Peripheral neuropathy encompasses disorders of the peripheral nervous system, affecting the axon and/or the myelin sheath. The prevalence of peripheral neuropathy increases with age. Thought to be of about 3000 per 100 000 in adults generally, this figure could be as high as 8000 above the age of 60 years. However more than half of these cases would be due to impaired glucose metabolism in its various forms. In the remainder, an aetiology may be found in about 70% of cases. The elderly population is at higher risk of peripheral neuropathy, as there is a correlation between age and impairment of the peripheral nervous system. The natural aging process affects adversely the function of peripheral nerves and of their target organs, resulting in the development of motor, sensory and autonomic symptoms in the absence of additional damage of other causes. In addition, the increased prevalence of chronic systemic disorders causing neuropathy, as well as the use of neurotoxic drugs in older patients, contribute to the onset of neuropathy.

This research paper is a realist review on the effectiveness of medical care for older people in the geriatric day hospital (GDH), based on trial data from a Cochrane review published in 2008. The Cochrane review indicated no overall difference between GDH care and alternative services. However, health care management and policy interventions are quite complex and methodologically more diverse than clinical treatments. Hence a ‘realist review’ is a more suitable explanatory analysis, aimed at discerning what works for whom, in what circumstances, in what respect, and how. This realist review on GDH care provides an explanatory analysis and has aimed to identify where GDH care is and is not effective.

Phosphate (PO4−) has a number of important functions in the human body and abnormalities of phosphate handling and phosphate levels are common in older people. We review the physiological functions of phosphate, the effects of phosphate deficiency and excess, and discuss the evidence underpinning management of these conditions in older people. Both hyper- and hypophosphataemia have been associated with a variety of adverse effects in different patient groups. There is currently little evidence to guide practice in treatment of abnormal phosphate levels specifically in older people. Studies looking into the effect of replacing phosphate on morbidity and mortality in milder cases of hypophosphataemia and into the dangers of, and treatment of, hyperphosphataemia in older people are required.

Many viral infections that cause minor illness in younger adults can lead to significant mortality and morbidity in older people, particularly as co-morbidities tend to accumulate with increased age. Respiratory and gastrointestinal viruses are ubiquitous and frequently cause outbreaks, with major impact on those in care homes or residential accommodation. Advances in medicine have opened the way for increased impact of the herpes viruses (varicella zoster virus, herpes simplex virus, Epstein–Barr virus and cytomegalovirus), as immune systems are manipulated. People are also leading more active lives in older age; human immunodeficiency virus (HIV) will be increasingly prevalent, as those living with HIV grow older in good health. In addition, new diagnoses of HIV, viral hepatitis and travel-related infections will present to those working in health care of older people. This review article of viral infections aims to highlight relevant pathology, with specific reference to management in older people.

Complementary medicine (CM) can be defined as 'diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine'. It has become a hotly debated subject, mostly because many physicians remain sceptical about its usefulness while consumers vote for it with their feet and their purses.

Stroke is a distressing event and in the western world it ranks in the top three leading causes of death in adults. The number of stroke survivors is increasing because of the improvement in the management of acute stroke. This has resulted in a larger group of patients with important residual physical and psychological impairment. The four major categories of cerebrovascular disease are atherosclerotic thrombosis, cerebral embolism, lacunae and intracranial hemorrhage. In this review, as in other published studies, all categories are defined as a stroke.

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.

Small intestinal bacterial overgrowth (SIBO) is a condition in which non-native bacteria and/or native bacteria are present in increased numbers in the small bowel, resulting in excessive fermentation, inflammation or malabsorption. Patients with SIBO vary in presentation, from being only mildly symptomatic to suffering from chronic diarrhoea, weight loss and malabsorption. A number of diagnostic tests are currently available, with aspiration of the small intestinal fluid being the gold standard. Treatment encompasses a multimodal approach including treatment of the underlying disease, nutritional support and antibiotic therapy. In this review, we discuss the risk factors, clinical manifestations, diagnosis and treatment of SIBO in older people.

Key strands in developing future services in geriatric medicine in Wales have been the 2000 ‘Review of Health and Social Care in Wales’ by Sir Derek Wanless, the Welsh Assembly Government document ‘Designed for Life’ of May 2005, and the National Service Framework (NSF) For Older People in Wales (published in March 2006). The common theme in these documents is for older people's health and social care issues to be managed nearer to their home, in the community. At present, the development of Intermediate Care Services has been ‘hit and miss’ – fragmented, unevenly developed and delivered with poor integration into mainstream services. The Academy of the Royal College's Medical Aspect of Intermediate Care identifies the lack of specialist medical input as being one of the reasons for the failure of development of Intermediate Care Services. It recommended that geriatricians should be encouraged to undertake well-defined roles in community work in planning and delivery of Intermediate Care Services.

Chronic obstructive pulmonary disease (COPD) is the fifth leading cause of mortality in the USA. For 1984 to 1993, among Canadian seniors aged over 65, COPD was the fourth cause of mortality in men and the seventh in women. Though the underlying pathology is initially confined to the lungs, the associated physical deconditioning and the emotional responses to chronic respiratory disease contribute greatly to the resulting morbidity. Increased shortness of breath leads to inactivity and consequent cardiorespiratory and muscular deconditioning, which in turn leads to further inactivity, social isolation, fear of dyspnoea and depression. Respiratory rehabilitation may offer a way to break this vicious circle.

Over the last few decades, the prevalence of chronic renal impairment has increased throughout the population, especially in the older age group. This is not just a consequence of the general increase in longevity, but is also caused by a higher incidence related to improved survival of patients with chronic diseases affecting renal function, such as diabetes, hypertension and ischaemic heart disease, and improved survival of patients with established renal failure.

There is overwhelming evidence to suggest that the neuropathology of Alzheimer's disease (AD) extends beyond amyloid plaques and neurofibrillary tangles. There is a clear overlap between the pathology of AD and vascular dementia (VaD), but the relationship is different for different types of vascular lesion. Cerebral amyloid angiopathy (CAA) and degeneration of the microvasculature are probably intrinsic to the AD process, whilst ischaemic white matter disease and areas of infarction are largely independent of AD pathology, but result in additional cognitive deficits and reduce the threshold of AD pathology necessary for the emergence of a clinical dementia syndrome.

The publication of the Black Report in 1980 is rightly seen as a landmark in the acknowledgement of an association between poverty and increased incidence of and premature mortality from a wide range of diseases. However, an increased incidence of disease with certain lifestyles or habits has been recognized since the time of Hippocrates, who identified ‘the mode in which inhabitants live, and what are their pursuits, whether they are fond of drinking and eating in excess’ as determinants of illness.