This review on Parkinson's disease (PD) considers pharmacological and surgical management and important non-motor symptoms (NMS) such as depression, dementia and sleep disorder. In the absence of a proven neuroprotective drug, therapy remains symptomatic and may be initiated with levodopa or a dopamine agonist or a monoamine oxidase inhibitor. Treatment should be tailored to the individual patient, with patient preference, extent of functional impairment and co-morbidity more important than age per se. As disease progresses, therapy usually becomes more complex and apomorphine, duodopa and surgical intervention may be useful.

NMS may be present at any stage of illness but become more common in severity and frequency with advanced disease, when neuropsychiatric features such as dementia and psychosis dominate the clinical picture. NMS are often unrecognized and undeclared by patients and carers in clinic. Novel agents for treating non-motor features, which are often poorly responsive to dopaminergic therapy, are urgently required.

Published literature shows that evidence-based medical care can improve hip fracture outcomes. The orthogeriatrician plays a key role in providing this care, in collaboration with surgical and multidisciplinary professionals, managing pre-operative conditions and post-operative complications that may affect functional recovery, and ensuring co-ordinated effective management of hip fractures right from admission to discharge. Several management guidelines are available for this vulnerable group of elderly patients. Recent UK guidelines recommend that, from time of admission, hip fracture patients should be offered a formal acute orthogeriatric or orthopaedic ward-based ‘Hip Fracture Programme’, which includes orthogeriatric assessment as an essential key component.

The proportion of older people becoming frail will increase with the expanding older population. Apart from poor health, frailty is associated with loss of strength and functional dependency. Building on previous work in this area, this review investigates the effectiveness, sustainability and adverse effects of exercise interventions on muscle strength and physical performance in frail older people. Randomized controlled trials reporting physical outcomes in frail older people were identified from seven electronic databases. Thirteen trials involving 1652 participants met the inclusion criteria. There was wide heterogeneity in degree of frailty, types of intervention, outcome measures and results. However, evidence from this review suggests that exercise and some physical activity programmes, particularly moderate intensity and multi-component programmes, are safe and can improve strength and function in the majority of frail older people except highly frail individuals with multiple co-morbidities. There was limited evidence on transferability of improvements into everyday life, and sustainability could not be determined.

Housing tenure takes a variety of forms, the most common of which are rental and owner-occupation. Currently, in the United Kingdom (UK), approximately 70% of older people live in owner-occupier properties, with the majority of the remainder renting from a public or private landlord. Research has consistently shown higher levels of morbidity and mortality among renters compared with owner-occupiers. However, it is unclear whether this is due to tenure acting as a proxy for other indicators of socio-economic status, such as income, which directly influences health, or whether other characteristics associated with tenure, including housing quality and location, explain the association. Untangling these competing influences of tenure on health is important, as it may provide clues on tackling health inequalities at older ages. Tenure too, appears to be related to the risk of long-stay care admission, with owner-occupiers significantly less likely to leave their home than renters; more work is required to identify why this is the case, as it may provide some insights on facilitating ageing in place.

The increasing number of old people is becoming a growing policy concern. Negative attitudes towards old people raise questions about the extent to which discrimination against old people exists and elder abuse occurs. This paper describes the occurrence of discrimination against old people and elder abuse, as well as the factors related to it, based on a review of (scientific) literature, official documents and the actions of legal bodies.

Frequent or regular age discrimination, as experienced by old people themselves, is reported by a quarter of European citizens. Data on elder abuse vary and are often not representative; the same goes for data on inequality. Nevertheless, the analysis shows that discrimination against old age and elder abuse occurs regularly in the ‘western world’. Vulnerable old people are especially at risk. National and regional, multi-component action plans are recommended to combat discrimination against old people.

That transfer of older people from one institution to another is detrimental to well-being, health and survival has been reported for 50 years. This has led to fear, anger and legal challenges when closures occur. Previous reviews identified accounts of relocation followed by adverse outcomes and others where problems were avoided or benefits claimed. This paper reviews the last twelve years of literature on health outcomes following involuntary relocation between nursing homes. Reports of post-move mortality, physical or psychological health suggest and confirm that relocation without preparation carries higher risk of poor outcomes than moves that are orderly and include preparation. The literature on the care home closure process, admissions and individual transfers offers insights into practices that might help minimize adverse outcomes. A number of agencies have produced helpful guidelines. How these are implemented needs to be monitored and linked to in-depth studies of sample closures.