Pruritus in older people is caused by a wide range of dermatological, systemic, neurological and psychogenic diseases. It can also be attributed to various cutaneous drug reactions. The dermatological, neurological and immunological changes associated with ageing predispose older people to pruritus of a wide range of aetiologies. The most common cause of pruritus in older people is xerosis, or dry skin. Regular use of emollients is the mainstay of treatment for pruritus of any cause, with general measures aiming to ensure optimal skin hydration and to prevent the itch–scratch cycle. Topical treatments are generally better tolerated for localized pruritus. Anti-histamines are the predominant agents to treat pruritus, but can be inadequate in many cases. Numerous other systemic agents have been demonstrated to alleviate pruritus depending on the cause, but may be limited by their adverse effects. This article reviews the current published literature on pruritus in older people, with a practical approach to its evaluation and management in non-specialist settings.

Syncope is a common cause of presentation to the emergency department in the older population, who are at increased risk of syncope resulting in serious injury in the form of fractures, adverse cardiac outcomes and death, lack of confidence and mental health issues. Older patients can present diagnostic challenges due to multiple co-morbidities, polypharmacy and the problem of amnesia associated with transient loss of consciousness. The underlying cause of their syncope can be established through a structured approach, and targeted patient selection can limit inappropriate investigations in syncope assessment units and ensure appropriate treatments are instituted. A previous review article in this journal, by Nath and Kenny in 2005, examined the evidence surrounding various aspects of syncope, including prevalence, cause, risks, investigations and treatment. This review updates the evidence and guidelines on the aetiology, investigation and treatments of syncope in the older person, with emphasis on recent advances.

Coeliac disease (CD) results from immunologically mediated inflammation of the small intestinal mucosa precipitated by ingestion of gluten in wheat and other cereals in genetically susceptible people. There is a broad spectrum of clinical and histological features associated with gluten sensitivity. Overt clinical malabsorption is uncommon, and clinical symptoms are often non-specific. This is particularly true of older people and the diagnosis of CD may be delayed or missed as a result. The incidence of metabolic bone disease, neurological symptoms and nutritional deficiencies are high in older people with CD and respond well to treatment. Sensitive and specific serological tests are now available and these have improved ease of detection of CD in patients without classical symptoms. Hence, a high index of suspicion is warranted in older people with potential symptoms of CD.

A major advancement in the field of medicine has been the timely advent of amyloid imaging, which has allowed critical evaluation of the complex relationship between amyloid β peptide (Aβ) aggregation and Alzheimer's disease in vivo. Most importantly, amyloid imaging has the potential to detect Aβ in mildly affected as well as asymptomatic individuals, when the therapeutic window of opportunity might still be open to pharmacological intervention. It also shows significant promise in differential diagnosis of mild cognitive impairment or atypical dementias. Amyloid imaging studies support a model in which amyloid aggregation is considered an early event on the path of dementia, beginning insidiously in cognitively healthy individuals being accompanied by subtle cognitive, functional and structural brain alterations suggestive of incipient AD. As individuals progress to dementia, clinical decline and neurodegeneration accelerate and might proceed independently of amyloid accumulation. In this review we focus on amyloid imaging with particular emphasis on [11C]PIB in AD, mild cognitive impairment and other dementias, and discuss the advances made in this perplexing field.

Identifying what makes people vulnerable to developing Alzheimer's disease (AD) is at the forefront of many research programmes, while early diagnosis is the goal in clinical practice. What individuals themselves tell their general practitioners (GPs) is clearly important because these subjective complaints may be a clue that something is wrong. More specifically, subjective cognitive complaints (SCC) may be the first sign of AD in individuals whose cognitive performance on standard neuropsychological tasks is normal for their age. The challenge for researchers in this field is twofold: (a) determining when SCC do or do not predict current cognitive functioning and future dementia; and (b) estimating how relevant they are for patients and their proxies. The current article addresses these issues, while guidelines are also provided in an attempt to help clinicians interpret and make treatment decisions about their patients’ SCC.

Human sexuality is a complex interaction of biological, social and emotional factors. When any or all of these factors are disrupted by a progressive dementia it is unsurprising that sexual ‘problems’ are identified. Most sexual behaviour ‘problems’ relate to expressions of normal sexuality complicated by changes in relationships, care needs and cognitive function, and complex ethical and legal considerations emerge. Rarely, new and severe hypersexual or paraphilic behaviours arise de novo, usually due to damage to certain brain areas, and sometimes due to medication side-effects, psychiatric disorder or delirium. Evidence and approaches to assess and to manage sexual behaviour problems in dementia are discussed.

The quality of life (QoL) of older people is of increasing interest in China, due to its ageing population. A systematic review of published QoL studies was undertaken to examine different measurements and related factors of QoL of older people in China. Papers were identified by searching the following electronic databases: Web of Science, PsycINFO, MEDLINE, PubMed, CINAHL, China Academic Journal and VIP Database for Chinese Technical Periodicals. Fifteen studies were included in the review, using eight different QoL measurement tools. Health status, psychological well-being, social well-being, housing and socio-demographic factors were identified as important related factors of QoL. Further studies are needed using valid measurement tools to explore more factors, especially culturally specific contributors, to the QoL of older people.