Long life expectancy is associated with a higher chance of experiencing cognitive impairment in a lifespan. It is well recognized that multiple factors play important roles in the maintenance of cognitive health when one gets older. While the mechanisms of neurodegeneration are complex, it is encouraging to note that simple healthy lifestyles maintained over time may modulate the rate of degeneration or buffer its effects when it becomes inevitable.

Behavioral and psychological symptoms of dementia (BPSD) frequently arise in people with Alzheimer's disease (AD) and other dementias. They cause significant distress and confer risk to the person and others, in addition to presenting a complex clinical challenge for treatment (Ballard et al., 2009b). There is good evidence for the value of first-line management strategies such as psychological interventions and treatment of concurrent medical conditions, particularly pain, which are known to be effective (Ballard et al., 2009b). However, there are limited pharmacological treatment options for severe aggression, which causes significant risk, and for other severe BPSD which do not respond to first-line approaches. The only pharmacological intervention with an adequate evidence base is the prescription of atypical antipsychotics, where 18 placebo-controlled trials have evaluated the effect of treatment over 6–12 weeks. The literature indicates modest but significant benefits in the treatment of aggression and psychosis with risperidone and aripiprazole (Cohen's d standardized effect size of 0.2), uncertain benefits with olanzapine, and no benefits with quetiapine (Ballard and Howard, 2006; Schneider et al., 2006a; Ballard et al., 2009b; Corbett et al., 2012). Unfortunately, the benefits of longer term prescribing are more limited (Schneider et al., 2006b; Ballard et al., 2008) and there have been increasing concerns regarding the potential for serious adverse outcomes, including accelerated cognitive decline, stroke, and death (Schneider et al., 2006b; Ballard et al., 2009a). There is therefore an urgent imperative to identify more effective pharmacological treatments for severe BPSD which have a better safety profile, particularly for long-term treatment and prophylaxis. Despite this urgency, there has been very little effort toward developing or evaluating potential novel therapies for the treatment of key symptoms such as aggression, psychosis, restlessness, and apathy.

The understanding of elder abuse and neglect, also called elder mistreatment, is at an interesting juncture, both empirically and conceptually. Since 2000 there has been a significant growth in prevalence studies, including major studies from the United Kingdom, Spain, Germany, Ireland, Israel, Finland, Canada, and the United States, with further studies planned in India and Hong Kong (see, for instance, Pillemer and Finkelhor, 1988; McDonald et al., 1991; Comijs et al., 1995; Penhale, 2008; Biggs et al., 2009; Goergen et al., 2009; Lowenstein et al., 2009; Naughton et al. 2010). And while development is still uneven, there is now a World Elder Abuse Awareness Day, held in June every year, with a network of grassroots support in a wide number of countries. At the International Congress of Gerontology and Geriatrics in Bologna, Italy (held on 14–17 April 2011, see http://iaggbologna2011.com), there were, for the first time, six symposia devoted to the topic, and in the Netherlands, a country with some of the first internationally recognized studies, the Leyden Academy in 2011 called the inaugural meeting of an international working group to critically consider interdisciplinary responses to this area of increasing professional concern.

Global population aging is pervasive, profound, and enduring, with the projected proportion of older persons reaching nearly 21% in 2050 (UNFPA and Help Age International, 2012). Accordingly, there is an increasing need for geriatric mental health services with the rapid growth of the aging population worldwide (Bragg et al., 2012).

Delirium is a cognitive disorder characterized by acute onset, fluctuating course, altered level of consciousness, inattention, disorganized thinking, disorientation, memory impairment, and perceptual and motor disturbances (American Psychiatric Association, 2000; World Health Organization, 2010). It occurs in hyperactive, hypoactive, or mixed forms in up to 42% of older hospital inpatients (Siddiqi et al., 2006) and 70% of older long-term care residents (McCusker et al., 2011). In both settings, delirium is independently associated with poor outcomes (Siddiqi et al., 2006; McCusker et al., 2010; Witlox et al., 2010).

Judging for the 2013 International Psychogeriatric Association (IPA) Junior Research Awards in Psychogeriatrics was undertaken by a panel of six experts, selected by the IPA executive, which I had the honor to chair. All three award-winning papers appear in this issue of International Psychogeriatrics immediately following this guest editorial. I am confident that, like their many predecessors awarded over more than two decades, they will be highly cited (Pachana, 2012) and will be seen in due course as crucial to the development of the young and very promising researchers who have received this prestigious acknowledgment of their excellent work.

It has long been observed that some patients suffer a significant cognitive impact following anesthesia and surgery. This should not be surprising when considering that not only is the target organ for general anesthetic agents the brain itself but also that the process of anesthesia is a form of deep, pharmacologically induced coma rather than “sleep.” The expectation that such a process should be fully reversible with transient neurophysiological effects contradicts our experience with repeated abuse of other central nervous system depressants such as glue, petrol, and alcohol. Of great concern is that, while approximately 10% of populations in developed countries undergo anesthesia and surgery of some form each year, the proportion of the elderly making up this group is much greater. In addition, it is the elderly who are potentially at a greater risk of cognitive impairment following such procedures because many have decreased cognitive reserve, either due to pre-existing mild cognitive impairment (MCI) or frank dementia, which may be diagnosed or unknown. The impact of anesthesia on these individuals is poorly understood, as are the implications of the emerging laboratory data that suggest an effect of anesthetic agents on the pathological processes of Alzheimer's Disease (AD) itself.

