Peripheral neuropathy encompasses disorders of the peripheral nervous system, affecting the axon and/or the myelin sheath. The prevalence of peripheral neuropathy increases with age. Thought to be of about 3000 per 100 000 in adults generally, this figure could be as high as 8000 above the age of 60 years. However more than half of these cases would be due to impaired glucose metabolism in its various forms. In the remainder, an aetiology may be found in about 70% of cases. The elderly population is at higher risk of peripheral neuropathy, as there is a correlation between age and impairment of the peripheral nervous system. The natural aging process affects adversely the function of peripheral nerves and of their target organs, resulting in the development of motor, sensory and autonomic symptoms in the absence of additional damage of other causes. In addition, the increased prevalence of chronic systemic disorders causing neuropathy, as well as the use of neurotoxic drugs in older patients, contribute to the onset of neuropathy.

The term 'graduate' (hereafter without quotation marks) has been used to describe the following groups of patients:

1) All those patients with enduring psychiatric illness who have graduated to old age (usually defined as age over 65 years);

2) 'Patients who entered hospitals for the mentally ill before modern methods of treatment were available and have grown old in them after many years there.'

3) Specifically, long-stay patients with schizophrenia over the age of 65 years who came into continuous psychiatric contact well before that age.

It is often said that the demand for health care is growing inexorably in the UK, so that the NHS is constantly struggling to keep up. The dilemma was most famously put by Enoch Powell, who said that any health service faces the problem of infinite demand meeting finite resources. This was an economist's view, which suggests that anything that is free will be demanded infinitely.

Joint problems in older people are common–both as ongoing chronic problems but also individuals presenting for the first time with joint symptoms. The assessment of an elderly person presenting with joint symptoms poses special challenges. There is a large potential differential diagnosis and more than one form of arthritis may co-exist, most commonly osteoarthritis. The clinical presentation in older patients may differ from typical findings in a younger individual and co-morbid conditions may complicate management strategies. In this article we discuss the differential diagnosis and management of conditions presenting as inflammatory arthritis in older people.

Average world life expectancy has seen a dramatic rise over the last two centuries although active life expectancy remains relatively unchanged. One reason for this is that aging results in skeletal muscle becoming smaller, weaker and more susceptible to contraction-induced injury. By the age of 70, muscle strength is reduced by around 30–40% and this can have catastrophic effects on quality of life. Despite a vast amount of research into age-related changes in skeletal muscle, the exact mechanisms responsible for this is still unclear and thus treatments to preserve muscle function with aging remain elusive.

This research paper is a realist review on the effectiveness of medical care for older people in the geriatric day hospital (GDH), based on trial data from a Cochrane review published in 2008. The Cochrane review indicated no overall difference between GDH care and alternative services. However, health care management and policy interventions are quite complex and methodologically more diverse than clinical treatments. Hence a ‘realist review’ is a more suitable explanatory analysis, aimed at discerning what works for whom, in what circumstances, in what respect, and how. This realist review on GDH care provides an explanatory analysis and has aimed to identify where GDH care is and is not effective.

In the developed, as well as developing countries, there is an immediate challenge to ensure an adequate supply of health professionals trained in providing care for older people to meet the needs of increasing numbers. Currently 20% of the population of the United Kingdom (UK) is over 60 – 12 million people. By 2031 this proportion will be nearly a third – 18.6 million people. The largest increases are anticipated among the over-85 age group, from 0.8 million in 1987 to 1.4 million in 2025. In Europe the number of people aged over 80 years will double within the next 25 to 30 years. It is estimated that there will be more than 1.2 billion elderly people in the world by the year 2025 – three-quarters of them living in the developing countries.

Urinary tract infection is the most common bacterial infection in older populations. It is an important clinical problem across the full spectrum – from elderly persons who are well and living in the community to highly functionally impaired residents of long-term care facilities. Symptomatic urinary infection is a frequent cause of morbidity, and urinary infection is responsible for substantial antimicrobial use. This review summarizes current knowledge relevant to both asymptomatic and symptomatic urinary infection in older populations, and identifies unresolved issues for further study. The discussion is relevant to older individuals without indwelling urethral catheters, unless it is specifically stated that the older person with an indwelling catheter is being addressed.

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).

Hip fracture is very common among older patients, who are characterized by increased co-morbidities, including cognitive impairment. These patients have an increased risk of falls and fractures, poorer functional recovery and lower survival both in hospital and 12 months after discharge. We review the survival and functional outcomes of older patients with cognitive impairment and hip fracture managed in orthogeriatric units, and highlight the gaps in our knowledge of the efficacy and efficiency of specific orthogeriatric programmes for such patients and the future research perspectives in this field.

Epilepsy is the third most common neurological disorder of older adults, with huge functional and psychological implications. It is often difficult to diagnose in the presence of cognitive impairment and lack of a witness account. The most common identifiable causes of epilepsy in old age are cerebrovascular disease and dementia. New guidelines recommend starting treatment after first unprovoked seizure. If there is any doubt about the diagnosis, electroencephalography (EEG) should be considered, or ‘wait and watch’. The aim of treatment should be to fully control seizure activity with the most effective monotherapy and fewest possible side-effects. Drug compliance is often difficult to achieve in older adults.

Use of the term frailty in the medical literature has increased significantly in the last 20 years. A MEDLINE search using the combined terms ‘frail’ and ‘elderly’ yielded 473 articles published between 1996 and 2001, compared with 85 between 1980 and 1985. This increasing interest in frailty has been fuelled by evidence that the ‘frail elderly’ are the group most likely to benefit from geriatric intervention programmes and by the close links between frailty and longer hospital stays, nursing home utilization and mortality.

Complementary medicine (CM) can be defined as 'diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine'. It has become a hotly debated subject, mostly because many physicians remain sceptical about its usefulness while consumers vote for it with their feet and their purses.

Phosphate (PO4−) has a number of important functions in the human body and abnormalities of phosphate handling and phosphate levels are common in older people. We review the physiological functions of phosphate, the effects of phosphate deficiency and excess, and discuss the evidence underpinning management of these conditions in older people. Both hyper- and hypophosphataemia have been associated with a variety of adverse effects in different patient groups. There is currently little evidence to guide practice in treatment of abnormal phosphate levels specifically in older people. Studies looking into the effect of replacing phosphate on morbidity and mortality in milder cases of hypophosphataemia and into the dangers of, and treatment of, hyperphosphataemia in older people are required.