Improvements in health care together with superior standards of housing, nutrition and hygiene have led to an increase in average life expectancy, with a fifth of the UK population being over 60 years of age. Skin problems are common in elderly people: one study of 20 000 non-institutionalized US citizens found a significant dermatological problem in 40% of those aged 65 to 74 years. This review aims to discuss some common and important dermatological conditions seen in the elderly population and provide guidance on diagnosis and management.

Inflammation is an innate immunological response that fends off or repairs injuries caused by foreign agents as part of an essential defence mechanism. There are two main classifications of the inflammatory process, based on its intensity and time-dependent responses: an acute, rapid response with resolution or a low-grade, chronic process without resolution. In this review, the latter case of a long sustaining inflammatory process is discussed in relation to aging. Many epidemiological and experimental studies in recent years report on the age-related activation of inflammatory processes by showing age-related increases in the activities of many pro-inflammatory mediators such as, NFkß, TNFα, IL-1, IL-6, C-reactive protein (CRP), thromboxane A, adhesion molecules, and free fatty acids.

The suggestion from post-mortem studies that there is an age-related fall in liver weight has been confirmed by in vivo studies, employing ultrasound or CT scanning. These demonstrate an estimated 28% lower volume in individuals above the age of 65 compared with those under 40 years of age. The functional significance of the fall in liver size with age is confirmed by the highly significant correlation between age, liver volume estimated by ultrasound and galactose elimination, the clearance of which is determined by functional hepatic mass this fall in mass of functional hepatocytes is also illustrated by an age-related reduction in binding of radiolabelled galactosyl-albumin. Liver blood flow, estimated by pulsed echo-doppler, or functional hepatic flow measured by the hepatic clearance of D-sorbitol or indocyanine green, falls significantly with aging, with around a 33% fall between youth and old age., The thickening of the sinusoidal endothelial lining with collagen, and fall in endothelial cell fenestrations, noted with increasing age in human liver, is likely to impair blood flow through liver sinusoids and hepatic perfusion, and reduce oxygen-dependent hepatocyte function, such as uptake of macromolecules. This may contribute to the link between the aging process and disease susceptibility.

Heart failure is predominantly a disease of older patients, and varies in its severity and presentation. Advances in the understanding of both the pathophysiology and approaches to treatment for patients with heart failure have resulted in marked improvements in prognosis over the past 20 years. In younger patients, heart failure is often a consequence of myocardial infarction, with resultant left ventricular remodelling and dilatation, while it is more likely to be due to hypertension, valvular heart disease and atrial fibrillation in older patients. Other heart-failure aetiologies include the cardiomyopathies and reno-vascular disease, and additional non-cardiac disease such as anaemia can result in a symptomatic deterioration.

Myopathy is a convenient shorthand term meaning muscle disease or dysfunction. In other words, the myopathies are those conditions in which the patient's symptoms and signs can be attributed to a pathological process affecting either the structure of muscle fibres or their associated interstitial tissues, or to disturbance of the biochemical or electrophysiological function of those fibres. Myopathies are rare in all age ranges. They may be inherited or acquired. Onset of inherited myopathies in elderly people, not surprisingly, is uncommon, but some of these diseases are asymptomatic, or cause such minor symptoms that their significance is not appreciated by the patient, and thus they may not be recognized until late on in life. Their recognition may have implications for other, younger, family members. Many of the acquired myopathies afflicting older people are treatable, but the commonest, inclusion body myositis, is not, and incorrect diagnosis and inappropriate use of steroids may compound morbidity.

Although the prevalence of acute pain does not increase as a result of aging, chronic pain problems tend to increase in late life. There is also limited evidence that there is a plateau or even a slight reduction in the frequency of chronic pain following the eighth decade of life. Many health conditions that affect older adults are associated with pain, and overall prevalence estimates for this population range from 25% to 65% for community-dwelling older persons, and up to 80% for seniors living in long-term care facilities. The wide variation in prevalence estimates is likely to be due to differences in survey methodologies and operational definitions of pain (e.g. ‘pain during the last week’ vs. ‘pain during the last month’). Nonetheless, a consensus view appears to converge on the conclusion that at least 50% of older persons suffer from at least one persistent or bothersome pain problem at any one point in time. Although many seniors with dementia have difficulty reporting pain due to cognitive impairment, in a large-scale investigation of nursing-home residents, it was shown that conditions that are likely to cause pain occur with equal frequency in residents with and without dementia.

Disequilibrium, or imbalance, is a type of dizziness typically described as a feeling of unsteadiness when standing or walking that is not present while sitting or lying down. Patients with disequilibrium often complain of vertigo, lightheadedness, or a similar ‘head’ sensation as the main symptom, but disequilibrium also occurs in isolation. The first step in determining the cause is to define exactly what the patient is experiencing, and any associated symptoms. The complaint of imbalance is very common among older people. Since the population is quickly aging, we can only expect the number of patients presenting with it to increase. As a result of this frequent presentation and the many potential causes of the symptom, some authors even argue that disequilibrium should be considered part of a geriatric syndrome. Further complicating the evaluation is the fact that most elderly people have at least one chronic disease and are taking several medications, factors that could contribute to, or even cause, disequilibrium. Signs on examination that could indicate early features of neurodegenerative disorders are also common in older people. Because dizziness and imbalance have a strong association with falls, searching for a reversible disorder and directing attention to fall-prevention strategies are paramount. Falls themselves are a major source of morbidity and mortality in the elderly population.