Traditional clinical review articles, also known as updates, differ from systematic reviews and meta-analyses. Systematic reviews comprehensively examine the medical literature, seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment. Meta-analyses, sometimes known as quantitative systematic reviews seek to answer a narrow clinical question, often about the specific treatment of a condition, using rigorous statistical analysis of pooled research studies. Updates review the medical literature almost as carefully as a systematic review but discuss the topic under question more broadly and make reasoned judgements where there is little hard evidence, based upon the expertise of the reviewer. It may not include evidence from foreign language journals or look for unpublished data on a topic, so will tend to be more applicable to the local situation than a systematic review, as it may take into account local shortages of equipment or personnel.

The connective tissues diseases are a group of related disorders, which are primarily autoimmune and triggered by environmental factors in susceptible individuals. They usually affect multiple organs and most of them can result in a shortened lifespan. Fortunately they are also very uncommon, and even rarer in later life. They are usually diagnosed on a clinical basis and, to help this, most have strict diagnostic criteria. However, a lot of patients do not fit well into one particular category, but overlap with several. Indeed a single individual could have features of or fulfil the criteria for all the diseases discussed in this review. A further group of patients are ‘undifferentiated’, often having mild disease and initially failing to fulfil any set of criteria.

Factors increasing the risk of urinary tract infections in old age include reduced T lymphocyte regulation, decreased B lymphocyte antibody synthesis, impaired killer T cell function and slowed neutrophil chemotaxis. More practical causes for a high incidence of urinary infections are multiple pathology and poor nutrition. In women, a low oestrogen level increases the intravaginal pH, resulting in the lactobacillus being replaced by a pathogenic agent. Faecal stasis may also increase the risk of a urinary infection. The presentation and severity of a urinary infection are affected by intercurrent disorders such as diabetes mellitus, poor bladder control, concurrent medication and cognitive impairment. Other relevant but less common disorders are bladder calculi and tumours. Common signs of pyouria in old age are urinary incontinence, anorexia, lethargy and confusion. The infection may even be asymptomatic and this is discussed later.

Polymyalgia rheumatica and temporal arteritis represent opposite poles of a single disease spectrum. In the former, girdle stiffness predominates; in the latter, frank vasculitis is demonstrable. There is no diagnostic laboratory test for polymyalgia rheumatica, and earlier reviews in 1993 and 1998 in this journal both drew attention to the difficulty in diagnosing polymyalgia rheumatica, particularly in the elderly.

Medical advances and improved living conditions mean that people who have an intellectual disability (ID), characterized by lifelong limited intellectual, social and vocational capabilities, are living longer. There has been a concomitant increase in the prevalence of age-associated diseases, including dementia.

This article will first set rehabilitation nursing and the older person into an appropriate context and then address the nature of rehabilitation nursing, how definitions have developed over time and lastly, what it is that we now provide, in conjunction with others, to meet the rehabilitative needs of our older population. The boundaries defining ‘old’, and between seeing a person as experienced, a bit wrinkly, forgetful and perhaps eccentric, versus a person who is old and demented are by no means clear-cut.

Falls, once thought to be an inevitable consequence of aging are now known to be the result of multiple pathological, psychological and social factors. Moreover, well-conducted research has shown that they can be prevented. Initially it appeared that multiple interventions by a multi-disciplinary team would be the most sensible and indeed the only effective approach. However, single interventions may sometimes be appropriate and on cost grounds would be preferable, provided that they are effective. This is clearly the case in the use of pacemakers for patients who are falling because of cardioinhibitory syncope. However, home modification, a seemingly obvious and intuitively correct intervention, has not been shown to prevent falls, although advice from an experienced occupational therapist can reduce falls, especially in those who have fallen previously. Whether balance training on its own is effective in reducing falls, or needs to be combined with muscle-strengthening exercises and other interventions, will be examined.

Over the last two decades, the care home sector has been a significant provider of long-term care for older people, with 11 500 homes providing care for 236 700 people across England and Wales. New admissions to residential care homes are increasingly older, aged 80 and over and have high levels of physical dependency, cognitive impairment and behavioural problems.