Frailty is a central concept in geriatric medicine, but without a clear definition. Many regard it as a syndrome with its own clinical manifestations and pathophysiology, whilst others consider it to be the result of the accumulation of age-related deficits that predict adverse changes in health. We analysed, through a systematic review, the definitions and markers of the frailty syndrome. Twenty-five articles were included and divided, according to design, into observational, intervention, review and qualitative studies. There was a predominance of operational definitions that used only physical markers to identify frailty. The only qualitative study found that health professionals chose a multidimensional definition that took into account factors other than just the physical. We conclude that there is still no standard definition or agreement about markers of the frailty syndrome.

Alzheimer's disease (AD) is the commonest form of dementia, estimated to affect 37 million people worldwide. Currently there is nothing to halt the progression of AD – treatment focuses largely on slowing the development of symptoms. More recently disease-modifying interventions, such as immunotherapy, have been investigated as their aim is to halt or even reverse symptoms by removing β-amyloid (Aβ) pathology. This paper assesses the developments made in this particular field, offers critical appraisal of important papers and assesses the viability of this potential form of treatment.

There are inadequate data to formulate evidence-based guidelines on cardiovascular medication and falls. A critical systematic review of medication as a risk factor for falls concluded that there was a weak association between drugs that reduce blood pressure and falls. The population studies reviewed, looking for an association between cardiovascular drug usage and falls, consisted of subjects who were much younger and who had a much lower drug burden when compared with the older clinic population. The magnitude of the effect of cardiovascular medications on falls may therefore have been underestimated in these studies.

Two observational studies in falls clinics showed significant reductions in falls and syncope following withdrawal of cardiovascular medication, with improvements in symptoms, in tilt-table parameters predictive of syncope, and in measures of gait and balance.

There are no randomized controlled trials of the effect of cardiovascular drug withdrawal on falls. An expert audience of 200 members attending the 2009 British Geriatrics Society Falls Section Conference held the unanimous opinion that cardiovascular medications were a significant cause of falls in older people.

Urinary incontinence remains a topic that both patients and clinicians find difficult to discuss and manage. Following the NICE guidance published in 2006, a well-defined structure for the management of urinary problems was outlined. Conservative measures are the mainstay for all patients, with anticholinergic drugs playing a major role in the management of over-active bladder and urge incontinence.

Surgical management is an area that continues to grow and develop. The types of procedures offered to patients have changed dramatically in the last 10–15 years, with the advent of tension-free vaginal tapes and more recently the use of botulinum toxin. It is important that health professionals encountering patients with incontinence are aware of the common urological/gynaecological operations available, the place of surgical options in the overall pathway, and the benefits as well as the risks associated with continence surgery. This article provides the non-specialist with an overview of the available surgical options for management of continence.

Populations throughout the world are ageing, with the oldest old the most rapidly growing segment of society. Caring for this ageing population, some of whom have multiple chronic and disabling diseases, will be challenging to healthcare systems. Current training programmes are generating relatively low numbers of geriatricians, largely because students and residents lack interest in a career in geriatric medicine. Therefore, specialists in geriatric medicine cannot directly provide care for all older people. There is a responsibility to ensure that successful practices and essential skills are shared.

Here we explore negative attitudes towards geriatric medicine and contrast these with factors motivating change. Educational theories are discussed to investigate how processes of learning and the personal development of students can be optimized. An understanding of geriatric medicine is important for undergraduates, postgraduate trainees in geriatric medicine, general practitioners and allied health professionals. The different challenges presented by each group are reviewed, accompanied by recommendations to enhance learning and examples of effective teaching practices.

Cancer-related fatigue (CRF) is a debilitating symptom that affects the majority of cancer patients. It can occur at all stages of treatment, worsening in advanced disease. It can be especially troublesome in the older person. CRF is often under-recognized and insufficiently treated routinely. This review will discuss both the postulated mechanisms and clinical tools for identifying and monitoring CRF during cancer treatment. The role of drug treatment and exercise to manage CRF is also assessed. Further studies, particularly in older people, are required to improve the poor levels of evidence for current CRF management options.

This review provides an update on current evidence surrounding the epidemiology, treatment and prevention of non-respiratory infections in care homes. It covers urinary tract infection (UTI), methicillin-resistant Staphylococcus aureus (MRSA), decubitus ulcers, scabies, tinea infections and viral and bacterial gastroenteritis. The care home sector provides a unique ecological niche for infections, housing frail older people with multiple co-morbidities and frequent contact with healthcare services in a semi-closed environment. This leads to differences in the diagnosis and management of infections – particularly of outbreaks – when compared with community-dwelling counterparts. It is essential that care home staff play a role in the early recognition, isolation and treatment of infections, but they are often not trained as healthcare professionals – this presents a challenge to systematized response. Effective interface between care homes, public health and infection control services are essential to the delivery of care, yet it is not clear how to structure such links most effectively.

The prevalence of falls and associated injuries increases with age and dependency. The highest occurs among individuals living in long-term care institutions. Preventing falls results in reduced physical and psychological morbidity as well as having cost-saving implications. This review explores both uni- and multifactorial approaches to reducing fall rates and risk in individuals in long-term care, as well as highlighting the differences in this group from community-dwelling individuals.

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.

Ageing is creating policy challenges for most developed countries and increasing the pressure on health and social care systems. The health status of patients is best described based on their own reports and quantitative data concerning factors such as functional disability, psychological status, pain, falls or cardiovascular risk, are critical to follow changes in patients’ condition and response to therapy. Standardized information concerning health status and co-morbidity risks can be collected easily and effectively from a ‘patient reported outcome measures (PROMs) questionnaire’ completed by the patient. Such data allow accurate description, months or years later, of changes in status. Without such records, neither the patient nor the health professional can remember the patient's earlier status reliably. This article will discuss the concept of PROMs and how they can be implemented into standard clinical practice.

Seasonal influenza remains a common cause of morbidity and mortality for older residents in aged care facilities. Whilst prevention is best managed by high vaccination rates for the general population, residents and aged care facility staff, new research suggests that a more active approach to surveillance and anti-viral treatment now plays an important role. The practicalities of managing an influenza outbreak are complex and best planned in advance with written protocols available. Good infection control remains a vital part of prevention and outbreak control.

Argentina does not yet have a formal nationwide health programme for older people, so there are huge differences in the quality and entitlement of health care for senior citizens. Academic infrastructure is also underdeveloped and this situation slows the advance of geriatrics. Teaching and research in this field is usually unpaid. However, a committed minority of teachers and health professionals are confident that their efforts are worthwhile and a new generation of geriatricians is starting to participate actively in international forums, to publish in recognized medical journals, to participate in Latin American academic forums such as ALMA (Latin American Academy of Senior Adult Medicine) and to foster geriatrics as a speciality.