Vertigo and dizziness are common problems in older patients visiting primary health care centres. Dizziness is often used as a non-specific term to describe many sensations, including vertigo, presyncope, disequilibrium and lightheadedness. In another sense, dizziness can be described more specifically as a feeling of unsteadiness or a mild intoxication, or as if the ground is rocking, or the affected person has to take side-steps to keep balance. Vertigo, by comparison, is often described as a feeling of rotation; the room or surroundings are spinning around like a carousel. Presyncope is often described as sensation of impending fainting or sense of falling. Lightheadedness is a much more vague description of dizziness, difficult to define. Disequilibrium, on the other hand, can be described almost in the same terms as dizziness: a feeling of unsteadiness or loss of balance.

Vascular cognitive impairment (VCI) is a relatively new concept, encompassing all forms of cognitive loss associated with cerebrovascular disease and ischaemic brain injury. It covers a broad spectrum of pathologies within the brain, with different causes and clinical presentations. VCI includes vascular cognitive dementia, (VaD). VCI also encompasses mixed (AD and vascular dementia) as well as hereditary disorders. Table 1 shows the main subtypes of VCI.

A stroke typically results in a variety of impairments that are primarily unilateral, with the severity of symptoms and resultant disabilities dependent on the site and extent of the insult. While the overall goal of rehabilitation after a stroke is to maximize the individual's functional independence at home and in the community, improved walking function is the treatment goal most often stated by patients following a stroke.

In 2002 the World Health Organisation (WHO) reported that worldwide, deaths due to chronic diseases were accountable for around 30 million people. An earlier report by the WHO revealed that the leading causes of deaths due to chronic disease were cardiovascular disease (17 million), cancers (7 million), chronic lung diseases (4 million) and diabetes (approximately 1 million). In developed nations, the most frequently reported risk factors associated with chronic diseases are exposure to tobacco products (12.2%), hypertension (10.9%), alcohol consumption (9.2%), elevated cholesterol (7.6%), and obesity (7.4%), unhealthy diets that include high saturated fat and sugar content (3.9%) and sedentary lifestyle (3.3%). In view of the demographic shifts, and the strong association with aging and chronic disease, it is estimated that worldwide, within the next two decades, the predicted number of deaths due to chronic illness will rise to around 50 million people per year. Amongst elderly populations in particular, circulatory diseases, respiratory diseases, mental health problems, and musculoskeletal diseases are frequently cited as causes of chronic illness. Population estimates in the UK suggest that around 70% of people by the age of 80 report some type of health-related disability. Patients with chronic conditions will often have multiple co-morbidities with complicated disease management which will necessitate considerable contributions from their caregivers. The caregivers of the chronically ill are often unpaid family members who are frequently placed under considerable stress, and as a result can themselves suffer from functional decline, depression, isolation and loneliness.

Chronic Heart Failure (CHF) is a disease of older people. The prevalence of the disease increases with age, reaching over 10% in those aged 80 and above. Not only does heart failure carry a burden of mortality worse than many cancers, it also severely impairs function and quality of life and is a leading cause of hospitalization in older people. Heart failure cost the British National Health Service £360 million in 1990–91; the cost is estimated to have doubled in the last decade.

The issue of not taking medicines as prescribed by medical practitioners has a history as long as the medical profession itself. The World Health Organization recently described the problem of patients diagnosed with chronic illnesses not taking their medication as prescribed as ‘a worldwide problem of striking magnitude’. Not taking medicines as prescribed has consequences not only for the individual in terms of therapeutic failure, but also for the wider society. For the individual, failure to take medication as prescribed may result in ill health, poorer quality of life, and reduced life expectancy. For the wider society, consequences include avoidable health care expenditure and the development of drug resistance.

The prevalence of obesity is increasing, both in developed and developing, countries. Since obesity is a major factor in the pathogenesis of chronic diseases including type 2 diabetes and cardiovascular disorders, the dramatic increase in obesity prevalence in recent years has major implications for the health of individuals and for the health economy. The number of aged individuals and their longevity is also increasing. Age is a major factor in the pathogenesis of chronic diseases.

