Telomere length is a reflection of cumulative oxidative and inflammatory stress throughout the life course, as well as oestrogen exposure. There is evidence that telomere length is associated with lifespan; however, it does not appear to be a better indicator of biological age than chronological age, even though it can be considered a biomarker of ageing. There are studies showing association between leukocyte telomere length and many of the common diseases of ageing, lifestyle factors and socioeconomic status. However, the associations are less marked among older people. Research in the area of manipulation of genetic control of telomerase activity controlling telomere length may have clinical applications in future.

Benign and malignant prostate disease is common in older men and becomes more prevalent with age. Many seek medical help due to bother associated with lower urinary tract symptoms (LUTS). Some fear their LUTS are secondary to prostate cancer or seek advice regarding prostate cancer screening. Furthermore, prostate cancer is now the most common male cancer in the UK. However, not all prostate disease causes LUTS. Equally, not all LUTS are due to a disease of the prostate. Thorough clinical assessment is therefore required to identify urological from non-urological, and benign from malignant causes of LUTS. This review presents a description of the current terminology for diseases of the prostate, the essential clinical assessment and investigations, and a description of the many treatment options currently available for both benign and malignant prostate disease.

Survival to discharge after in-hospital cardiopulmonary resuscitation (CPR) is about 20% in those aged 65–69 years, declining with advancing age to about 10% in those aged 90 years or more. There are conflicting reports on whether or not advanced age, independent of the severity of acute and chronic illness, is a determinant of outcome. Recognition that the outcome of CPR in hospital patients is often poor has prompted extensive debate regarding the appropriate use of this procedure. In particular, there has been concern about unnecessary CPR in extended-care and hospice settings. Conversely, there has also been evidence that doctors and families may be prone to underestimate the quality of life and likelihood of benefit from CPR in older people and to make resuscitation decisions without considering the preferences of older people themselves. Recent guidelines have attempted to strike a balance between ensuring patient participation whenever possible but without offering illusory choices where CPR is very unlikely to succeed.

Urinary incontinence is a common symptom in women, more so in older people, with a significant impact on physical health and wellbeing. About 1 in 5 people have impaired continence. Symptom categorization at initial assessment is the key to guiding further therapy. Non-pharmacological options (bladder training for 6 weeks with guidance from a trained physiotherapist) are preferred and can be supported with biofeedback. If unsuccessful, anticholinergics are added and, rarely, surgical options need consideration.

Anticholinergics are the mainstay of pharmacological management of urge incontinence. The National Institute of Health and Clinical Excellence (NICE) recommends immediate release oxybutynin as the first-line agent, with recourse to others if there are adverse effects. The pharmacology, efficacy and adverse effect profile of the various anticholinergic drugs is reviewed, allowing the reader to make an informed choice of appropriate anticholinergics for urge incontinence.

Musculoskeletal symptoms are extremely common, with almost one-third of people aged 75 years and over having a significant musculoskeletal problem. Joint pain due to inflammatory arthritis is important to identify, as it is potentially treatable. In elderly patients, inflammatory arthritis may not present in the ‘classical’ way, may present with non-specific symptoms and may co-exist with other musculoskeletal problems, all of which can result in diagnostic difficulty. In addition, co-morbid conditions and polypharmacy may present treatment challenges. In this paper, we discuss the general considerations in the clinical evaluation and management of a patient with inflammatory joint symptoms and discuss in more detail the diagnosis and management of the common causes of inflammatory arthritis.

Alcohol use is common in older adults and is associated with numerous health and social problems. Recent evidence suggests that in addition to level of alcohol consumption, drinking pattern may also be important. Moderate alcohol intake may confer some cardiac benefits, while heavy episodic drinking seems particularly problematic. Detecting alcohol misuse in older adults is difficult since clinical acumen is often poor, screening questionnaires have serious limitations and laboratory tests are not diagnostic. Brief alcohol interventions to reduce alcohol consumption appear useful in younger populations, but are less studied in older adults. While there is increasing research into the issue of alcohol use among older adults, clinicians and policy-makers must rely on limited evidence when making clinical decisions.

This review provides an update on current evidence surrounding epidemiology, treatment and prevention of lower respiratory tract infection, with special reference to pneumonia and influenza, in care home residents. The care home sector is growing and provides a unique ecological niche for infections, housing frail older people with multiple co-morbidities and frequent contact with healthcare services. There are therefore considerations in the epidemiology and management of these conditions that are specific to care homes. Opportunities for prevention, in the form of vaccination strategies and improving oral hygiene, may reduce the burden of these diseases in the future. Work is needed to research these infections specifically in the care home setting, and this article highlights current gaps in our knowledge.