As the mean life expectancy of the population continues to increase, the challenge for individuals is to remain healthy and fit throughout their life span. This review examines the relationships between moderate-vigorous physical activity and sedentary behaviour in relation to the fitness-frailty continuum. The association between increased physical activity and decreased adverse health outcomes is firmly established. A direct association between frailty and moderate-vigorous physical activity has been established to a lesser degree. What has some potential to undermine even these gains is the increasingly recognized relationship between sedentary behaviour and poor health. It now seems likely that sedentary behaviour can have a negative impact on an individual's health, over and above that of meeting the recommendations of moderate-vigorous physical activity. Individuals must consider both increasing their level of moderate-vigorous physical activity and minimizing their level of sedentary behaviour during all aspects of daily life.

Evidence from England, Australia, Canada, Japan and the USA indicates that the single homeless population is ageing, and that increasing numbers of older people are homeless. This paper reviews evidence of changes in the age structure of the single homeless population, and the factors that are likely to have had an influence on the growth of the older homeless population. In many Western cities, the housing situation of older people is changing and there is a growing reliance on the private rented sector. Unemployment is also having an impact on older people who are under the official retirement age. An increasing number of older people are experiencing problems linked to alcohol, drugs, gambling and criminality, and these are all behaviours that can contribute to homelessness. Despite high levels of morbidity and disability among older homeless people, they are a relatively neglected group and receive little attention from policy makers and mainstream aged care services.

The heart failure epidemic predominantly affects older people, particularly those with concurrent co-morbid conditions and geriatric syndromes. Mortality and heath service utilization associated with heart failure are significant, and extend beyond the costs associated with acute care utilization. Over time, older people with heart failure experience a journey characterized by gradual functional decline, accelerated by unpredictable disease exacerbations, requiring greater support to remain in the community, and often ultimately leading to institutionalization. In this narrative review, we posit that the rate of functional decline and associated health care resource utilization can be attenuated by optimizing the management of heart failure and associated co-morbidities. However, to realize this objective, the manner in which care is delivered to frail older people with heart failure must be restructured, from the bedside to the level of the health care system, in order to optimally anticipate, diagnose and manage co-morbidities.

Acute heart failure is a highly prevalent geriatric syndrome presenting one of the most frequent reasons for visits to the emergency department and hospital admission, and is associated with a high morbidity and mortality and acute functional impact. The present study reviews some of the features that characterize diagnosis and immediate management of acute heart failure in older people, as well as recommendations about the management of co-morbidity, risk stratification and the decisión-making process, and the design of care plans in this older age group within the setting of hospital emergency departments.

This study systematically reviews the published literature regarding inappropriate prescribing in frail individuals aged at least 65 years. Twenty-five of 466 identified studies met the inclusion criteria. All papers measured some surrogate indicators of frailty, such as performance-based tests, cognitive function and functional dependency. Beers criteria were used in 20 studies (74%) to evaluate inappropriate medication use and 36% (9/25) studies used more than one criterion. The prevalence of inappropriate medications ranged widely from 11 to 92%. Only a few studies reported the relationship between potentially inappropriate medication use and surrogate measures of frailty. These diverse findings indicate the need for a standardized measure for assessing appropriateness of medication in frail older individuals. Prescribing tools should address both medication and patient-related factors such as life expectancy and functional status to minimize inappropriate prescribing in frail individuals.

Exercise and physical activity are thought to be among the most important lifestyle factors for the maintenance of health and prevention of premature disease and mortality. Yet sedentary lifestyles are common. Many people avoid exercise, and have done so across their lifespan. Exercise and physical activity are also considered important for positive psychological functioning; however, this has received limited research attention. This mini-review discusses the effects of exercise and physical activity on mental health and well-being in later life. It draws on international peer reviewed research, summarized in systematic reviews and/or meta-anlaysis, and presents the key findings. Systematic reviews and meta-analyses generally confirm the importance of exercise for mental well-being; however, there is a lack of good quality research. The review discusses some of the barriers to exercise, and identifies strategies that may facilitate uptake and adherence in later life. Limitations in the current evidence are discussed. Based on the current evidence, it is recommended that health practitioners should encourage exercise or physical activity of low to moderate intensity, and leisure time activity such as walking, especially at retirement. Future intervention research would benefit by focusing on people who have not self-selected into studies so as to understand the causal direction, and include theory driven approaches to behaviour change.