There is strong indirect evidence that free radical production appears to be an important mechanism of brain injury after exposure to ischaemia and reperfusion. Although significant brain damage occurs during an ischaemic episode, new cerebral damage can occur after reperfusion. One proposed mechanism for the brain damage that occurs during reperfusion involves generation of free radicals. Body defences against free radicals depends on the balance between free radical generation and the antioxidant protective defence system. Many of these protective antioxidants are essential nutrients or have essential nutrients as part of their molecule that has to be obtained from diet.

Growth hormone and related growth factors are essential for normal childhood development, secretion rate then declining from early adulthood. Adults with growth hormone deficiency, e.g. after pituitary ablation, have many clinical features such as reduced muscle and bone mass which are also seen in healthy older people. In both cases, growth hormone treatment at least partly reverses these changes. This has led to the rather elegant notion that growth hormone decline may be responsible for age-related involution and death and raises the prospect of hormonal replacement therapy for aging and frailty.

The accurate measurement of renal function in elderly subjects is often required, due to structural and functional changes resulting from age and diseases affecting the kidney. Structurally, with age there is progressive loss of renal mass, particularly in the cortex, leading to a decreased number of glomeruli and an increase in the proportion of sclerotic glomeruli. A decline in the glomerular filtration rate (GFR) has been observed in both cross-sectional and longitudinal studies. However, it has also been noted that about one third of subjects have stable renal function, implying that this decline is not universal, and may reflect the effects of age-associated diseases.

The present review, building on a previous review published in 1993, gives a general overview of a large subject. As on the previous occasion, it is primarily concerned with the assessment of risk and the improvement of outcome in the older surgical patient. However, some of the previously-discussed technical difficulties of assessing risk, which apply to a wide range of medical and surgical specialties, have not been repeated this time. Updates have been given on cardiac, respiratory and nutritional risk assessment in older surgical patients, and a section on post-operative changes in mental function has been added. The use of new outcome measures, including the measurement of quality of life, is also discussed more fully in the present review.

The dementias which affect the elderly are chronic diseases with protracted courses, substantial morbidity, complicated presentations and serious effects on families and caregivers. The care of a patient with dementia is therefore complex, requiring a rational model of treatment including careful multidisciplinary evaluation, a treatment plan, and ongoing reassessment. The aim of this article is to provide a framework for any clinician involved in the management of patients with dementia. Dementia has been thought of as untreatable by some health professionals: however, in many ways it can be managed effectively and its consequences reversed or stabilized, even though the disease process may be irreversible. With evolving knowledge in basic research and with the development of new intervention strategies, more effective treatments will be available over the next several years. Therefore we provide a guide to the management of patients with dementia which is responsive to the introduction of future treatments.

The last twenty years have seen a rapid expansion in the provision of post-acute rehabilitation services for patients with traumatic brain injuries (TBI) in North America, although such provision remains limited in Britain. These developments have been precipitated by a growing appreciation by health purchasers and providers of the neuropsychological and social sequelae of TBI and demands by patients and their families for effective treatment. Most investigations have found that the majority of TBI survivors are young males under the age of thirty and that by far the most common cause of TBI is road traffic accidents. Typically the frontal and temporal lobes of the brain suffer the greatest impact and survivors subsequently present with deficits affecting memory and new learning, attentional dysfunction and impaired planning and organizational skills.

Whilst there is a considerable literature surrounding predictors of depressed mood in stroke survivors, much less research has been directed towards identifying the impact of a stroke on primary informal carers and the nature of the relationship between patient and carer characteristics, stroke consequences and carer distress. This review attempts to elucidate such relationships so that implications for health and social care provision can be drawn.

Smoking has been closely implicated in many cardiovascular, lung and other diseases which are prevalent in the elderly, but most prevention programmes tend to be aimed at younger age groups.

The prevention of smoking in retired people is a subject which is not yet fully researched, but there is a little information which suggests that it may be a worthwhile pursuit. Certainly, work has shown that longevity can be improved even in older people by stopping smoking. Coronary heart disease death rates for 65-74 year olds who have recently given up are similar to non-smokers. For other causes of death, especially lung cancer and bronchitis, the benefits of stopping smoking take up to five years to appear. In terms of morbidity, there are suggestions that ex-smokers move reasonably quickly towards the state of non-smokers for bone density, pulmonary function and muscle strength.

The World Wide Web (WWW) has much to offer clinicians, nurses, scientists and all those concerned with gerontology, including our patients and their relatives. This article reviews the history and structure of the WWW, outlines the basics of how to use it and what is available for the gerontologist. This is not a comprehensive list of all known webpages in gerontology, since this would not be possible, given the ever-changing nature of the WWW. Instead, this article offers a background knowledge and introduction to the types of resources that are available, enabling more productive use of the WWW for finding information in gerontology.