In the developed, as well as developing countries, there is an immediate challenge to ensure an adequate supply of health professionals trained in providing care for older people to meet the needs of increasing numbers. Currently 20% of the population of the United Kingdom (UK) is over 60 – 12 million people. By 2031 this proportion will be nearly a third – 18.6 million people. The largest increases are anticipated among the over-85 age group, from 0.8 million in 1987 to 1.4 million in 2025. In Europe the number of people aged over 80 years will double within the next 25 to 30 years. It is estimated that there will be more than 1.2 billion elderly people in the world by the year 2025 – three-quarters of them living in the developing countries.

Older people with cognitive impairment and dementia are at increased risk of falls and their adverse consequences when compared with cognitively intact older adults. Using prospectively gathered data, approximately three-quarters of older people with cognitive impairment and dementia can expect to fall each year, double the fall-risk of cognitively normal older people. In addition, compared with their cognitively normal counterparts, people with cognitive impairment and dementia have an increased annual incidence of fractures, and are less likely to make a good functional recovery after a fall. The prevalence of dementia in the United Kingdom is about 5% of the population aged over 65, and 15% of those aged over 80. Falls in patients with cognitive impairment and dementia represent a significant health problem in the UK.

Heart failure has been defined in many ways and definitions change over time. The multiplicity of definitions reflect the paucity of our understanding of the primary underlying physiology of heart failure and the many diseases for which heart failure is the common end-point. Fundamentally, heart failure represents a failure of the heart to meet the body’s requirement for blood supply for whatever reason. It is thus a clinical syndrome with characteristic features – not a single disease in its own right. The syndrome includes symptoms and signs of organ underperfusion, fluid retention and neuroendocrine activation. The syndrome arises from a range of possible causes of which ischaemic heart disease is the commonest. From the point of view of a clinician, the underlying pathology will determine treatment options and prognosis. The extensive range of possible aetiologies present a diagnostic challenge both to correctly identify the syndrome amongst all other causes of dyspnoea and to identify the aetiology, allowing optimization of treatment.

Hypoxaemia is a common complication of stroke, and an association between adverse outcomes and hypoxaemia has been reported. However, it remains unclear whether hypoxaemia is the cause or just a sign of poor prognosis. While clinical guidelines unanimously recommend treatment of hypoxaemia after stroke, the guidance does not specify at what level of hypoxaemia treatment should be started. Recent evidence from a Swedish study suggests that overtreatment can also have detrimental effects on outcome. The aim of this review is to explore issues relating to hypoxaemia after stroke.

The classification of schizophrenia-like and paranoid disorders in elderly people has a long and somewhat confusing history which can largely be blamed for the currently uncertain nosological position of such patients. To Kraepelin, dementia praecox was fundamentally a disorder of emotion and volition, while paraphrenia was characterized by hallucinations and delusions without deterioration or disturbance of affective response, and paranoia involved the insidious development of a permanent delusional system which resulted from internal causes and was accompanied by perfect preservation of orderly thinking, acting and will. However, by the eighth edition of his textbook in 1913, Kraepelin was expressing serious doubts about the assumptions on which his conception of dementia praecox had been based. In some cases, a complete and lasting recovery was seen and the relationship between onset and early adult life was not absolute. Indeed, Bleuler had introduced the term ‘schizophrenia’ in order to get away from the concept of the disorder as an adolescent mental deterioration.

If we can better understand why people kill themselves, it should be possible to reduce suicide rates. The major aim of this article is to consider whether any factors associated with higher rates of suicide in old age are amenable to preventive interventions.

It is said that epidemiology is the basic science of prevention. Multiple interacting factors contribute to the causation of suicide, though commonly, in the individual case, a single circumstance or condition can be identified as the major precipitant of suicidal behaviour. Cross-sectional studies may reveal factors that correlate with high suicide rates in particular populations, while long-term studies can show associations between changes in suicide rate and in socio-environmental conditions.

There are estimated to be more than 18 million people world-wide suffering from dementia and, on entering the twenty-first century, demographic projections suggest that there will be a significant growth in elderly populations due to decreasing infant mortality, improved public health and safety, medical advances, better education and housing and increased service provision. These population shifts will predictably lead to a greater demand on medical and welfare services.

Despite the fact that a sizeable proportion of the elderly population will at some time develop cognitive problems, accurate diagnosis is difficult due to the multiple pathology involved in these impairments. With the introduction of pharmacological treatments for cognitive impairments, the emphasis on establishing if people are suffering from a dementing illness is crucial. Furthermore, patients who are categorized as ‘subclinical’ cases of cognitive impairment often have an underlying risk for further progression. Although all clinical definitions of dementia stress that there must be evidence of intellectual decline, the most common being memory failure, there is confusion surrounding the nature of cognitive deficits in the three most commonly applied criteria for dementia – The International Classification of Diseases (ICD-10), The Diagnostic and Statistical Manual for Mental Disorders (DSM–IV) and the National Institute of Neurological Disorders and Strokes (NINDS), Association Internationale pour le Recherche et l’Enseignement en Neurosciences (AIREN).

The National Bed Inquiry indicated that up to 20% of older people might be inappropriately occupying acute hospital beds and could be discharged if alternative services were available. The report proposed the concept of ‘Intermediate Care’ as a scenario that might contribute to resolving issues around the use of acute hospital beds. The Department of Health (DoH) Circular to Health Authorities and Local Councils with regard to Intermediate Care and the publication of the National Service Framework for Older People have brought intermediate care into mainstream health policy.