The maintenance of independence by older people is seen as a priority by health and social services, and by people themselves. This review explores the constructs of independence and dependence in relation to aging, and considers the ways that discourses surrounding these topics affect our thinking about growing older.

Incontinence is a common problem and the incidence increases with age. Approximately 85% of all cases of incontinence occur in women, essentially because bladder neck competence and pelvic floor/urethral sphincter activity is more readily compromised than in the male. Incontinence is an important cause of admission to and a common finding in nursing homes for the elderly but is not an inevitable sequela of aging.

Chronic obstructive pulmonary disease (COPD) is the fifth leading cause of mortality in the USA. For 1984 to 1993, among Canadian seniors aged over 65, COPD was the fourth cause of mortality in men and the seventh in women. Though the underlying pathology is initially confined to the lungs, the associated physical deconditioning and the emotional responses to chronic respiratory disease contribute greatly to the resulting morbidity. Increased shortness of breath leads to inactivity and consequent cardiorespiratory and muscular deconditioning, which in turn leads to further inactivity, social isolation, fear of dyspnoea and depression. Respiratory rehabilitation may offer a way to break this vicious circle.

A great deal of attention has been devoted to the ever-increasing incidence of fractures of the proximal femur in elderly patients and the impact which this has had upon their life expectancy and quality of life. The condition has also made heavy demands on the Health Service, and much effort has been devoted to increasing hospital throughput by effective programmes of rehabilitation. In these circumstances, it is not surprising that much less has been written about the issues involved in treating elderly patients with less serious forms of fracture. Nonetheless, closer attention to this group reveals that it also makes heavy demands on the Health Service. An example is that, in 1995, out of 1771 elderly patients admitted to the acute orthopaedic wards at Edinburgh Royal Infirmary, only 47% had fractures related to the proximal femur or displacement of a hip prosthesis (Figure 1) (CT Currie, unpublished data, 1996). Most of the remainder had fractures at other sites, while 8% had soft tissue injuries. The percentage of fractures involving more common sites in old people was 2.5% for the neck of humerus, 3% for the shaft of humerus, and 7% for the wrist. The low proportion of vertebral fractures emphasizes that this condition rarely leads to admission to an acute unit, so that the size of the problem is usually underemphasized.

This paper addresses the ethical and legal issues which arise in the UK in the care of demented people, updating and revising the 1993 review in this journal. In 1993 the ‘end of medical ethics’ had recently been suggested, an American fear that the doctor‘s responsibility and authority would be fatally eroded by administrators and cost controllers, concerned only with budgets. These concerns persist.

In recent years, psychiatrists have improved their accuracy and efficiency in diagnosing delirium, particularly in hospitalized elderly patients. Early and accurate diagnosis is essential as unrecognized and untreated delirium is associated with longer length of hospital stay and greater expense, accelerated functional decline, an increase in nursing home placements, persistent cognitive deficits, and elevated rates of mortality.

The growth of the elderly population in the UK and other Western societies, as well as in the USA, Australia and Japan, has led to widespread interest in the living arrangements of this group. Although co-residence patterns within the household alone are not sufficient indicators of the strength of conjugal and intergenerational ties, they do provide a measure of potential intra-household support for the elderly. Studies have shown that children who live at home provide greater assistance to their parents (both financially and with domestic tasks) than non-co-resident children. Thus, residential patterns appear to be important for exchange relationships between the elderly and their kin.

The ability to differentiate science from science fiction might be considered an essential quality in those who stand on their soapboxes to proclaim the virtues of particular therapies. Not so the protagonists of electrotherapy. It is difficult to think of any treatment modality which until recently has been so neglected by the purists. This is reflected in the plethora of literature churned out on the subject, much of which relates to 'back street' studies which are woefully short on science and method.

Dementia with Lewy bodies (DLB) is being increasingly recognized as a common cause of progressive cognitive decline in the elderly, with hospital-based autopsy series demonstrating rates of between 7% and 25% of all cases of dementia, second only in frequency to Alzheimer's disease (AD). Although DLB has only recently been described, it is unlikely to be a newly occurring disease but one which has become identifiable as a result of advances in neuropathological techniques which make cortical Lewy bodies (LBs) easier to detect.

In many developed and developing countries, life expectancy has greatly increased over the last two decades. However, this seemingly favourable change raises new questions concerning the quality of the years of life gained, particularly in the elderly. Do the individuals who escape death accumulate disabilities, sequelae of accidents or consequences of chronic diseases? The concept of disability-free life expectancy, and more widely that of health expectancy, has been developed in order to answer this question.

