Good communication between health and social care professionals and patients, their families and carers is recognized increasingly as integral to best management. Thus a central principle of the NHS Plan is that all patients should have open access to information about services, treatments and performance and should be treated as partners in their own care. Lack of information and poor communication is a common basis for complaints, and there is little evidence that older patients want any less information than those who are younger Certainly, if elderly people living with long-term illness, frailty or disability are fully informed, they will be better able to make appropriate decisions and actively participate in managing their own condition and their lives. In general, it is for professionals to provide the required information and support, or to direct people to other quality sources of evidence-based information, and not for them to decide whether or what should be disclosed.

Since the last review of this subject in this journal, there have been a number of developments in this area that are of relevance to the management of clinical problems of older people. It is important to note that the results of blood tests obtained in older people may differ in significance compared to those obtained from younger people. This review is based on a literature search using Medline, usually going back to 1998, combining sets of papers with the key word ‘elderly’. Studies known to the author were also included.

Joint problems in older people are common–both as ongoing chronic problems but also individuals presenting for the first time with joint symptoms. The assessment of an elderly person presenting with joint symptoms poses special challenges. There is a large potential differential diagnosis and more than one form of arthritis may co-exist, most commonly osteoarthritis. The clinical presentation in older patients may differ from typical findings in a younger individual and co-morbid conditions may complicate management strategies. In this article we discuss the differential diagnosis and management of conditions presenting as inflammatory arthritis in older people.

The kidneys undergo a multitude of structural and functional changes with advancing age. Structurally, there is a progressive loss of predominantly cortical renal mass, a decrease in the number of glomeruli, an increase in the proportion of sclerotic glomeruli, atherosclerotic vascular changes and interstitial changes resulting in atrophy and fibrosis. Functionally, there is a decline in the glomerular filtration rate (GFR), resulting primarily from a decrease in the number of functioning nephrons.

Loneliness may be regarded as a ‘geriatric giant’, leading to impaired quality of life, greater need for institutional care and increased mortality. For the past 30 years, a growing number of studies have focused on loneliness. However, the majority of these have been descriptive and cross-sectional. Further longitudinal studies are needed to understand the causal relationship between life-events and loneliness, its prognostic significance and, in particular, whether negative consequences may be alleviated.

The use of the term ‘technology’ in relation to dementia care provokes conflicting reactions. For some, ‘technology is a saviour, the way to paradise; others are deeply suspicious of technology and scrutinize its proponents carefully for any tell-tale marks of the Beast’. These conflicting reactions may be attributed to the confusion surrounding the term ‘technology’, the lack of awareness at all levels of the potential of technology to assist people with dementia, and the ethical issues surrounding the use of technology.

The upper limb (UL) is a common site for poststroke pain, which is often regarded as a direct consequence of proximal motor impairment. Although the subacromial region is the commonest site, pain can also occur lower down the UL and some causes are not directly related to hemiplegia. As distal clinical features unrelated to motor consequences of stroke can be useful for making a management plan for pain, this review will generally refer to poststroke upper limb pain (PULP) rather than use traditional terms such as hemiplegic shoulder pain (which may erroneously imply a proximal, purely motor related aetiology).

The increasing number of older people requiring interventions for improved health and social care has been identified as a crucial challenge for the twenty-first century. The reported high prevalence of pain in older people in long-term care facilities has been described as a public health issue not only in the USA but also globally. Rather than merely extending life, the reduction of morbidity, ways of coping with disability, preventing incapacity, extending the quality of life and enhancing the functional independence of older people are identified as important components of service provision. In Britain, the number of people aged over 65 years has doubled in the last 70 years and the number of people over 90 years is expected to double in the next 25 years, which will increase the need for health care in the future. Estimates for the UK indicate that approximately 445 800 older people are currently resident in care homes. The UK government has recently pledged to provide high-quality care and treatment for this population, to treat older people with respect and dignity and to allocate fair resources for conditions that affect them, while simultaneously easing the financial burden of long-term care.