term care facilities. Symptomatic urinary infection is a frequent cause of morbidity, and urinary infection is responsible for substantial antimicrobial use. This review summarizes current knowledge relevant to both asymptomatic and symptomatic urinary infection in older populations, and identifies unresolved issues for further study. The discussion is relevant to older individuals without indwelling urethral catheters, unless it is specifically stated that the older person with an indwelling catheter is being addressed.

Oral mucosal lesions occur frequently in older people and are important as they may reduce quality of life, represent pre-malignant change or indicate systemic disease. The commonest mucosal lesions in adults are denture-related lesions such as stomatitis, angular cheilitis, ulcers and hyperplasia, and occur in 8.4% of the adult population. In the hospital setting, oral mucosal lesions may lead to malnutrition, slow rehabilitation and recovery from illness, and adversely affect quality of life. The two major risk factors associated with oral lesions are denture use and smoking, and frequently older people have been exposed to both of these. Commonly used drugs such as antihypertensives, antidepressants and antibiotics may have oral mucosal side-effects, and polypharmacy may worsen these. Decreased awareness of changes in the oral mucosa, or inability to raise concerns due to dementia, delirium, social isolation, or difficulty accessing dental care may further compound the problem. Hospital admission could represent an opportunity to intervene, but oral mucosal lesions, and indeed oral hygiene, are areas which can be overlooked by doctors. This article is intended to highlight common or important oral mucosal diseases and increase awareness of these conditions for the practising hospital or community geriatrician.

Providing symptomatic palliation in terminal malignant disease is integral to high-quality elderly-care medicine. Effective pharmacological treatment, especially pain relief, is the mainstay of palliative care, but physical intervention is sometimes required to relieve mechanical problems. Interventional radiology is rapidly evolving and there are many clinical situations in which it is indicated. It is as effective as open surgery, but without the risk of general anaesthesia and surgical morbidity. Most interventional radiology procedures can be performed with a much shorter hospital stay than the alternative surgical procedure, and often as a day case admission. Reducing hospital stay and recovery time is of great importance to the older patient who may have a short life expectancy because of the cancer and co-morbidities.

Salt and electrolyte disturbances are commonly encountered in older patients. A sound understanding of the underlying physiological and pathological mechanisms underpinning the predisposition of older people to the common electrolyte imbalances can help clinicians minimize their considerable associated morbidity and mortality. This review focuses on the more common and clinically relevant salt and electrolyte disorders of older people. The epidemiology, causes, symptoms, diagnosis and treatment of hyponatraemia, hypernatraemia, hyperkalaemia, hypokalaemia and calcium and phosphate imbalance in old age are covered from a clinician's perspective.

Key strands in developing future services in geriatric medicine in Wales have been the 2000 ‘Review of Health and Social Care in Wales’ by Sir Derek Wanless, the Welsh Assembly Government document ‘Designed for Life’ of May 2005, and the National Service Framework (NSF) For Older People in Wales (published in March 2006). The common theme in these documents is for older people's health and social care issues to be managed nearer to their home, in the community. At present, the development of Intermediate Care Services has been ‘hit and miss’ – fragmented, unevenly developed and delivered with poor integration into mainstream services. The Academy of the Royal College's Medical Aspect of Intermediate Care identifies the lack of specialist medical input as being one of the reasons for the failure of development of Intermediate Care Services. It recommended that geriatricians should be encouraged to undertake well-defined roles in community work in planning and delivery of Intermediate Care Services.

Young-onset dementia (dementia in people under 65 years of age) remains an under-researched area of dementia care. As populations age in industrialized countries, dementia is set to increase: this includes dementias in younger people. Current estimates suggest there are over 15 000 younger people living with dementia in the UK, whilst dedicated services and research in this area remain limited. Younger people may be affected by rarer forms of dementia that can create various kinds of impairment in the individual. For example, as Boxer and Miller report, although memory can be affected, people with conditions such as frontotemporal dementia can present initially with personality changes as the primary symptom. Younger people may also have more difficulties with visuospatial and semantic tasks when compared with an person, and there are likely to be personal and societal implications for the entire family.