Two previous publications by the author in Reviews in Clinical Gerontology have dealt firstly with the background physiology of exercise and secondly with the benefits to health of regular exercise across a wide spectrum of diseases and disabilities in older people. This article assumes that the reader is familiar with these reviews. A useful recent report focusing on coronary heart disease, diabetes mellitus and arthritis summarizes recommended physical activities for various age groups and conditions.

Bleeding in elderly patients is most commonly due to an underlying structural problem or an acquired coagulopathy. Occasionally, previously asymptomatic congenital bleeding disorders may present at an advanced age. When considering the possible causes of a clinical bleeding problem, the coagulation cascade is still a good starting-point. However, it is important to realize that the traditional model of the coagulation cascade has been superceded by the concept of a ‘coagulation network’. This updated model recognizes the importance of tissue factor in the initiation of coagulation. Despite the complexity of this model, the basic coagulation tests can still be interpreted in relation to the ‘intrinsic’, ‘extrinsic’ and ‘final common pathway’ components of the old-fashioned cascade (Figure 1).

Type 2 diabetes is a chronic progressive condition with a prevalence which rises with age. Its origins are believed to be multifactorial, and include genetic effects and environmental interactions, which may start in the uterus (with an association with low birth weight) and early developmental plasticity, resulting in compensatory growth through childhood and a tendency to abnormal glucose tolerance in adult life. The consequences are multi-systemic, with a combination of microvascular and macrovascular disease affecting multiple organs of the body. There is a high level of morbidity and mortality, typically accruing through adult life and into older age.

In the UK it is established that health and social care services for people with dementia from black and minority ethnic communities need to move towards providing evidence-based culturally appropriate care. At present, however, the evidence base available to guide professionals working with people with dementia from diverse ethnic and cultural groups is limited, and beliefs about dementia and the type of treatment and support needed have received little attention. Consequently this creates problems for service providers faced with appropriately supporting people with dementia and their families from black and minority ethnic communities.

Elder neglect and abuse is a widespread, largely undiagnosed and often ignored problem in our society. However, recently elder abuse has gained increasing recognition as a significant problem, meriting the attention of both clinicians caring for older people and society at large. Its occurrence in differing forms throughout the world has been highlighted as part of a recent WHO report about violence and health. In the United Kingdom, the House of Commons Health Committee has inquired into elder abuse and published its report and recommendations in April 2004. Concurrently with this rising public interest, there is a slowly developing body of scientific work on the subject. Although, much of the research has been criticized for significant scientific flaws, recent work has been more rigorously designed, tending to use standard case-definitions and scientifically acceptable research methods.

The care of older people to the end of this century and beyond presents a unique challenge to medicine and the rest of society. There is need for careful analysis and evaluation of our responses to this challenge.

The social environment is one of the key factors determining the quality of life of older people. Research has consistently demonstrated a strong and positive relationship between social engagement in all forms but especially participation within kin and wider social networks, and a high quality of life. However, this recognition of the importance of this relationship is not new. In the early 1960s, the ‘activity theorists’ of aging posited that the key to a good old age was the maintenance of high levels of activity, including social participation and the maintenance of kin- and friendship-based relationships. This resonates with the ideas of Rowe and Kahn who suggest that a high level of social engagement is a key factor in achieving the individually and socially desired goal of ‘successful aging’. Furthermore, they argue that, with advanced age, the social context, in combination with the physical environment, exerts a more potent influence upon the experience of later life than either intrinsic genetic or biological factors. Whilst the prescriptive strictures of activity theory and successful aging remain the subject of debate, there seems little doubt that the social environment continues to exert both a powerful influence upon, and provides a context within which people experience old age, both individually and collectively.