The elderly population has greatly increased in the last few decades as life expectancy has risen. In 2005 life expectancy at birth for females born in the UK is 80.2 years, compared with 75.2 years for males. This is in contrast to 49 and 45 years respectively in 1901. Cardiovascular disease is still the most important cause of death in the population over the age of 65, causing 40% of deaths in women and 42% in men of this age.

Osteoporosis is defined in adults as having a bone mineral content at the lumbar spine or hip of more than 2.5 standard deviations below the expected mean for the healthy young sex-matched population (WHO criteria). Osteoporosis and consequent fragility fractures are common problems, increasing in frequency with age. Several classes of drug of proven value in reducing the risk of osteoporotic fractures are now available. This review will examine how the evidence that treatment of osteoporosis reduces fracture risk applies specifically to older people, particularly those over 70 years of age.

Airflow obstruction is common in older persons but frequently under-diagnosed. The term refers to a spectrum of chronic respiratory disorders characterized by cough, dyspnoea, mucus hypersecretion, wheeze and impaired pulmonary function tests. Patients may be diagnosed as having late-onset asthma, chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema or fixed airflow obstruction of the elderly.

Severe dementia is associated with frequent psychiatric and behavioural disturbances in addition to marked cognitive and functional deficits. Research to determine a neurochemical understanding of dementia over the last three decades has generated therapeutic strategies which improve patients' cognition and activities of daily living. Different key dementia syndromes have been shown to have distinct neurotransmitter biochemical patho-logy, with important implications for therapy. The current review focuses predominantly upon excitatory neurotransmitter systems.

This review is the first in a three-part series on substance problems in older people. This section reviews terminology, epidemiology, outcome studies and policy directions. Subsequent articles will provide an overview of assessment, physical and psychological co-morbidity, as well as treatment options.

In the UK, research continues to confirm that people with certain chronic illnesses, such as chronic lung disease and cardiac failure, represent the ‘disadvantaged dying’ compared to those with terminal cancer. But what is the situation for people dying with advanced dementia and what is the experience of their carers? Practical guidance for clinicians is scarce. In Standard 7 of the National Service Framework for Older People, which covers mental health, there is mention neither of how care should be provided nor of how patient choice should be ensured for people with dementia at the end of life. In the UK, 5% of the population aged 65 and over and 20% of those aged 80 and over have dementia similar prevalence figures are found in the USA. Current predictions suggest that the number of people with dementia will increase by 40% by 2026 and will double by 2050. The increased demand for end-of-life care for people with dementia will be associated with major social and economic costs, but what is the current standard of such care? How can the quality be improved? And how should future services be configured to cope with this increasing need? In this paper, we review current knowledge around end-of-life care in dementia, discuss the clinical challenges and ethical dilemmas presented to carers, consider the difficulties in delivering such care and suggest practical approaches to improve the quality of such care.

The purpose of this review is to discuss how healthcare professionals, and particularly nursing practice, impact upon pain management with older people (65 years and over), following surgery. The review commences with an introduction presenting why this is an important area to consider. Current available literature and findings from an ethnographic study which was designed to examine peri-operative pain-management practices with older people will then be discussed to highlight the key issues of pain assessment and management. Three overarching themes; (1) pain assessment (2) knowledge/strategies to cope with pain and (3) organization of care (culture and context), will guide the discussion. It is suggested that comprehensive pain assessment, proficient communication and multidisciplinary working, are essential to improve pain-management practices. The paper demonstrates some of the multiple and complex factors that affect the older person's pain experience and identifies possible developmental work in this field.