The proportion of older people in our society is increasing more rapidly than any other section of the population. This group uses health and social services more than the young do and this is reflected in the NHS and social service budgets from recent years. For example, 40% of the NHS budget was spent on patients over 65 years in 1998. The much-heralded National Service Framework (NSF) for Older People, recently published by the Department of Health in England, was therefore awaited with much anticipation by all sections of the community concerned with older people’s health. This document is described as the ‘key vehicle for ensuring that the needs of older people are at the heart of the government’s reform programme for health and social services’. It has as its first and fundamental standard ‘rooting out age discrimination’. The sections on prevention and treatment of stroke, general hospital care, the management of falls and mental health have been generally well received and when implemented fully are likely to be beneficial to older people. Some areas such as the treatment of care home residents have not been addressed in nearly enough detail. In contrast, one particular section, that on ‘Intermediate Care’, has been heavily criticized, including a fierce attack by two of the United Kingdom’s leading geriatricians.

Research shows that approximately one in three people over the age of 65 years falls in any one year, with approximately one in three falling again in the following year. Prevalence of falls also increases with age, and women are more likely to fall than men. However, in advanced old age the ratio of men and women fallers reaches equal proportions.

The diagnosis of neurosyphilis is important but remains difficult because of variable clinical features and an unpredictable course. Laboratory confirmation involves a combination of serological tests, none of which alone provides a reliable indication of current disease activity. Although in the UK the incidence of neurosyphilis has fallen steadily, its many manifestations require clinicians to remain alert to the diagnosis, particularly because incidental antibiotic therapy may modify the presenting features. As a sexually-transmitted disease, the diagnosis of syphilis carries great social stigma. The need for informed consent before routine testing, and the provision of psychological support for the patient and carers in the event of a positive diagnosis, must be considered.

Dietary, biochemical and anthropometric data indicate good nutritional status, in general, in community-dwelling, healthy elderly people, at least in the USA. In a sample of 209 men over 65 years of age without acute disease-related nutritional risk factors, mean intake of nutrients generally met or exceeded the recommended dietary values, with the exception of calories, although 7% of subjects consumed inadequate amounts of thiamine, vitamin A, vitamin C and calcium. Few subjects were extremely underweight or obese, although body fat, as assessed by skinfold thickness, fell over the two years of evaluation. The prevalence of malnutrition in patients with chronic disease living in the community in the UK is estimated to be around 8%, however. In this study of more than 11 000 men and women aged 18 years or over, consultation rates in general practice and prescription rates were lowest amongst patients with a body-mass index between 20 and 25. Hospital outpatient referral rates were not related to nutritional status, but both hospital admission rates and mortality were greatest in people with a body-mass index(BMI) (kg/m2) below 20, and declined as BMI increased.

Control of hypertension is generally acknowledged to be important in reducing the risk of vascular events. Although hypertension affects over 50% of people aged 60 years or over, a study in 1995 showed that general practitioners were much less likely to treat an older person with a blood pressure outside the normal range than a younger person.

This paper addresses some ethical and legal issues which arise in the UK in the care of people with dementia, focusing on the law in England and Wales – updating and revising the 1997 and earlier version. The ‘end of medical ethics’ continues to be debated, with an attendant fear of doctors’ responsibility and authority being fatally eroded by administrators and cost controllers, concerned only with budgets and ‘bureaucratic parsimony’.

Spinal cord injury (SCI) is a catastrophe that affects the individual, the partner, the family and the community. Society is involved in the broader sense, in the funding of the treatment and long-term support of individuals with SCI. SCI causes complex medical, physical, psychological, social and financial interactions. Although the physiological impairment following a SCI typically affects the locomotor and sensory systems, there is nearly always a resulting dysfunction that affects most bodily systems. Both the multi-system physiological impairment/dysfunction and non-medical aspects of SCI remain in a dynamic state for the rest of the individual’s life. This means that lifelong treatment and monitoring is required by a dedicated multidisciplinary/interdisciplinary team of health and social care professionals.

Rehabilitation aims to reduce symptoms, restore function and minimize disability through an interventionist approach that is not always concerned with pathology, disease processes and cure. This approach will be described in the context of spinal pain in the elderly. The syndrome of lower back pain (LBP) is such a common symptom that it is an almost universal human experience. It is the third most commonly reported bodily symptom after headache and fatigue. In 1998, 40% adults were affected by an episode of LBP lasting more than a day, and 40% of those in pain sought medical help. The resources provided for research and clinical management of LBP are concentrated mainly on the working population. This is because of the profound biopsychosocial consequences and huge cost to society of the ‘back pain epidemic’. The direct health care costs of back pain have been estimated as £1632 million in 1998.

The proportion of older people in the UK is increasing in relation to the population as a whole. This trend is reflected in the age profile of patients in hospital and those requiring continuing care in the community – domicilary, residential and nursing home sector. The HAS Report identified that more than 40% of patients over 65 with disability will require admission to an acute hospital over a two-year period. Ensuring appropriate, equitable and quality care for this age group is therefore a priority.