Chronic kidney disease (CKD) refers to long-term impairment of renal function. It is predominantly a disease of older people and the true extent of this has only recently been recognized. CKD has a number of implications including increased cardiovascular risk, secondary complications such as renal anaemia and bone disease and a small but significant risk of progression to established renal failure (ERF). It is associated with significant morbidity, mortality and healthcare costs and, against the background of an ageing population and the rising prevalence of type 2 diabetes, represents a growing public health problem. Evidence that specific interventions can reduce the cardiovascular risk associated with CKD and the risk of progressive CKD, as well as improving quality of life, has highlighted the importance of early detection of this disease.

Accurate assessment of renal function is vital, especially in older individuals, as this is the population in which the greatest burden of chronic kidney disease (CKD) occurs. With ageing, the kidneys undergo a multitude of structural and functional changes. The age-related changes in the kidneys may be further complicated by concurrent pre-renal, renal and post-renal factors common in old age, such as hypertensive glomerulosclerosis, diabetic nephropathy, congestive cardiac failure, renovascular atheroma, urinary outflow obstruction, urinary tract infections, renal stones and drug-induced nephrotoxicity. Structurally, there is a progressive loss of predominantly cortical renal mass, a decrease in the number of glomeruli, an increase in the proportion of sclerotic glomeruli, tubulo-interstitial changes resulting in fibrosis and atrophy, arteriosclerotic vascular changes and a reduction in renal blood flow. Excretory and reabsorptive capacities of the renal tubules may also decline with ageing. Functionally, although there may be a decline in the glomerular filtration rate (GFR) resulting primarily from a reduction in the number of functioning nephrons, this decline may not be universal. Up to a third of elderly people may not demonstrate a decline in GFR with ageing, whilst in some individuals GFR may actually increase with age.

Impaired hearing is prevalent amongst older people, adversely affecting physical and psychosocial function and, hence, quality of life. It may also cause depression. Yet evidence suggests that hearing problems are all too often regarded as a ‘normal’ part of ageing and more likely to be ignored than diagnosed and/or treated; many believe that little can be done to improve hearing. Furthermore, ‘many of the behaviours of a hearing-impaired individual (e.g. irritability, inattention or inappropriate responses) may be interpreted as evidence of dementia’ though they may simply reflect communication difficulties that can, in turn, damage personal relationships.

Vitamin D has been known to play a key role in calcium homeostasis and bone health for almost a century. Its main current clinical use is as an agent to prevent osteomalacia and reduce fragility fractures in older people. Vitamin D may however play a wider physiological role, with effects on cancer prevention, cardiovascular health and immune function. This review article will outline the physiological role of vitamin D, the disease processes that have been associated with insufficiency and examine whether vitamin D supplementation can ameliorate these disease processes in older people.

The topic of hypoxaemia after stroke was last reviewed in this journal in 2001. Since then a lot of new information on the subject has been published, and while some questions have been resolved, new problems have emerged. This article discusses new research in the light of what is already known and outlines areas of persisting uncertainty.

The challenges of treating malignant disease in the older population are gaining greater prominence. In the last 10 years the European Organisation for Research and Treatment of Cancer (EORTC) has established a task force to examine challenges of managing older cancer patients. As an indication of their importance, the American Society of Clinical Oncology (ASCO) specifically addressed the issues raised by older patients at their annual conference in 2004.