Faecal incontinence is a disabling condition, with a high personal, social and economic cost. Whilst it may occur at any age, prevalence and severity of symptoms is higher among older people. There are many therapeutic options, ranging from non-invasive treatments to complex surgical techniques, with results that can be considered satisfactory in about 70% of individuals. A comprehensive study of the type of incontinence and its presentation and severity, together with consideration of the general condition of the patient and their environment, are the keys that will decide the best treatment option.

Recently, diagnostic criteria for preclinical Alzheimer's disease have been proposed. These describe and define three stages of disease. Stage I is focused on asymptomatic cerebral amyloidosis. Stage II includes evidence of synaptic dysfunction and/or early degeneration. Finally, stage III of the disease is characterized by the beginning of cognitive decline.

Parkinson's disease (PD) is a common and costly condition affecting a predominantly older population. Physical rehabilitation has been shown to enhance motor performance and functional mobility in the short-term. However, there is limited information available about how best to design and deliver an ambulatory rehabilitation (AR) programme for this patient group. This article reviews the current evidence, aiming to provide guidance about best-practice service provision. We highlight the benefits of group therapy and techniques aimed at reducing falls. Further research is required to determine the optimal dose and intensity of AR necessary to provide sustained benefits in people with different stages of PD.

Evidence suggests that there is a greater prevalence of pain, particularly chronic pain, in the older than in the younger population. This review looks at how dementia affects older people's ability to report pain, and indicates that pain is poorly assessed and managed in people living with dementia, in particular in care and acute settings. The review also reports findings from two recent studies looking at ways of improving the assessment and management of pain in acute settings. Multi-dimensional, patient-centred approaches to assessing and managing pain in those living with dementia are required, and future research should focus on innovative and practical approaches that can be applied in care home and acute settings.

Older people are high consumers of prescription drugs and are at increasing risk of polypharmacy and adverse reactions. Pharmacokinetic and pharmacodynamic modifications due to age and co-morbidities are an important consideration, but pharmacological background evidence to guide safe and effective therapeutic approaches are often inadequate since the older population is under-represented in clinical trials. We review the pharmacokinetic and pharmacodynamic changes that are characteristic in old age and consider evidence regarding potentially safer prescription and monitoring of drugs commonly used in older patients. We also introduce the possible role of pharmacogenomics and therapeutic drug monitoring as tools to guide the individualization of drug therapy.

Vitamin D has a wide range of biological effects beyond calcium and bone metabolism, and low 25-hydroxyvitamin D levels have been associated with many disease states in recent years, including cardiovascular disease, diabetes, infections and cancer. Association studies of vitamin D are notoriously prone to confounding and to reverse causality, however, and current intervention trial data for non-skeletal indications have been disappointing. Vitamin D is indicated for treatment of osteomalacia in older people, falls prevention in institutionalized older people, and as adjunctive therapy for osteoporosis. Large trials currently underway will ascertain whether potentially beneficial effects of vitamin D supplementation on all-cause mortality in older people are borne out.