As politicians and pollsters are well aware, it is easy enough to get different answers to the same question by adjusting the details of the question posed. So I clarify at the outset that I am not considering depression in the broadest sense of any depression occurring in any older person. It seems self-evident that differences are present when defined this way; that is, this includes people with depression in dementia, post-stroke depression, depression in the context of other chronic illnesses and so any assessment of clinical or biological factors would yield differences (in cognition, physical symptoms, and so on) compared to a similar sample of depression in all younger adults. Rather I focus the question on unipolar major depressive disorder (MDD). This is because if there are no differences in late-life MDD compared with younger adults, then it seems unlikely that such differences are present in broader constructs of unipolar disorder (minor depression and dysthymia) and pragmatically because this more tightly defined group has been better assessed. A problem in addressing this question is that relatively few studies have directly compared aspects of depression in older and younger people. Thus, the answer will necessarily be limited and subject to a potential “absence of evidence” error. Here, three key areas of evidence where such comparisons have been made will be examined.

The official introduction of the psychiatric diagnosis of personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders (DSM) began in 1952 with the publication of the first edition (American Psychiatric Association, 1952). DSM-I contained 12 main types of PDs with a total description for all types in only two paragraphs. In the following DSM-II (American Psychiatric Association, 1968), just 10 specific types of PDs were described, including a very brief general definition of PDs. The DSM-III (American Psychiatric Association, 1980) included a significant paradigm shift from the medical model by incorporating the design of a multi-axial approach, in which the combinations of symptoms of more than five primary axes were used to describe the pathological state and formulate the diagnosis. Notably, the PDs were placed on a separate axis (Axis II) to distinguish their long-standing nature from the more episodic clinical disorders placed on Axis I. PDs were recognized as important formal diagnoses and included a more comprehensive listing of polythetic diagnostic criteria for each specific PD.

As population longevity increases, living with cognitive disorders during a significant part of the remaining lifespan becomes a strong possibility for the majority of older adults. Therefore, the development of treatment strategies to address the principal causes of cognitive and functional decline is a healthcare priority. The aims of medical and psychological therapies vary according to clinical severity. In the stages of mild cognitive impairment and early dementia, maintaining personal independence and enjoyment of life is a major objective from individual, societal, and economical perspectives (Neugroschl and Wang, 2011; Mokhtari et al., 2012). Current anti-dementia drugs contribute to this goal to a very limited extent. In individuals with mild cognitive impairment these compounds do not prevent the onset of dementia (Raschetti et al., 2007), and in those diagnosed with early dementia, these compounds delay the worsening of symptoms only for several months (Kurz and Lautenschlager, 2010). Drugs with novel mechanisms of action are being developed for Alzheimer's disease and other neurodegenerative conditions. These have the potential to slow down the progression of pathology and expand the number of years for which patients remain at mild levels of cognitive and functional impairment. It is less likely that these treatments will stop cognitive and functional decline completely (Kurz and Perneczky, 2011). Therefore, psychosocial interventions are urgently needed in addition to current and future pharmacotherapy. At any level of cognitive and functional impairment the role of psychosocial interventions is to strengthen and make the best use of preserved skills in order to attain or maintain optimal levels of activity, participation, and interpersonal relationships. In contrast to drugs, psychosocial treatments primarily operate at the behavioral level. Some attempt to restore functions through cognitive, social, or physical activity, while others attempt to minimize disability through compensatory cognitive, behavioral, or environmental strategies. Recent research has shown that psychosocial interventions may increase regional cortical thickness or modify the pattern of neuronal network activation (Draganski and May, 2008; van Paasschen et al., 2009; Voss et al., 2010; Erickson et al., 2011). These neurobiological effects clearly demonstrate that brain plasticity persists into old age, but the relationship to behavioral gains and the importance for the prevention of cognitive decline (Lautenschlager et al., 2012; Steffener and Stern, 2012; Valenzuela et al., 2012) are currently unclear.

In the United States, there are signs that we are coming to terms with the growing healthcare needs of older Americans. Over the past decade, exploding Medicare costs and the federal budget deficit have forced medical professionals, policy-makers, and other stakeholders to consider the consequences of an aging population. The US Congress commissioned a report from the Institute of Medicine (IOM) on the physical healthcare needs of the elderly adults and the geriatric healthcare workforce required to meet them, resulting in the 2008 IOM report Retooling for an Aging America: Building the Health Care Workforce (IOM, 2008). Following this report, Congress recognized that the work was not finished and that more information was needed about mental health and substance use (MH/SU) disorders in older Americans. The IOM was commissioned by Congress to convene a committee to study and report on the workforce needed to care for this group. In 2012, the IOM released The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? (IOM, 2012).

