Oral anticoagulant therapy has become more commonly prescribed for people of 65 years and over following the widening of its clinical indications to include thromboembolic prophylaxis in atrial fibrillation. It is estimated that approximately 470 000 people in the UK, almost 1% of the population, are currently receiving oral anticoagulant therapy and this is growing. Due to its narrow therapeutic index, and the intra-individual variation in dose requirement, there is a need to monitor the level of anticoagulation in each patient. In consequence, health systems have had to invest resources into monitoring services to cope with this development.

Dysphagia is defined as difficulty in swallowing solids or liquids and is distinct from odynophagia, which is pain on swallowing. Dysphagia occurs in a range of conditions that affect the oral, pharyngeal and oesophageal phase of swallowing. The problem of dysphagia assumes greater importance in older persons. Some people may not be able to communicate that a problem exists. In others the lack of nutrition due to dysphagia compounds existing undernutrition, a common problem in institutionalized older persons. This paper discusses dysphagia in the context of the older person and outlines the normal mechanism of swallowing, the important clinical distinction between oropharyngeal dysphagia and oesophageal dysphagia, the aetiology of dysphagia and issues of management.

Many doctors have the impression that elderly-onset epilepsy is uncommon. This has no basis in the recent literature. There is evidence from many countries e.g. USA, Denmark, that the incidence of seizures rises sharply in old age. The United Kingdom National General Practice Survey of Epilepsy and Epileptic Seizures (NGPSE), a prospective-based, community-based study found that 24% of new cases of definite epilepsy were in subjects over the age of 60. A study of a primary care database covering 82 practices and nearly 370 000 subjects, 62 000 of whom were over the age of 60, revealed a continuing rise in the incidence of seizures in old age, whereas the incidence for the overall population was 69 per 100 000, the incidence in the 65 to 69 age group was 87, in the 70s, 147 per 100 000, and in the 80s, 159 per 100 000. Over one-third of all incident cases placed on antiepileptic drugs (AEDs) were individuals over the age of 60.

Urinary incontinence has been defined by the International Continence Society as ‘the involuntary loss of urine, which is a social and hygienic problem and can be objectively demonstrated’. This is a useful definition, although due to the subjective component, prevalence can only be estimated.

The current focus on dementia risks eclipsing other mental health problems of later life. While the National Service Framework for Older People (NSF) has highlighted depression as an important disorder meriting special consideration,1 anxiety and psychoses in older people remain difficult problems for practitioners to manage. This paper reviews the prevalence and impact, recognition, complexity and prognosis and treatment for these three clinical problems, and proposes a framework for ‘good enough practice’

Whilst clinical psychologists and a few fellow professionals have long known the importance of psychology in rehabilitation, it has recently been formally acknowledged as an essential professional discipline in such settings. In relation to stroke care for example, the recently published National Service Framework for Older Adults, England (NSFOA) specifies (Standard Five) that multidisciplinary stroke rehabilitation teams should include clinical psychologists, a view that is echoed in the Royal College of Physicians’ ‘Guidelines for Stroke Care’. The NSF is not yet universal to all areas of the UK, however, this article will reflect the English NSF as appropriate standards for health care across the country.

Unilateral spatial neglect is a disorder that has, for many years, intrigued and frustrated researchers and clinicians working in the area of stroke rehabilitation. A vast literature exists on the subject of neglect, much of it published by neuropsychologists and neurologists. Many of these papers aim to identify the underlying causal mechanisms, in terms of the neuroanatomical structures and cognitive processes involved. More recently, research has focused on evaluation of rehabilitation strategies to reduce the disabling effects of neglect. Various research designs have been used to examine whether a particular approach is effective or not. These range from single-case experimental designs (where the individual acts as their own control) through to randomized controlled trials (RCTs). In the latter, comparisons are made between (typically) two groups, one randomly assigned to receive the therapy approach under investigation and the other assigned to the control treatment.

It is often said that the demand for health care is growing inexorably in the UK, so that the NHS is constantly struggling to keep up. The dilemma was most famously put by Enoch Powell, who said that any health service faces the problem of infinite demand meeting finite resources. This was an economist's view, which suggests that anything that is free will be demanded infinitely.