This paper reviews the handling of water and electrolytes by the ageing kidney and the clinical consequences in everyday clinical practice. Normal physiology in the adult kidney is discussed, followed by description of the main physiological changes (adaption) that occur as the kidney ages. Clearly, successful management of the elderly patient requires a knowledge of these changes, which result in: (i) increased tendency for volume depletion and dehydration; (ii) decreased ability to tolerate a volume load; (iii) increased propensity for potassium disturbances (hypo- and hyperkalaemia); (iv) diminished production of renin and blunted physiological response to the effects of aldosterone and antidiuretic hormone; (v) increased tendency to lower levels of phosphate; and (vi) tendency for the development of hypocalcaemia and hypomagnesaemia. A brief review of the role of extracellular fluid volume depletion and other factors contributing to acute renal failure in elderly patients is also presented.

Nursing homes and long-term care facilities are usually considered as reservoirs for methicillin-resistant Staphylococcus aureus (MRSA) carriers. Actually, there are major differences in MRSA carriage between institutions, with variations from 1% to more than 30%. Overall there is a low incidence of MRSA infection in these institutions, even though carriage is associated with a higher risk of subsequent MRSA infection, with high mortality rates. The main risk factors for carriage are well known: recent hospitalization in an acute-care ward, skin wounds and recent antimicrobial therapy. Age over 75 years is also a risk factor. Residents of nursing homes and long-term care facilities pose a risk of MRSA transfer to acute-care wards, with potential consequences in terms of infection control strategy or surgical antibiotic prophylaxis. No well-designed study has identified the best strategy for MRSA control in institutions for older people and strategies that have been proposed are controversial. Studies to elucidate this would be useful, as well as studies specifically designed to identify the relative importance of different ways of MRSA transmission in these institutions (cross-transmission via healthcare workers or the environment, or direct transmission from one resident to another). Finally, a first important step towards MRSA control is a strict application of standard precautions, particularly good compliance with hand hygiene.

The prevalence of type 2 diabetes is set to increase, and with it the complications associated with diabetes. Since 2007 there have been a number of significant trials that may change the way we think about treating people with diabetes, especially our older patients. These trials include the Steno-2 trial, UKPDS legacy trial, ADVANCE, ACCORD and VADT. These trials are reviewed in detail in this article, including the implications for the patients we treat. Recent work assessing the effect of HbA1c on cognitive function and the effects of hypoglycaemia are also discussed. We conclude with suggestions for targets for glycated haemoglobin level based on NICE guidance.

People with dementia are particularly vulnerable to abuse. It is inherently difficult to study as it is a hidden offence, perpetrated against vulnerable people with memory impairment, by those on whom they depend. In the general population, 6% of older people have experienced abuse in the last month and this rises to approximately 25% in vulnerable populations such as people with dementia. We know that various factors in the carer and the care recipient can predispose to a higher rate of abuse and this knowledge can be harnessed to try and improve prevention. There are also valid and reliable scales available to help detect abuse in vulnerable older adults. All health and social care professionals have a responsibility to act on any suspicion or evidence of significant abuse or neglect in order to ensure that appropriate management is taken.

The status of the geriatric day hospital within the National Health Service (NHS) in the UK has changed significantly over the past fifty years. We conducted a literature review starting from the inception of the geriatric day hospital, when it was viewed as the ‘shop front for geriatric services’ and was subsequently replicated in many western health systems, to the present uncertainty surrounding the model in terms of outcomes and cost effectiveness. The article also highlights the input of the Royal College of Physicians and the British Geriatric Society to the management and development of day hospitals. The geriatric day hospital has become one of the many service models under the umbrella of intermediate care services, offering comprehensive geriatric assessment and care to older people in the community. However, with the current practices of commissioning of services and ‘payment by results’, the future of this precious health resource remains uncertain.

Loneliness and social isolation are two core concepts regarding social relationships in human life that are particularly relevant in old age. This article focuses on the prevalence of loneliness in a community sample of 1266 autonomous people aged 50 or more and on the structural circumstances (demographic social network and general health condition) that could better contribute to its experience. The prevalence of loneliness was 16.3% (n = 206) and a small number of people presented low social network (7%). Predictors of loneliness (explaining 29% of variance) were being widowed, perceiving own health as poor or very poor, and having psychological distress and cognitive impairment. The authors emphasize the importance of psychological distress as a predictor of loneliness and the need for social and psychological interventions to prevent its consequences in morbidity and mortality.

Falls have a significant impact upon independent living ability in older people, with fall-related fractures one of the leading predictors of having to move into assisted living facilities. The loss of independence associated with a severe fall is often accompanied by a decline in physical, social, emotional and economic well-being. Rehabilitation programmes to restore functional ability following a fall have a greater chance of success if they adopt a multi-disciplinary approach and, if appropriate, are conducted in the patient's own home. Additional multi-component interventions that improve confidence and reduce the risk of subsequent falls may confer benefits by assisting individuals independently to perform activities of daily living.