-Elderly patients represent a large number of admissions to hospital, accounting for a disproportionate number of hospital bed days. Discharge planning can improve the safety and appropriateness of discharge from hospital, and can have a positive impact on length of stay and efficiency. Despite this, discharge planning is often neglected. This review, both evidence and experience based, is provided to aid with the safe discharge of elderly patients back into the community.

Addison's disease is a relatively rare endocrine condition resulting from adrenal insufficiency due to various causes. Weight loss is a common feature; however, patients may be seen by a variety of specialists, even requiring acute admission before the diagnosis is made. Addison's disease is commonly associated with other autoimmune diseases. In some cases such as autoimmune polyendocrine syndromes (APS) types 1 and 2, these associations are more commonly found. We present a case of one such patient who presented to the acute medical team having been referred to the gastrointestinal services in the previous year for persistent vomiting and weight loss. On review of history, the cause of vomiting and weight loss was questioned and combined with subsequent biochemical testing a diagnosis of Addison's disease was made. The patient was also noted to have other associated endocrine and autoimmune conditions.

Society is undergoing massive demographic change, the most striking feature of which is the large increase in the proportion of elderly, frail patients. These patients have similar expectations to their younger counterparts, and rationalization of treatment on the basis of age has been consigned to the past. Future health service provision and medical training will need to reflect this, and consequently junior doctors (almost irrespective of chosen speciality) will require in-depth understanding of how to evaluate and manage these complex patients.

No abstract

Postherpetic neuralgia is the commonest complication of shingles, a debilitating disease common in daily clinical practice. Treatment of postherpetic neuralgia is often complicated, with numerous potential options. This review looks at the evidence in support of the more commonly used medical therapies for this challenging condition.