Over the past several years health care policies ‘have created a lack of NHS recuperative care beds. As a result, elderly patients have been discharged too early, or kept in acute care - blocking these beds.’ A King’s Fund discussion paper stated: ‘There is a group of people who have health care needs which, while not requiring the facilities of the acute hospital sector, do demand considerable support to regain a maximum level of health’.

We read with interest the review article by Paul V Knight and Alan McKenzie on diabetes in the elderly. They highlight the fact that close examination of the feet or fundoscopy is often not performed. We have audited the care of elderly diabetic patients on our acute wards using the BGS guidline for diabetic care.

Scientific progress in human immunosenescence research is pointing increasingly towards the clinical importance of age-associated changes in immunity, although many areas remain controversial. For infectious disease, there is accumulating good empirical evidence, discussed in this review, that immunosenescence compromises protection in elderly people. This implies that an age-associated decreasing immunity results in increased incidence of those diseases that the immune system is designed to protect against, i.e. infectious diseases. This unsurprising conclusion suggests that preventing these infections using interventions designed to prevent or reverse immunosenescence could extend the period of life enjoyed in good health.

Benign prostatic enlargement (BPE) is an increase in the volume of the prostate gland which can be detected by digital rectal examination (DRE) or more accurately by transrectal ultrasound (TRUS). BPE may be due to benign prostatic hyperplasia (BPH) which is a histological diagnosis characterized by a combination of atrophy and proliferation in both glandular and stromal tissue. The onset of BPH is dependent on the presence of testes and increasing age. The first pathological signs appear under the age of 40 years followed by a rapid increase in prevalence with age: 80% of 80-year-olds have evidence of BPH. Bladder outlet obstruction (BOO) is defined by pressure-flow studies (PQS) and may be due to benign prostatic obstruction (BPO).

This review examines the relationship between dysequilibrium, falling and anxiety, and their combined impact on the lives of elderly people. More than one in four people aged over 69 fall each year, and a higher proportion of those over 74. Although only one in ten incurs serious injury as a direct result of the fall, fear of falling can often lead not only to psychological distress but also to restriction of activity and an unnecessary and undesirable loss of independence. Naturally, symptoms of imbalance constitute a key risk factor for falling.

The cochleovestibular system is unique in that the peripheral labyrinth subserves two senses, hearing and balance, while the central auditory and vestibular connections diverge within the central nervous system and interact with a multiplicity of information from other sensory inputs. During the seventh decade of life, approximately 40% of people in Great Britain have a significant hearing impairment while in the eighth decade of life this figure rises to 60%. By the age of 65, 35% of people have experienced episodes of dizziness and by the age of 80, two-thirds of women and one-third of men have suffered episodes of vertigo. The elderly population is reported to be increasing by approximately 30% every 20 years and the prevalence of vertigo and hearing loss has been reported to rise in parallel with advancing age.

Polymyalgia rheumatica and temporal arteritis are still held to represent opposite poles of a single disease spectrum. In the former, girdle stiffness predominates; in the latter, frank vasculitis is demonstrable. Earlier reviews that were slanted at geriatricians in 1983 and 1993 both bemoaned the lack of an adequate diagnostic test and the differential diagnosis still remains particularly difficult in elderly people. Reviewing the situation after a further five years, this diagnostic confusion still exists, though there has been an increased recent interest in research into this condition. Although such endeavours have yet to help us diagnostically, the last five years have seen further insights into aetiopathogenesis as well as new approaches to treatment.

Consent is a conceptual issue, and it can be argued that some of the most complex cases in assessing competence to consent arise when dealing with patients with dementia. This paper is concerned with the practical difficulties nurses face, an area for which there is little guidance.

Much of the literature relates to the ethics and legalities of informed consent for treatment or research, frequently in relation to medicine, philosophy and the law. Some frameworks are offered within these areas by which to assess a person‘s competence to consent, but they are of limited use in nursing.

The concept of formal or standardized tests for assessing function came to the fore in the 1960s. Katz et al. acknowledged the hierarchical nature of activities of daily living (ADL) such as eating, continence, transferring, going to the toilet, dressing and bathing in his ’Index of ADL’ and by 1968 ‘ADL’ was an accepted Index Medicus category. The definition of instrumental activities of daily living (IADL) began in 1969 with the work of Lawton and Brody who presented two scales to assess function which recognized the different degrees of complexity required for performing functional tasks. The first scale, taking life maintenance and activities essential for self-care as the primary level, was called the Physical Self-Maintenance Scale.

The well-being of older adults in general, and their loneliness in particular, are important themes in recent discussions in the Western world. The social integration and participation of older adults in society are seen as indicators of productive aging, and the alleviation of loneliness forms part of policies aimed at achieving the goal of ‘successful’ aging. Discussions about loneliness date back to ancient times, when they were led by philosophers. They wrote primarily about ‘positive’ loneliness. This positive type of loneliness - as indicated in the concept of ‘Einsamkeit’ used in German literature until 1945 - is perceived to be related to the voluntary withdrawal from the daily hassles of life and oriented towards higher goals, such as reflection, meditation and communication with God.

In July 1997 Harriet Harman, the new Secretary of State for Social Security in the UK, announced a fundamental and wide-ranging review of all aspects of pension provision. The review comes at a time when trust in the pensions industry is at an all-time low. The reputation of occupational pensions was dealt a severe blow by the Maxwell scandal, and personal pensions have now been revealed as a very bad buy for many of the almost six million people who have signed up for them since 1988. That such pensions were mis-sold has now been formally acknowledged and steps taken to prevent a repetition, but many people are still waiting for their compensation. State provision is also not immune from this crisis of confidence. Since 1980 the basic pension has been indexed to prices rather than to earnings as previously. As a result its value has shrunk to 14% of average male earnings, compared with 21% in 1980, and it is predicted to fall further to a ‘nugatory’ 9% by 2020.

The clinical syndrome of heart failure affects more than 1% of the population, and its prevalence increases steeply with advancing age, especially after 75, where it reaches approximately 10%. It is one of the commonest reasons for the admission of elderly people to hospital.

Despite recent advances in treatment of heart failure with angiotensin-converting enzyme (ACE) inhibitors, which were proven to provide survival benefit, the rates of morbidity and mortality from heart failure remain high, and new therapeutic strategie s are needed.