Multiple myeloma is a neoplastic proliferation of a plasma cell clone that produces a monoclonal immunoglobulin. It is one of the most common haematological malignancies and the incidence increases with age, with a median age at diagnosis of 65–70 years. The diagnosis of multiple myeloma requires the presence of ≥10% plasma cells in the bone marrow and an M-protein in serum and/or urine. Cytogenetic status, serum β2-microglobulin and response to therapy are the key prognostic factors. Treatment is necessary for the patient diagnosed with symptomatic multiple myeloma, with organ damage. Patients older than 65 years are ineligible for autologous transplantation. The introduction of novel agents, such as thalidomide, bortezomib and lenalidomide, have changed the management of myeloma and extended overall survival. However, in older patients the results are not as satisfactory and treatment strategies have to be individualized to improve tolerability and optimize efficacy.

Delirium has been associated with institutionalization, increased length of hospital stay, cognitive and functional decline and mortality. Research in the last thirty years has recognized that accurate diagnostic criteria allow for targeted interventions for those suffering from delirium. However, despite the advances made in understanding delirium, adverse outcomes persist.

This article will first review how the evolution of diagnostic criteria has fostered improvements in the recognition of delirium and facilitated the development of therapeutic strategies. Second, we discuss how this foundation in approach to delirium has influenced outcomes and the evidence for causality. Finally, the candidate factors responsible for propagating adverse events are considered and future research direction outlined.

Prostate cancer is the most frequent tumour diagnosed in men, especially in older people. Radical prostatectomy is the treatment of choice for this disease, but is also the main cause of stress urinary incontinence in men by iatrogenic injury. This procedure is performed far more frequently now than 10 years ago, so the incidence of post-prostatectomy incontinence (PPUI) has increased. PPUI has a detrimental impact on a patient's quality of life and is a significant problem that needs to be solved. The artificial urinary sphincter is still the gold standard treatment for PPUI. In recent years, less invasive approaches such as suburethral slings have been used with promising results. The selection criteria and most appropriate choice of device for the treatment of PPUI are not well standardized. In this review, the different forms of assessment and management of PPUI will be discussed.

Populations are ageing worldwide. The prevalence of dementia will rise exponentially with the oldest old the most rapidly growing segment of society. Caring for this ageing population with dementia, many of whom will have multiple chronic and disabling diseases, will be a challenge to healthcare systems, particularly general hospitals. At any one time, a quarter of acute hospital beds in the UK are in use by people with dementia. Delivery of high-quality care to this growing and vulnerable population must be high on any health service agenda.

Current medical training not only generates relatively low numbers of geriatricians and specialists with interest in dementia, but also there is a lack of appropriate training in assessment and management of dementia. There remains huge need for better staff training and support to provide safe, holistic and dignified dementia care. Here we explore various key features for non-specialist assessment and management of older people with dementia in the general hospital setting.

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.

Rising unplanned hospital admissions are a problem in ageing populations worldwide. These admissions are associated with poor outcomes for older people, contribute to rising health care costs and impede the provision of planned care. Policy and practice in recent years has focused on identification of those at risk of unplanned admission and early intervention via a range of admission avoidance services. Despite this, unplanned admissions in older people continue to rise, and managing demand for unplanned care remains a priority. Questions remain about the risk factors for unplanned admission and the best approaches to identifying and intervening with those at risk. This review explores recent evidence on admission rates, risk factors for unplanned admission in older people, identification of those at highest risk and interventions to avert unplanned admission.