One of the greatest challenges of medicine in old age is for physicians to understand the process of aging and to be able to distinguish it from disease, lifestyle factors and environmental exposures whose cumulative effects account for many of the changes observed in older people. As a result, physicians have a duty to recognize and intervene appropriately against age-related diseases.

Cognitive impairment is one of the major health problems facing elderly people in the new millennium. This does not only refer to dementia, but also to lesser degrees of cognitive deficit that are associated with a decreased quality of life and, in many cases, progress to dementia. Some studies suggest that delaying the emergence of dementia for a few years would result in a considerable decrease in the human and economic burden related to the condition.

The purpose of this review is to discuss how healthcare professionals, and particularly nursing practice, impact upon pain management with older people (65 years and over), following surgery. The review commences with an introduction presenting why this is an important area to consider. Current available literature and findings from an ethnographic study which was designed to examine peri-operative pain-management practices with older people will then be discussed to highlight the key issues of pain assessment and management. Three overarching themes; (1) pain assessment (2) knowledge/strategies to cope with pain and (3) organization of care (culture and context), will guide the discussion. It is suggested that comprehensive pain assessment, proficient communication and multidisciplinary working, are essential to improve pain-management practices. The paper demonstrates some of the multiple and complex factors that affect the older person's pain experience and identifies possible developmental work in this field.

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.

Alzheimer's disease (AD) is the commonest form of dementia, estimated to affect 37 million people worldwide. Currently there is nothing to halt the progression of AD – treatment focuses largely on slowing the development of symptoms. More recently disease-modifying interventions, such as immunotherapy, have been investigated as their aim is to halt or even reverse symptoms by removing β-amyloid (Aβ) pathology. This paper assesses the developments made in this particular field, offers critical appraisal of important papers and assesses the viability of this potential form of treatment.

In their summary of changes in renal function with age, Porush and Faubert do not mention one of the most troublesome and least understood: the reversal of the circadian rhythm of water and electrolyte excretion. Young adults normally excrete the greater part of their 24-hour urine volume during the day and have a low night output. This rhythm has been shown to weaken by the age of 50 years and to be lost or apparently reversed by the eighth decade. Increased urine production is probably the principal cause of the need to get up at least once at night experienced by practically all elderly people. Together with bladder hyperreflexia, it is also an important cause of nocturnal incontinence.

‘Syncope’ is derived from the Greek words ‘syn’ (meaning ‘together’) and ‘koptein’ (meaning ‘cut’). It is a syndrome characterized by transient loss of consciousness resulting from temporary and self-limited cerebral hypoperfusion, most often the result of systemic hypotension.

The lymphatic system must have variation in tissue pressure to load it and to help flow. Being a low pressure system, external pressure must not be constantly high on any segment and there must be a pressure gradient along it. When the flow rate of lymph fails there can be compromised immunity, a tendency to deposit fat, fibrotic induration, and a vicious cycle of worsening of cellular and organ health often associated with recurrent infection.

As we age we become less active, lose muscle tone, and increase our weight, develop a higher percentage of body fat, and may have poor skin care and be prescribed medications which impact on lymphatic load. Combined with this, the tendency to immobility, limb dependency and periods of time when high external pressures exist in small superficial areas increase the risk of or contribute to lymphoedema through reducing lymphatic flow. Older people are more likely to have had more radical surgery and radiotherapy for cancer with more significant damage to their lymphatic systems, again adding to lymphoedema risk. Immobility, hypertension, venous disease, kidney and liver failure can lead to oedema, while thyroid dysfunction can cause myxedema, and genetic or metabolic issues can cause lipoedema, compounding the clinical problems.

A key point in good management is early identification and accurate diagnosis. Ideally, other issues that especially impact on lymphatic load should be managed prior to targeted and sequenced treatment for the swelling, with the aim being to improve patient comfort. Management can involve the patient, partner, family or carer as well as a range of health professionals to help reduce or maintain limb size, appearance and function as well as reduce symptoms of heaviness, tension and discomfort and a range of other issues that impact on quality of life and activities of living.

Meta-analyses of randomized controlled trials have reported the efficacy of dose-adjusted warfarin therapy (target International Normalised Ratio (INR) 2–3) in reducing stroke risk in atrial fibrillation by 68%, with aspirin reducing relative risk by 22%. Absolute benefit for an individual patient depends on the presence of the risk factors for stroke; these include previous stroke, transient ischaemic attack, hypertension, diabetes, valvular heart disease, heart failure and advanced age. In spite of reported benefit, many people with atrial fibrillation and a high risk of stroke are not receiving anticoagulation: disappointingly, risk stratification is not being sufficiently used to guide treatment.

The prevalence of obesity is increasing, both in developed and developing, countries. Since obesity is a major factor in the pathogenesis of chronic diseases including type 2 diabetes and cardiovascular disorders, the dramatic increase in obesity prevalence in recent years has major implications for the health of individuals and for the health economy. The number of aged individuals and their longevity is also increasing. Age is a major factor in the pathogenesis of chronic diseases.

Constipation is a common complaint in geriatric patients, especially when older people are asked specifically about their bowel habits. It can cause serious complications, such as recurrent urinary tract infections, urinary incontinence, faecal incontinence and even bowel obstruction and perforation. As a result of the tremendous advances in understanding of the epidemiology and pathophysiology of constipation in the older patient, the definition of constipation has changed considerably, leading to the development of new treatment options.

Successful aging seeks to counteract and replace the old ‘decline and loss’ paradigm that views aging as a series of individual decrements or losses to which both older people and society needed to adapt or adjust. This new gerontology, based on the concept of successful aging, adopts a preventive model: modify individual behaviours throughout life in order to avoid the decrements and losses. Research has led to the development of a variety of models for successful aging, which share the fundamental assumption that successful aging is a result of a lifelong developmental process that involves the combination or interaction of traits or predispositions present at birth or in early life and cumulative life experiences. Successful aging builds on a life history of successful adaptation, which in turn, is a result of interactions among inherited and learned personality attributes and levels of adversity or advantage and resources. Research driven by the successful aging theorist is turning attention to the development of indicators that might explain and predict successful old age. A number of factors are already well known to promote well-being, for instance regular exercise, cognitive stimulation, friendship and the presence of a confiding relationship. However, little is known on how persons from different age groups perceive the preparation of a good old age. In this exploratory study we attempt to expand this topic, since it will allow the understanding of how these perceptions can influence, in a positive or negative way, the achieving of a good old age.