High suicide rates are observed in elderly men, and the identification of high risk individuals is a challenging task. The Suicide Assessment Dimension (see Box 1) is intended to aid the evaluation process. We are concerned that the proposed assessment may miss some seniors in need of intensive management.

In certain older adult subpopulations, e.g. those with dementia or cognitive impairment, aggression would appear to be commonplace, particularly in inpatient settings (Winstanley and Whittington, 2004; Stewart et al., 2008). Healthcare professionals have a spectrum of different techniques they may employ to avoid and manage aggression (National Institute of Clinical Excellence, 2005). Aggression may manifest itself in many forms, but physical assault is particularly troublesome as this may have many deleterious effects on the victim's health. The displays of such behavior increase the likelihood that more intrusive measures, such as physical intervention and/or administration of psychotropic medication, are used by the responding healthcare professionals (NICE, 2005).

The aging of society inevitably leads to an increase in the numbers of elderly with dementia who reside in nursing homes, and delaying disease progression of residents with dementia has become a big concern. Rehabilitation that focuses directly on training cognitive function (e.g. memory training) reveals what patients are unable to do. Realization of their cognitive deficits can devastate their self-confidence and lead to anxiety, depression and the lowering of self-esteem (Small et al., 1997). We propose rehabilitation that encourages patients' motivation for self-improvement through social interaction based on five principles as follows: (1) the activities should be enjoyable and comfortable for patients, (2) therapists should praise the patients naturally to motivate them, (3) the activities should be associated with empathetic two-way communication to make patients feel valued and safe, (4) therapists should encourage the patients to play “social roles” to restore self-worth, and (5) error-less learning based on brain-activating rehabilitation (BAR; Yamaguchi et al., in press) should be adopted wherever possible. It is suggested that the positive feelings activate those areas of the brain related to reward, which plays a critical role in motivation (Berridge et al., 2003), and it is a typical social reward to be praised and appreciated in public.

The authors wish to add the following Acknowledgment:

This work was supported by an award from the U.K. NIHR Biomedical Research Centre for Ageing and Age-related Disease to the Newcastle upon Tyne Hospitals NHS Foundation Trust.