Dementia has traditionally been viewed as a global, undifferentiated impairment of intellect and memory. The implication is that patients with dementia share a common clinical syndrome. It is, however, now recognized that different dementing diseases give rise to distinct patterns of mental change, reflecting differences in the topographical distribution of pathological change within the brain. Contrary to the traditional view, analysis of the characteristics of dementia can contribute substantially to differential diagnosis. Indeed, since many patients with a dementing illness exhibit few physical signs, evaluation of the mental changes may be critical to diagnostic accuracy. With the advent of new therapies for dementia, precise diagnosis has become increasingly important. Moreover, understanding of patients’ symptom pattern provides a rational basis for patient management and for advice to carers.

Alcohol misuse among older people has now been investigated for over 30 years. Schonfeld and Dupree previously described studies of alcohol use and abuse in the USA and UK, categories of older problem drinkers, age-inappropriate assessments, and examples of age-specific treatment. This review addresses more recent studies on drinking behaviour across several countries, screening assessment for older adults, alcohol problems in primary care medical settings, current age-specific treatment programmes, and treatment recommendations by expert panels, as well as in-home detoxification and use of the medication naltrexone as adjuncts to treatment.

The last twenty years have seen a rapid expansion in the provision of post-acute rehabilitation services for patients with traumatic brain injuries (TBI) in North America, although such provision remains limited in Britain. These developments have been precipitated by a growing appreciation by health purchasers and providers of the neuropsychological and social sequelae of TBI and demands by patients and their families for effective treatment. Most investigations have found that the majority of TBI survivors are young males under the age of thirty and that by far the most common cause of TBI is road traffic accidents. Typically the frontal and temporal lobes of the brain suffer the greatest impact and survivors subsequently present with deficits affecting memory and new learning, attentional dysfunction and impaired planning and organizational skills.

Depression in old age is common, disabling and undertreated. This review will examine recent advances in our understanding of its clinical presentation, epidemiology, management and prognosis. The relationship of depression in old age with dementia and with physical illness is also discussed, as are the links between suicides, deliberate self-harm and depression in old age.

Whilst there is a considerable literature surrounding predictors of depressed mood in stroke survivors, much less research has been directed towards identifying the impact of a stroke on primary informal carers and the nature of the relationship between patient and carer characteristics, stroke consequences and carer distress. This review attempts to elucidate such relationships so that implications for health and social care provision can be drawn.

With significant demographic changes already apparent amongst the older population, care of elderly people in the community is becoming ever more important. It is predicted that the number of elderly people aged 65 years and over will rise from 8.4 million in 1985 to 9 million by the year 2001. The most significant growth will be found amongst those aged 85 years and over, with a projected rise from 8-13% of the population by the millennium.

The last five years have produced a large output on the epidemiology of dementia and cognitive impairment, specially on apolipoprotein E (apo E), vascular changes, and education as risk factors. Minor cognitive deficits have been studied prospectively to assess their value in predicting dementia. Reviews of work from particular centres and articles on special aspects give more detail. Preference is given to population-based over clinic-based studies and to those published in or after 1994.

The epidemiology of hearing loss in the elderly has been well documented in the UK by Davis and in the USA by Gates. Both studies confirm that presbyacusis is common. Hearing loss results in significant disability in social communication. Davis based his conclusions on a cohort of 2910 subjects while Gates looked at 1475 subjects six years apart. Both studies carried out detailed audiological examinations.

In his book ‘Effectiveness and Efficiency’ Cochrane drew attention to the need to evaluate the effectiveness of health service intervention. Despite his plea for more evaluative research in health services, it has been suggested that only 20% of health care interventions have been rigorously evaluated. Changes in the structure and philosophy of the NHS in the past decade have stimulated interest in the evaluation of health services interventions at both local and national levels.

