The challenges of treating malignant disease in the older population are gaining greater prominence. In the last 10 years the European Organisation for Research and Treatment of Cancer (EORTC) has established a task force to examine challenges of managing older cancer patients. As an indication of their importance, the American Society of Clinical Oncology (ASCO) specifically addressed the issues raised by older patients at their annual conference in 2004.

Agism was the term chosen by Butler to name the process of discrimination based on chronological age, which usually results in an image of the elderly as unproductive, sick, depressed and with cognitive impairment. This form of bias, like others that devaluate and stereotype groups of people, has a marked effect on social interaction, influencing social attitudes and perceptions in a covert manner. The use of negative images relating to old age and the aging process promotes negative attitudes relating to elderly people, affects the way they live and the way people of other ages prepare to face their old age.

Key strands in developing future services in geriatric medicine in Wales have been the 2000 ‘Review of Health and Social Care in Wales’ by Sir Derek Wanless, the Welsh Assembly Government document ‘Designed for Life’ of May 2005, and the National Service Framework (NSF) For Older People in Wales (published in March 2006). The common theme in these documents is for older people's health and social care issues to be managed nearer to their home, in the community. At present, the development of Intermediate Care Services has been ‘hit and miss’ – fragmented, unevenly developed and delivered with poor integration into mainstream services. The Academy of the Royal College's Medical Aspect of Intermediate Care identifies the lack of specialist medical input as being one of the reasons for the failure of development of Intermediate Care Services. It recommended that geriatricians should be encouraged to undertake well-defined roles in community work in planning and delivery of Intermediate Care Services.

Young-onset dementia (dementia in people under 65 years of age) remains an under-researched area of dementia care. As populations age in industrialized countries, dementia is set to increase: this includes dementias in younger people. Current estimates suggest there are over 15 000 younger people living with dementia in the UK, whilst dedicated services and research in this area remain limited. Younger people may be affected by rarer forms of dementia that can create various kinds of impairment in the individual. For example, as Boxer and Miller report, although memory can be affected, people with conditions such as frontotemporal dementia can present initially with personality changes as the primary symptom. Younger people may also have more difficulties with visuospatial and semantic tasks when compared with an person, and there are likely to be personal and societal implications for the entire family.