Background: This paper identifies core elements in principal definitions of elder abuse or mistreatment of older adults (EA/MOA) and discusses the relevance of four crucial concepts: age, vulnerability, trust, and power balance in relationships.

Method: A critical analysis of selected literature in EA/MOA with a focus on works from the last 10 years.

Results: Current definitions of EA/MOA share commonalities regarding an understanding of elder abuse as a status offence, the inclusion of both acts and omissions, and the consideration of multiple levels of behavior and its effects. Definitions differ with regard to aspects as crucial as the intentionality of an abusive action and its actual or potential harmful effects. EA/MOA can be considered as a complex subtype of victimization in later life limited to victim–perpetrator relationships, where the perpetrator has assumed responsibility for the victim, the victim puts trust in the offender, or the role assigned to the offending person creates the perception and expectation that the victim may trust the perpetrator. Vulnerability is identified as a key variable in EA/MOA theory and research. With regard to neglect, the mere possibility of being neglected presupposes a heightened level of vulnerability. Power imbalance often characterizes victim – perpetrator relationships but is not a necessary characteristic of abuse.

Conclusion: Research on EA/MOA needs conceptual development. Confining phenomena of EA/MOA to specific relationships and tying them to notions of vulnerability has implications for research design and sampling and points to the limits of population-based victimization surveys.

Background: Social networking sites can be beneficial for senior citizens to promote social participation and to enhance intergenerational communication. Particularly for older adults with impaired mobility, social networking sites can help them to connect with family members and other active social networking users. The aim of this systematic review is to give an overview of existing scientific literature on social networking in older users.

Methods: Computerized databases were searched and 105 articles were identified and screened using exclusion criteria. After exclusion of 87 articles, 18 articles were included, reviewed, classified, and the key findings were extracted. Common findings are identified and critically discussed and possible future research directions are outlined.

Results: The main benefit of using social networking sites for older adults is to enter in an intergenerational communication with younger family members (children and grandchildren) that is appreciated by both sides. Identified barriers are privacy concerns, technical difficulties and the fact that current Web design does not take the needs of older users into account.

Conclusions: Under the conditions that these problems are carefully addressed, social networking sites have the potential to support today's and tomorrow's communication between older and younger family members.

Background: Most people with dementia in Western societies will eventually be placed in a nursing home. This can be stressful to those with dementia and to their families. The adjustment to this new caring environment by both residents and their family caregivers and the factors that influence this are the focus of this review.

Methods: A literature search of Embase, Scopus, and Medline databases of articles published in English between 1990 and 2011 using specified search terms was performed to examine this transition. The 174 titles located were screened and reference lists hand searched resulting in the 49 relevant articles included in this review.

Results: This decision and the subsequent adjustment period is a difficult time for people with dementia and their family caregivers. Admission has been linked to increased behavioral symptoms and in particular depression and agitation, decreasing cognition, frailty, and falls in people with dementia. For caregivers, guilt, depression, feelings of failure, and continuing burden but also improvement in quality of life have been variously reported. Research to determine what influences the trajectory of these different outcomes and the prevalence of positive outcomes for people with dementia is lacking. Successful transitions may be assisted by ensuring that the person with dementia has input into decision making, orientation procedures for the person with dementia and family member prior to and on admission, a “buddy” system for new arrivals, and a person-centered approach.

Conclusions: Adjustment to admission to residential care can be difficult for people with dementia and their family caregivers. Longitudinal research examining factors influencing the adjustment can provide a basis for intervention trials to improve this transition.

The last few years have seen considerable progress in revisions of clinical diagnostic criteria for dementia. In relation to Alzheimer's disease (AD), the focus of this particular debate, the original McKhann criteria were described in 1984 (McKhann et al., 1984) and represented a landmark in their field, allowing accurate categorisation of a type of dementia that was indeed shown subsequently by validation studies to largely represent AD. The criteria distinguished between “probable” AD, which despite its name was the highest level of clinical certainty available, “possible” AD, when there were variations in the course and presentation or the presence of another comorbidity that could be the cause of dementia, and “definite” AD for which autopsy validation was necessary. The impact of these criteria cannot be overestimated. Most of what we know regarding the natural history, and certainly the therapeutic response (and sadly non-response) of AD, is based upon cohorts diagnosed with these criteria, and most usually the probable Alzheimer type. Validation studies have shown reasonably good, and clinically applicable, sensitivity for the criteria of around 80%, but specificity has been lower, at around 70% (Knopman et al., 2001). This low specificity is an issue, largely because of the lack of any positive features for ruling AD in (they have largely, though somewhat unfairly, been labelled criteria of exclusion). In addition, the low specificity is in part because the criteria often also include conditions that were not well defined or even recognised in the 1980s as separate disorders. For example, dementia with Lewy bodies, subcortical ischaemic vascular dementia, and various subtypes of frontotemporal dementia, which have now been shown to have distinct clinical, pathological and, in some cases, genetic components.