Clostridium difficile is a spore-forming gram positive anaerobic bacillus that is part of the normal faecal flora of about 3% of healthy adults. Colonization rates may be much higher than that in hospitalized patients and in newborns. It can occur at any age, but elderly adults and debilitated patients are most susceptible to disease. In such patients, even a short course of antibiotic therapy for prophylaxis or treatment of minor infections can lead to colonization and Clostridium difficile infection. The list of causative antimicrobials is extensive but, in general, any antimicrobial agent that can get into the intestinal lumen can, even in small amounts, induce disease.

Over the last decades of the twentieth century survival after stroke has increased considerably, with the greatest effect being in patients over 75 years. As a result, stroke is now affecting tissues and organs previously regarded as being of little relevance. The skeleton is one body system that in the longer term is affected by stroke, with fracture now becoming a significant complication. Bone loss can now readily be measured, and therapies that may be able to prevent bone loss and fracture are available for clinical trial. This review examines the direct and indirect factors that influence the relationship between fracture and stroke.

Over the last few decades, the prevalence of chronic renal impairment has increased throughout the population, especially in the older age group. This is not just a consequence of the general increase in longevity, but is also caused by a higher incidence related to improved survival of patients with chronic diseases affecting renal function, such as diabetes, hypertension and ischaemic heart disease, and improved survival of patients with established renal failure.

Orthostatic hypotension (OH) is a clinical condition which frequently results in troublesome symptoms such as dizziness, giddiness, blurred vision and light-headedness. It is a common disorder associated with an increased risk of falling, especially in older individuals. OH is the presenting haemodynamic manifestation of several different and diverse underlying pathological conditions, including disorders of blood pressure (BP) regulation and disorders leading to reduced intravascular volume.

Acute stroke is a commonly-used term in clinical practice and in standard texts, but tends to reinforce a widely-held perception of stroke as a short-term condition. Arguably, this brief, time-limited approach to stroke care has become more dominant, with the reliable evidence that hospital-based stroke care, using the model of a stroke rehabilitation unit, confers improved patient outcomes. For patients disabled by stroke, however, the substrate for longer-term problems is obvious, and stroke as a chronic condition is a more helpful and user-centred health care paradigm.

There is overwhelming evidence to suggest that the neuropathology of Alzheimer's disease (AD) extends beyond amyloid plaques and neurofibrillary tangles. There is a clear overlap between the pathology of AD and vascular dementia (VaD), but the relationship is different for different types of vascular lesion. Cerebral amyloid angiopathy (CAA) and degeneration of the microvasculature are probably intrinsic to the AD process, whilst ischaemic white matter disease and areas of infarction are largely independent of AD pathology, but result in additional cognitive deficits and reduce the threshold of AD pathology necessary for the emergence of a clinical dementia syndrome.

The aims of psychosocial intervention for people with early-stage dementia are essentially those of rehabilitation. That is to say, the focus should be an attempt to optimize functioning and wellbeing, and to support the person’s social system, thus facilitating continued engagement and participation. It can be argued that a focus on rehabilitation is consistent with the person-centred approach advocated by Kitwood, emphasizing the potential disabling effects of negative social environments and the importance of attempting to counter the resulting excess disability and thus support the selfhood of the person with dementia.

The Government’s National Health Service Plan followed by the English National Service Framework for Older People (NSF) has sparked widespread discussions, debates, research agendas, service developments and resource allocations surrounding ‘intermediate care’. In the UK there has been no universally accepted definition for the term. Different authorities have defined intermediate care in different ways.

The growing number of old and very old people in the United Kingdom is attracting increasing attention, particularly with respect to the cost of providing institutional, residential and nursing home care. It is estimated that about 6% of people will require this type of care and the current annual cost is over 3.5 billion pounds. In the United Kingdom, provision of institutional care for elderly people has undergone significant change in the past two decades, with a shift from National Health Service provision of long-term hospital care to the current dominant role of private home care by independent commercial sector providers.