Complementary medicine (CM) can be defined as 'diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine'. It has become a hotly debated subject, mostly because many physicians remain sceptical about its usefulness while consumers vote for it with their feet and their purses.

Continence promotion includes all nonsurgical therapies that enable a patient to recover continence. Examples include bladder training, pelvic floor exercises, anticholinergic drugs, oestrogen, electrical therapies, vaginal cones and intermittent self-catheterization. Implicit in the use of all of these therapies is a detailed history and examination to diagnose any cause for the symptoms. Continence promotion is most closely identified with the role of the nurse, in co-operation with the doctor, in recognizing medical and surgical causes of incontinence.

Since pronounced aging of the population became evident in the 1976 Australian census, there have been repeated expressions of concern about the health care costs associated with this trend. The latest of these has come from the National Commission of Audit (NCA) which was established by the newly elected conservative Commonwealth Government in June 1996 to undertake a wide-ranging review of the financial position of the Commonwealth Government. The Terms of Reference on which the NCA was to report included 'the impact of demographic change on Commonwealth finances, with the intention of making recommendations as to how emerging pressures could be provisioned'. Many of the themes canvassed in its report are in common with those raised in analyses of the implications of aging for health care costs in other countries, but some reflect particular characteristics of the Australian aged care system and social policy context.

Urinary incontinence is a condition in which involuntary loss of urine is objectively demonstrated and results in a social or hygienic problem. A poll conducted for the Association for Continence Advice estimated that up to three million people in the UK suffer from incontinence. The incontinence may be transient, e.g. as a result of a urinary tract infection, or permanent, e.g. as a result of damage to the pelvic floor. Many sufferers may not seek medical advice for their predicament and the figures given above may be a gross underestimation of the problem.

Despite the growing recognition of the importance of housing for the health and well-being of elderly people there has been less research on the topic than on health or personal social services. Moreover, until recently, what research there was tended to concentrate on specialized, rather than mainstream, forms of housing. This review looks at research on the meaning of home; the kind of housing elderly people live in; tenure; specialized and nonspecialized housing; some issues to do with an assessment of needs; and at links between services. The very important related topic of moving in old age is not covered because this was the focus of a recent review in this journal. However, it is relevant to note that research shows that many people move into specialized housing against their will and wish that they could have remained at home. This review also excludes consideration of other related topics such as household composition, affordability, the contribution of technology such as alarms and ‘smart’ houses, and problems of specific groups, such as those who are homeless.

Dying is the one common and certain event in life but it is a difficult process to study. Official statistics give information about the point of death; studies covering random samples of deaths are inevitably retrospective and based on the accounts of those who knew the person who died; other studies are selective and generally focused on people dying from cancer, so they include a relatively small proportion of old people. Yet, in developed countries, deaths are concentrated among older people. In England and Wales in 1994 83.6% of all deaths were of people aged 65 or over; 59.0% were 75 or more.

The term 'graduate' (hereafter without quotation marks) has been used to describe the following groups of patients:

1) All those patients with enduring psychiatric illness who have graduated to old age (usually defined as age over 65 years);

2) 'Patients who entered hospitals for the mentally ill before modern methods of treatment were available and have grown old in them after many years there.'

3) Specifically, long-stay patients with schizophrenia over the age of 65 years who came into continuous psychiatric contact well before that age.

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.

For those of us who have been working in the elder abuse movement for a decade or more, progress towards understanding and prevention of elder abuse has been exceptionally slow. This situation may be attributed as much to the complexities of elder abuse as to the importance given to the problem by national governments. However, one trend in the past five years is particularly noteworthy. The increased awareness of elder abuse among the nations of the world, underscored by an ‘“explosion” of interest’ in the UK, has been the most salutary accomplishment. The purpose of this paper is to review the status of the field with specific reference to the past five years. Of necessity, this review is selective and thus may omit worthy research and policy achievements. As with an earlier paper (see Rev Clin Gerontol 1992; 2: 269-76), this review is limited to elder abuse in domestic settings.

Over 2000 randomized trials are reported in the literature for the treatment of dementia and cognitive decline. Yet the responses to the question, ‘Which treatments are effective in dementia?’ are likely to be various and conflicting. Wide variation in practice exists, and for drug therapy, where information is more readily available, different treatments are used in different countries. For example, only one drug (Hydergine) is licensed in the UK for dementia, though rarely used, while there are over 30 drugs in use in Japan for dementia and cognitive decline, five in Spain, and two in the USA. This inconsistency is likely to be even greater for interventions of psychological and behavioural therapies, environmental therapy and the organization of care.