A new theoretical framework for understanding and working with the dementing illnesses of old age is presented, and explicated with particular reference to senile dementia of the Alzheimer type. For several reasons the commonly accepted model, which assumes a simple linear causal relationship between neuropathology and dementia, is inadequate. A more comprehensive model, grounded in a monistic view of the mind-brain relationship, must take into account not only the psychological states that correspond to particular brain states, but also both developmental and pathological aspects of brain structure. Using this we can describe the dementing process, ‘normal’ psychological functioning in old age, pseudodementia and ‘benign senescent forgetfulness’. Further, the scope for some degree of ‘rementia’ is explored.

One of the principal motives behind pension reform in Britain in the post-war era has been to reduce dependence on means-tested assistance. Alternating attempts have been made to attain this objective through State and occupational collectivism but with only partial success. The present Government has shifted the emphasis away from collective provision towards individual saving promoted in the form of portable pensions. However, recent research has underlined the importance of structural determinants of dependency on means-tested assistance in retirement and of other factors over which individuals have little if any control. In the light of these findings questions are raised about the potential effectiveness of portable and occupational pensions as mechanisms for reducing future dependency on means-tested supplementation.

Resistances to empathy with older service users are outlined, drawn primarily from Jungian psychology. It is suggested that lack of a helper's personal experience of old age allows disproportionate influence to be played by archetypal intrapsychic processes. These are augmented by helpers perceptions of a negative personal future and a tendency either to ignore the age appropriate projects of older persons or replace them with those appropriate for the helper. Consequences for helper training are briefly explored.

Violence to elderly people in residetial institutions is well documented. In this paper both violence and resulting death are examined in the German context. A thesis is put forward that is not lack of humanity but lack of professional routine which is the main cause.