Alzheimer’s disease (AD) is a treatable disorder. Two classes of anti-dementia agents have emerged in the recent past: anti-oxidants and cholinesterase inhibitors. A recent study showed that the anti-oxidants alpha tocopherol (vitamin E) and selegiline slowed the progress of AD. Patients treated with either agent alone or with both agents in combination progressed to end-point more slowly than patients on placebo. Patients on placebo reached one of the end-points - death, nursing home placement, progression to severe AD, or significant loss of activities of daily living - in approximately 400 days, whereas patients on active agent required approximately 600 days to reach the same end-points. Both these agents have anti-oxidant properties; selegiline is a monoamine oxidase-B inhibitor that reduces free radical generation and alpha tocopherol has free radical capture capabilities. These agents are applied to patients in mild or moderate phases of AD, where slowing the progression of the illness and maintenance of patients at higher levels of function are the principal goals. Slowing the progression of the disease in more advanced phases of the illness may be less desirable.

In Europe, vertebral fracture incidence has increased 300–400% for women and more than 400% for men during the last 30 years. These data are age-adjusted and therefore highlight that there is a decrease in bone mass or bone quality from generation to generation. To arrest or reverse the increases in osteoporotic fractures, effective general preventive regimens must be established. However, in order to do so, basic understanding of age-related changes in the material quality, 3D cancellous bone architecture, macrostructure (shape and size), and strength of human bone is crucial.

Cancer in older patients is an international health problem of mounting importance, resulting from the slow rise in the proportion of the population over 65. Age is the major risk factor for malignancy, with two-thirds of cancer deaths in the USA in those over 65. By 2000 this will be the same in Europe. Most treatment trials have included only patients under 65 and results cannot necessarily be applied to older patients. Many trials now include older patients, but these may overestimate population benefits by excluding the particularly frail.

The importance of a specialist viewpoint on blood tests in elderly people and their interpretation was established by Hodkinson. He described the need for full investigation, the choice of suitable reference populations in old age, the difference in reference ranges between older and younger people and the effect of the special features of medicine in old age on appropriate testing strategies. In this journal, Rochman has discussed problems in chemical pathology interpretations in the elderly. This review builds on previous work by looking at recent papers relevant to biochemical and haematological investigations of practical relevance to the clinical medicine of old age. It is based on a Medline search combining sets of papers relating to specific investigations and clinical situations with those using the key word ‘elderly’. Added to these papers are others known to the author and colleagues.

Rehabilitation has received considerable attention recently, having been the subject of a number of consultations, reviews and policy documents. Despite such activity it is recognized that ‘there is widespread confusion about the meaning of rehabilitation’, with a general failure to clarify aims and objectives. Nevertheless, there is an emerging consensus that the elements of effective rehabilitation include:

- responsiveness to users' needs and wishes

- multidisciplinary and interagency working

- availability when required

- clear rehabilitative purpose and goals

The three key words in the title deserve scrutiny. ‘Innovation’ can mean something that is completely new, but more often innovations are drawn from practice in other fields. Innovations can be imposed from above, developed from practitioners or even happen incrementally. They are very often creative responses to other pressures, necessity being the mother of invention in this field as much as any other. Innovations can be reflected in day-to-day practice or they can be embodied in whole new units. Stale, out-of-date practice can happen in new units, and vice versa. It is too easy to see new buildings alone as innovations.

Rehabilitation stands between acute care and long-term care. As such, it is difficult to define and harder still to measure. Put simply, it is a process, an attitude of mind, a philosophy; something that patients need but acute hospitals would rather do without. This paper discusses the problems of measuring and forecasting rehabilitative activity before explaining how behavioural models of flow demonstrate the interaction between acute, rehabilitative and long-stay care. Managers, directors of social service departments, and clinicians need scientifically valid methods that enable them to measure performance and to optimize decision-making. Inherent flaws in the current methods used to measure hospital activity must be overcome if rehabilitation is to occupy its rightful place in health care management.

In this paper recent studies of the relationships between social networks and mortality among older people are reviewed. Although a large amount of research effort has been expended on identifying and explaining such relationships, many studies have focused predominantly on those in middle age groups and very few have included sufficient numbers of older old people to allow separate analyses. Moreover, although relationships between various indicators of social support, participation and mortality have been demonstrated, this finding is not universal and considerable uncertainties remain about the strength of any such association, how it may vary between age and social groups and how it operates. In part, these uncertainties reflect the wide range of conceptual definitions of social networks or social support, methodologies and data sets used to address the issue.