Most of the things done by the professionals in the health service have evolved over the years through personal experience, expert views and trial and error. Since the last World War, initially with the randomized controlled trials of TB therapy, there has been increasing interest in objectively measuring the effect of treatment on patients. The proponents of this approach suggest that, where tested, personal experience, even in those with a great deal of experience, does not always allow us to draw our evidence from sufficient numbers nor does it immunize us against unfounded enthusiasm for one treatment over another.

Until recently, there has been relatively little scientific research investigating the influence of food or nutrient intake on longevity. This is partly due to the fact that most investigators have been interested in the relationship of food or nutrient intake to specific diseases i.e. communicable diseases, coronary heart disease and cancer of specific sites, rather than to overall mortality or longevity. Another significant factor is the difficulty of comparing the nutritional intake of populations, owing to the wide variability in individual intake and poor individual recall of specific food items in epidemiological studies.

Frailty is a term that is used often, but commonly not defined precisely. As reviewed elsewhere most definitions share several features. Typically, older adults who are frail have a greater rate of dependence on others, so-called ‘loss of physiological reserve’ and multiple diseases. A dynamic component is often included (e.g. ‘loss of reserve’ and such synonyms as ‘unstable disability’ and ‘impaired homeostenosis’) and is manifest when, over time, patients respond less well to stress, or when those with given levels of frailty have higher rates of adverse outcomes. Still, the imprecision of the term frailty has led some to question its merit, and either to develop alternative means of classification or to stay with the concept of function and disability. Alternative methods of classification are either broadly or narrowly focussed.

Coeliac disease (CD) is a syndrome caused by damage to the small intestinal mucosa caused by ingestion of gluten in wheat and other cereals in genetically susceptible people. In recent years, there is increasing recognition of the broad spectrum of clinical and histological features associated with gluten sensitivity. CD can present at any age.

Little is known about the frequency of headache in the elderly population as few epidemiological studies have been carried out. In one year in the USA, 70% of the general population had a headache, 5% of whom sought medical attention. In a large population-based study carried out in East Boston, US, some 17% of patients over 65 yrs of age reported frequent headache, with 53% of women and 36% of men reporting headache in the previous year.

Use of the term frailty in the medical literature has increased significantly in the last 20 years. A MEDLINE search using the combined terms ‘frail’ and ‘elderly’ yielded 473 articles published between 1996 and 2001, compared with 85 between 1980 and 1985. This increasing interest in frailty has been fuelled by evidence that the ‘frail elderly’ are the group most likely to benefit from geriatric intervention programmes and by the close links between frailty and longer hospital stays, nursing home utilization and mortality.

The term counselling is a nebulous one. For the purposes of this paper it refers to a therapeutic approach that places value on the person’s subjective experience and challenges the person to accept responsibility for his or her own life. The relationship that develops between counsellor and client can foster personal growth. The overall aim is to provide an opportunity for the client to work towards living in a way he or she experiences as more satisfying and resourceful. Counselling may be concerned with addressing and resolving specific problems, making decisions, coping with crises, working through conflict or improving relationships with others.

Alzheimer’s disease (AD) is an international problem of enormous significance. The human and financial cost to the sufferers, their families and friends is huge, matched by the costs to health and social services in all developed countries and, increasingly, elsewhere.

Foot problems are common in elderly people and healthy feet are recognized as a key factor in maintaining activity and independence. People aged over 75 years exhibit a greater degree of foot pathology than a younger population and foot pain is prevalent in a high percentage of elderly patients. Foot problems impair mobility in many older people and may also contribute to falls. The immobility that results from a local foot problem can have a significant impact on the patient’s ability to maintain life as a useful member of society and has been identified as a common cause of unreported disability, often accepted as an accompaniment of the aging process. With increasing age, many foot problems which may have been well compensated for earlier in life will begin to reduce an elderly person’s mobility and health-related quality of life.

Elderly people and their carers are not homogeneous groups, but are highly diverse in terms of their age, ethnicity, income, housing, education, geographical location and access to providers of health. In planning provision, particularly respite care, we need to focus attention on the needs and preferences of those who are not currently receiving help, as well as on the satisfaction with existing services of those who are. There been evidence for some years, for instance, that those in rural areas have different needs from those in urban areas.