ABSTRACT
This chapter highlights some of the ways a different approach to older people may yield dividends by illustrating the presentation, diagnosis and management of some specific conditions. A common problem is how far to investigate iron deficiency in old age. Older ladies sometimes hide bleeding per vaginam, or haematuria, though both have to be very substantial to cause iron deficiency. In the United Kingdom severe immunosuppression is uncommon. Immune suppression should be considered with any unusual infection, and perhaps especially with a crop of herpes simplex or herpes zoster. Lowering (blood pressure) BP rapidly in older people is seldom necessary and is potentially dangerous. Accelerated and very severe hypertension and even hypertensive crises do occur in the old and lowering BP gently over a period of days is wise. Many older patients will have some difficulty in looking after themselves in the immediate weeks after myocardial infarction as they adjust to impaired cardiac function and as left ventricular function recovers.