Successful aging seeks to counteract and replace the old ‘decline and loss’ paradigm that views aging as a series of individual decrements or losses to which both older people and society needed to adapt or adjust. This new gerontology, based on the concept of successful aging, adopts a preventive model: modify individual behaviours throughout life in order to avoid the decrements and losses. Research has led to the development of a variety of models for successful aging, which share the fundamental assumption that successful aging is a result of a lifelong developmental process that involves the combination or interaction of traits or predispositions present at birth or in early life and cumulative life experiences. Successful aging builds on a life history of successful adaptation, which in turn, is a result of interactions among inherited and learned personality attributes and levels of adversity or advantage and resources. Research driven by the successful aging theorist is turning attention to the development of indicators that might explain and predict successful old age. A number of factors are already well known to promote well-being, for instance regular exercise, cognitive stimulation, friendship and the presence of a confiding relationship. However, little is known on how persons from different age groups perceive the preparation of a good old age. In this exploratory study we attempt to expand this topic, since it will allow the understanding of how these perceptions can influence, in a positive or negative way, the achieving of a good old age.

The search for the most appropriate, effective and efficient ways to care for vulnerable older people is an enduring one. Hence, the importance of research which seeks to explore how best to meet the needs of frail older people at the margins of care, whose care needs can therefore be appropriately met in more than one setting. The theme of balance of care has been a recurrent theme in the literature of long-term care and relates to ideas of optimality and efficiency in resource use and has been primarily, but not exclusively, applied to the care of older people. Interestingly, it is not a new concept but rather one which is implicit in policy relating to the care of vulnerable older people since the 1970s, although periodically it has risen to become more explicit. In this context it almost always relates to the relative priority accorded to services provided in the community compared to those provided in long-term care settings, such as care homes or hospital.

Provision of services for older people is now a priority for policy makers, not least because of population aging precipitating a ‘demographic revolution’. In England, one response by policy-makers has been a National Service Framework, designed to provide standards and models for the care of older people. Furthermore, recent moves to create strategic partnership agreements between the Department of Health, the NHS and the Voluntary and Community Sector point to increasing awareness of the interconnections between health and social care. However, even when services are in place, older people do not always use them. Understanding why this might be the case is key to further service planning and implementation.

The population of the UK is aging, with a fifth of the population of England now over 60years old. Between 1995 and 2025, the number of people over the age of 80 is set to increase by almost half, and the number of those over 90 will double. While there is some decline in cognitive function as a result of normal aging, most older people do not develop dementia. Only about 2% of people aged between 65 and 75 have some form of dementia, and this is thought to rise to 20% in those over 80. Thus there are some 670000 people with dementia in the UK, and this figure is expected to rise to nearly 1000000 by 2021. The cost of dementia care, at 5.6% of total healthcare costs, is almost equal to that of the combined costs of cancer (3.2%) and coronary heart disease (2.5%). Twenty-five per cent of the costs of caring for this group may be attributable to the time carers spend helping with eating and drinking. Eating and drinking involve the co-ordination of complex physical and mental activity. These activities are often affected by aging as well as the progressive impairment of memory, thinking, perception, planning, organization, communication and skilled movement that characterize dementia. Consequently eating and drinking may be affected by tooth and mouth problems, poor hand-to-mouth co ordination, poor concentration, apparent food refusal, wandering away during mealtimes and the side-effects of individual drugs, polypharmacy and dysphagia.

Population aging is conventionally understood to refer to increases in the percentage of the population aged 65 and over. Developed economies have for some time shown evidence of this and it is projected that they will continue to experience aging over at least the next 20 years. As the population ages, so the level and pattern of demand for health care is likely to change, and difficulties in financing care to increase. Older persons, for example, tend to consume more health care than those in younger age cohorts, as well as different types of care (for example more long-term care). By the same token, older persons (who are often retired) tend to have less income than those in younger age cohorts. A consequence of this is that they are less able to meet the costs of health care directly (i.e. out of pocket) or contribute through direct taxation to meeting the costs of publicly funded health care. These two factors – growing demand and diminishing income among those for whom demand is expanding – will present challenges to the future finance and delivery of care.