Involuntary movements become increasingly common with age and often lead to considerable disability, handicap and social embarrassment. Many causes of involuntary movements can be readily treated once the correct diagnosis is established. Getting the diagnosis right in older people is often challenging even for specialists. Even the identification of conditions thought easy to classify in younger people, such as Parkinson's disease, can be very difficult in older adults. This burden of movement disorder in older people reflects the increasing prevalence of neurodegenerative and vascular disease with age as well as the growing exposure to medication and the natural history of conditions such as essential tremor, which tend to worsen with age and precipitate medical presentation later in life. A complex and poorly understood relationship exists between motor control, disorders of mood and cognitive function. In older subjects involuntary movements are often associated with gait abnormalities and poor mobility and falls may be the presenting feature.

Ethics increasingly becomes a forefront issue in health care decision-making, as health care becomes more technologically and organizationally complex. Hence, a great number of new laws on the status and rights of patients and professional codes have been adopted in Europe. However, research suggests that violation of patients’ rights of autonomy, informed consent and privacy may still be common, especially in elderly care.

Darwin described how animal populations have two adaptation strategies: natural selection based on genetic variation acting over many generations, and developmental plasticity acting within the lifetime of an individual. The contribution of these processes can be difficult to distinguish at the individual level, and the relevance of human developmental plasticity to aging and health in later life is only now being recognized. The formal definition of developmental plasticity is ‘the ability of a single genotype to produce more than one alternative form of structure, physiological state or behaviour in response to environmental conditions’. As an alternative to adaptation to changing environments through genetic diversification, living things have evolved plastic responses. This enables the production of phenotypes that are better suited to their environment than would be possible if the same phenotype was produced regardless of environmental conditions

It is clearly established that older people suffer a high rate of disease related to medication. Probably the major reason for this is that older patients are prescribed more drugs than younger people and the rate of prescribing appears to be increasing all the time. In the UK, data are currently collected on all prescriptions dispensed and this shows that older patients (aged over 65 years) receive 35-40% of all drugs prescribed. Between 1977 and 1988, prescription items increased by 17% overall, but by 52% in people over 65 years. compared to only 1% in adults under 65. Prescription rates are rising for a number of reasons, including new advances in therapeutics, a rapidly enlarging older population, moves to treat older patients more effectively (i.e. a less agist policy), rising patient expectations and defensive medical practice.

Falls have always been a major health issue for older people, but over the past few years there has been an explosion of interest in their prevention. We are now at the challenging stage of incorporating best evidence into routine clinical practice. This has been recognized by the UK government in its National Service Framework for Older People in England, which has set targets to reduce the number of falls that result in serious injury, and to ensure effective treatment and rehabilitation for those who have fallen.

Cognitive impairment is one of the major health problems facing elderly people in the new millennium. This does not only refer to dementia, but also to lesser degrees of cognitive deficit that are associated with a decreased quality of life and, in many cases, progress to dementia. Some studies suggest that delaying the emergence of dementia for a few years would result in a considerable decrease in the human and economic burden related to the condition.

The National Service Frameworks for Older People and for Mental Health are setting standards for services in areas where problems are complex and solutions limited. Primary Care Trusts seeking to raise the quality of primary care for older people and commission specialist services rationally face many challenges. Specialists in old age medicine and old age psychiatry will find themselves working closely with primary care practitioners to develop services and extend professional skills, for it is uncertain that specialist services will be able to deal with the scale of the clinical and social problems unaided.

The purpose of this review is to explore the evidence currently available and to identify the framework within which to consider bladder and bowel emptying problems following a stroke. The author was a member of the Intercollegiate Working Party for Stroke Continence Subgroup that reviewed the evidence for the National Guidelines. The review is based on the author’s personal knowledge of published and unpublished work. References in large textbooks and in the landmark papers were checked and a Medline search was performed using the terms stroke, cerebrovascular disease, incontinence and constipation.

For each person the experience of aging highlights special concerns: Will it be possible to be happy in later life? How can this goal be attained? Is it worthwhile striving to remain youthful, without taking advantage of the experience offered by other stages of life?