Coronary artery disease is extremely common among elderly people and accounts for half of all deaths in those who are more than 65 years old. Although the condition is essentially the same as that encountered in younger patients, the management of coronary artery disease in elderly subjects can be difficult because the anticipated benefits and risks of the various treatment options are often altered by the presence of co-morbid conditions. Moreover, the results of the major outcome studies that underpin most treatment guidelines may not be relevant to the needs of many elderly patients for several reasons.

Telomere length is a reflection of cumulative oxidative and inflammatory stress throughout the life course, as well as oestrogen exposure. There is evidence that telomere length is associated with lifespan; however, it does not appear to be a better indicator of biological age than chronological age, even though it can be considered a biomarker of ageing. There are studies showing association between leukocyte telomere length and many of the common diseases of ageing, lifestyle factors and socioeconomic status. However, the associations are less marked among older people. Research in the area of manipulation of genetic control of telomerase activity controlling telomere length may have clinical applications in future.

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.

Malnutrition is common in older people and is associated with a number of adverse outcomes. We review the evidence for the effectiveness of nutritional supplementation for older people in the community, in institutional care and following discharge from hospital. Studies in these settings are scarce, often include only small numbers of participants and are of variable quality. The interventions used are heterogeneous and difficult to directly compare. Oral nutritional supplements (sip feeds), dietary fortification, educational programmes, exercise, flavour enhancement and meal setting have all been studied. Evidence for use of oral nutritional supplements as sip feeds in undernourished community-dwelling and institutionalized older people and in those discharged from hospital is currently insufficient to recommend routine use. Flavour enhancement and more sociable meal environments may be beneficial. Further, more methodologically robust research is needed to clarify the effect of these interventions.

Frailty as a clinical syndrome is becoming more widely recognized and current evidence shows the importance of early detection of pre-frail states with a potential for reversibility of poor outcomes. The purpose of this review is to present the latest literature on frailty since the last review in this journal in 2007, with a particular focus on interventions aimed at reversing the processes of frailty.

The world population is aging rapidly. The post World War II ‘baby boomers’ have benefited from improved medical science, sanitation, political freedom, and social and economic development, resulting in the knock-on demographic trend of an aging population. From a health-economic perspective, this places increasing demands on society and on health services to meet evolving medical and social needs. By 2025, over 30% of the populations of developed countries will be aged over 60 years (US Bureau of Census 2004).

Urinary incontinence is a common problem, more so in older people and those in residential or nursing homes. Guidelines promote a structure to the management of incontinence, recommending non-pharmacological measures (including continence aids) as first-line options. Anticholinergic medications are used widely for urge incontinence, and surgical measures employed in selective cases.

Whilst other treatments are being tried, or where incontinence is refractory to treatment (about 30% of cases), it is important to promote continence or contain incontinence with continence aids in order to minimize psychological complications. What can be a bewildering array of aids is available and choosing the right type of aid requires knowledge of these. Here, we suggest a classification of continence aids, describing individual characteristics and appropriate situations for use.

Stroke and coronary heart disease (CHD) share many risk factors, suggesting at least some similarities in pathogenesis. It is therefore surprising that the role of one of the major risks for CHD, dyslipidaemia, remains so contentious as a risk factor for stroke. Because of a lack of good clinical trials, conflicting views have been expressed on the association of lipids, primarily serum cholesterol and its subfractions, with stroke disease and the merits of preventing stroke by lowering cholesterol. Many of the issues involved are intimately related to those of managing dyslipidaemia in the elderly. If stroke occurred as commonly below the age of 65 as above this age it is likely that the necessary epidemiological and intervention studies would already have been undertaken.

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.

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.

Good quality research on grief and bereavement has flourished in the last decade. Until now, relatively few studies have studied grief specifically in an older population. However, a series of papers arising from the Changing Lives of Older Couples (CLOC) study carried out at the University of Michigan have clarified the mechanisms of psychological and social adjustment to spousal bereavement in a population of older people. The last five years have witnessed the replication and refinement of the University of Pittsburgh group's research on the important concept of complicated or ‘traumatic’ grief, which was highlighted in the last review of this topic in this journal. Major reviews on social support after bereavement and on treatments for grief symptoms have been published, and guidelines written on the management of the bereaved in a general hospital setting. This review will attempt to summarize the main themes from these and other important recently published papers in this area.

Depression in old age is common, disabling and undertreated. This review will examine recent advances in our understanding of its clinical presentation, epidemiology, management and prognosis. The relationship of depression in old age with dementia and with physical illness is also discussed, as are the links between suicides, deliberate self-harm and depression in old age.

Seasonal influenza remains a common cause of morbidity and mortality for older residents in aged care facilities. Whilst prevention is best managed by high vaccination rates for the general population, residents and aged care facility staff, new research suggests that a more active approach to surveillance and anti-viral treatment now plays an important role. The practicalities of managing an influenza outbreak are complex and best planned in advance with written protocols available. Good infection control remains a vital part of prevention and outbreak control.

This paper will review some fundamentals of normal renal physiology necessary to understand the changes occurring with age and enable the reader to distinguish between chronic renal insufficiency and the consequences of normal ageing on kidney function.

Traditional clinical review articles, also known as updates, differ from systematic reviews and meta-analyses. Systematic reviews comprehensively examine the medical literature, seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment. Meta-analyses, sometimes known as quantitative systematic reviews seek to answer a narrow clinical question, often about the specific treatment of a condition, using rigorous statistical analysis of pooled research studies. Updates review the medical literature almost as carefully as a systematic review but discuss the topic under question more broadly and make reasoned judgements where there is little hard evidence, based upon the expertise of the reviewer. It may not include evidence from foreign language journals or look for unpublished data on a topic, so will tend to be more applicable to the local situation than a systematic review, as it may take into account local shortages of equipment or personnel.

If we can better understand why people kill themselves, it should be possible to reduce suicide rates. The major aim of this article is to consider whether any factors associated with higher rates of suicide in old age are amenable to preventive interventions.

It is said that epidemiology is the basic science of prevention. Multiple interacting factors contribute to the causation of suicide, though commonly, in the individual case, a single circumstance or condition can be identified as the major precipitant of suicidal behaviour. Cross-sectional studies may reveal factors that correlate with high suicide rates in particular populations, while long-term studies can show associations between changes in suicide rate and in socio-environmental conditions.

Dementia with Lewy bodies (DLB) is being increasingly recognized as a common cause of progressive cognitive decline in the elderly, with hospital-based autopsy series demonstrating rates of between 7% and 25% of all cases of dementia, second only in frequency to Alzheimer's disease (AD). Although DLB has only recently been described, it is unlikely to be a newly occurring disease but one which has become identifiable as a result of advances in neuropathological techniques which make cortical Lewy bodies (LBs) easier to detect.