‘When I use a word, it means just what I choose it to mean’. So it is with rehabilitation, except that several definitions and explanations have been proposed. Although the similarities between the definitions are considerable and far eclipse any differences, the perceived diversity of view has contributed to confusion over the purpose and process of rehabilitation. Is it ‘elderly care’? Is it ‘therapy’? Is it ‘post-acute’ care? The apparent ambiguity and the intangible qualities of rehabilitation contrast with the concrete ‘ologies’ of contemporary organ-based medicine and contribute to its vulnerability in our modern general hospitals. Pressures caused by rising emergency admissions and cost-driven bed closures have necessitated steadily reducing lengths of stay and rehabilitation, as a less visible component of care, has tended to be squeezed out. Paradoxically, the consequences of the ‘sicker and quicker’ discharge approach, with fresh burdens placed on community health and social services, have drawn attention to rehabilitation as a missing ingredient. We have now entered a phase of rediscovering at a strategic policy level the rehabilitation needs of older people but redefined in new terminology as ‘recuperation’ or ‘recovery’ This article will describe the core concepts of rehabilitation for older people and set the scene for forthcoming articles addressing specific rehabilitation topics.

In England there are over 100 000 elderly people registered blind and a further 80 000 registered partially sighted. Visual impairment is common in the elderly population, with approximately 10% of people of 65 years of age and over having poor vision. The prevalence of visual problems appears to be much greater among older people in institutionalized care. A study of 100 elderly people living in residential homes in London revealed that 51% had cataract and 34% had significant refractive errors. A further study of patients attending a geriatric day centre found that about one-third had unrecognized visual loss.

Smoking has been closely implicated in many cardiovascular, lung and other diseases which are prevalent in the elderly, but most prevention programmes tend to be aimed at younger age groups.

The prevention of smoking in retired people is a subject which is not yet fully researched, but there is a little information which suggests that it may be a worthwhile pursuit. Certainly, work has shown that longevity can be improved even in older people by stopping smoking. Coronary heart disease death rates for 65-74 year olds who have recently given up are similar to non-smokers. For other causes of death, especially lung cancer and bronchitis, the benefits of stopping smoking take up to five years to appear. In terms of morbidity, there are suggestions that ex-smokers move reasonably quickly towards the state of non-smokers for bone density, pulmonary function and muscle strength.

The World Wide Web (WWW) has much to offer clinicians, nurses, scientists and all those concerned with gerontology, including our patients and their relatives. This article reviews the history and structure of the WWW, outlines the basics of how to use it and what is available for the gerontologist. This is not a comprehensive list of all known webpages in gerontology, since this would not be possible, given the ever-changing nature of the WWW. Instead, this article offers a background knowledge and introduction to the types of resources that are available, enabling more productive use of the WWW for finding information in gerontology.

Unfortunately, stroke is an extremely common disease. Around 100 000 people suffer a first-ever stroke each year. Stroke is the third commonest cause of death in the western world and is a major cause of long-term disability. Many patients admitted acutely to hospital after stroke will have a transient or persistent problem with their swallowing. Impaired swallowing results in a failure to maintain nutritional status and hydration, a break-down of vital organs, increasing susceptibility to infection and an increased likelihood of dying.

The recent Royal Commission report on funding long-term care was produced following more than 100 visits and evidence from 400 organizations. It was set up following concern at the costs of long-term care for elderly people and what was seen to be the anomalous position of elderly people cared for by the NHS in long-term beds, where all costs were found by the state, albeit that elderly persons themselves lost most of their benefits. This contrasted with those in the social or independent sector, where payment has to be made unless the elderly person is poor.

As the number of elderly people in society increases then the number of those with diabetes will increase. The prevalence of diabetes varies both geographically and between different ethnic groups. The large population study NHANES 2 in the USA showed rates of 9.3% and 8.4% for diagnosed and undiagnosed diabetes, respectively, in those aged 66-74 years. These figures have been roughly corroborated, using similar diagnostic criteria, in a more recent population-based study in Italy (10% and 5% respectively). Although known risk factors for non-insulin-dependent diabetes mellitus (NIDDM) such as family history, obesity and central distribution of fat are important in the elderly, aging itself seems to be a stronger risk factor.