In his book ‘Effectiveness and Efficiency’ Cochrane drew attention to the need to evaluate the effectiveness of health service intervention. Despite his plea for more evaluative research in health services, it has been suggested that only 20% of health care interventions have been rigorously evaluated. Changes in the structure and philosophy of the NHS in the past decade have stimulated interest in the evaluation of health services interventions at both local and national levels.

There are two black boxes. One is Pandora's, stuff of myth and legend, and remembered for releasing into the world all its cares and troubles, leaving only hope behind in the bottom of the box. The other, more recent and less mythical, is the in-flight recorder, used to monitor the events in an aircraft's flight, for later analysis in case of difficulty. Both these boxes have their analogy when we consider the role and current state of rehabilitation research in physiotherapy.

Important and common syndromes of old age, such as dementia, parkinsonism, falls, depression, and urinary incontinence, may be associated with vascular pathology affecting subcortical brain structures. The advent of neuroimaging has brought this more to the attention of clinicians and researchers, with increasing evidence that the common findings of white matter change, and small lacunar infarcts are not entirely benign, as previously assumed. Such lesions are common in elderly populations: only 5% of 1077 subjects aged between 60 and 90 from the Rotterdam study were found to be completely free of white matter lesions. Even in otherwise healthy elderly people, such lesions may impact on cognitive and physical abilities.

Prostate cancer is the most frequent tumour diagnosed in men, especially in older people. Radical prostatectomy is the treatment of choice for this disease, but is also the main cause of stress urinary incontinence in men by iatrogenic injury. This procedure is performed far more frequently now than 10 years ago, so the incidence of post-prostatectomy incontinence (PPUI) has increased. PPUI has a detrimental impact on a patient's quality of life and is a significant problem that needs to be solved. The artificial urinary sphincter is still the gold standard treatment for PPUI. In recent years, less invasive approaches such as suburethral slings have been used with promising results. The selection criteria and most appropriate choice of device for the treatment of PPUI are not well standardized. In this review, the different forms of assessment and management of PPUI will be discussed.

Myopathy is a convenient shorthand term meaning muscle disease or dysfunction. In other words, the myopathies are those conditions in which the patient's symptoms and signs can be attributed to a pathological process affecting either the structure of muscle fibres or their associated interstitial tissues, or to disturbance of the biochemical or electrophysiological function of those fibres. Myopathies are rare in all age ranges. They may be inherited or acquired. Onset of inherited myopathies in elderly people, not surprisingly, is uncommon, but some of these diseases are asymptomatic, or cause such minor symptoms that their significance is not appreciated by the patient, and thus they may not be recognized until late on in life. Their recognition may have implications for other, younger, family members. Many of the acquired myopathies afflicting older people are treatable, but the commonest, inclusion body myositis, is not, and incorrect diagnosis and inappropriate use of steroids may compound morbidity.

Chronic kidney disease prevalence will continue to rise due to increased life expectancy and population ageing. It is likely that the decline in glomerular filtration rate with increasing age represents a renal manifestation of widespread vascular disease. In addition to its associated cardiovascular risk, chronic kidney disease in older people is associated with increased prevalence of geriatric syndromes such as functional and cognitive decline, which lead to disability and frailty. Competing risks for mortality, because of the co-existence of multiple co-morbidities in old age, means that the majority of older people with chronic kidney disease will not progress to end-stage renal disease. Management of chronic kidney disease in older people is complex and an individualized and holistic, rather than disease-orientated, approach is necessary, which takes into account patients’ priorities and wishes, especially frail and very elderly populations with multiple co-morbidities.

Acute heart failure is a highly prevalent geriatric syndrome presenting one of the most frequent reasons for visits to the emergency department and hospital admission, and is associated with a high morbidity and mortality and acute functional impact. The present study reviews some of the features that characterize diagnosis and immediate management of acute heart failure in older people, as well as recommendations about the management of co-morbidity, risk stratification and the decisión-making process, and the design of care plans in this older age group within the setting of hospital emergency departments.

Symptoms of thyroid disease in older people are often subtle, and in most cases the diagnosis of hypothyroidism is made on the biochemical findings of high thyroid-stimulating hormone (TSH) combined with a low thyroxine (T4) level. However, with the routine use of sensitive assays, a significant number of patients have been identified with elevated TSH but normal T4 level and few or no symptoms. These patients have subclinical hypothyroidism (SCH).

Chronic Heart Failure (CHF) is a disease of older people. The prevalence of the disease increases with age, reaching over 10% in those aged 80 and above. Not only does heart failure carry a burden of mortality worse than many cancers, it also severely impairs function and quality of life and is a leading cause of hospitalization in older people. Heart failure cost the British National Health Service £360 million in 1990–91; the cost is estimated to have doubled in the last decade.

The World Wide Web (WWW) has much to offer clinicians, nurses, scientists and all those concerned with gerontology, including our patients and their relatives. This article reviews the history and structure of the WWW, outlines the basics of how to use it and what is available for the gerontologist. This is not a comprehensive list of all known webpages in gerontology, since this would not be possible, given the ever-changing nature of the WWW. Instead, this article offers a background knowledge and introduction to the types of resources that are available, enabling more productive use of the WWW for finding information in gerontology.

Urinary incontinence is a common and under-reported symptom, affecting one in five people, with a higher prevalence in women and those who are elderly. It can have a major impact on physical health and social activity. Initial assessment to categorize symptom type is the key to guiding further therapy. Non-pharmacological (NP) options are preferred as first-line intervention, and if unsuccessful, are followed by anticholinergics, often in combination with NP options. Surgical intervention must be sought where appropriate. However, NP interventions are often not considered due to uncertainty about the evidence-base, perceived difficulty of application and perhaps a lack of awareness of or access to specialist continence services. This article addresses the first of the barriers, summarizing the evidence for various NP interventions, including lifestyle interventions, physical therapies, behavioural therapies and containment options, enabling the reader to formulate an evidence-based opinion and a pragmatic view on the feasibility, efficacy and applicability of the various NP interventions, without automatic recourse to anticholinergic medication in the first instance.

Orthostatic hypotension (OH) is defined as a systolic blood pressure (SBP) drop of at least 20 mmHg, or a diastolic blood pressure drop of at least 10 mm Hg within three minutes of standing from a supine position. It can be symptomatic or asymptomatic and is a common condition that can affect up to one in three older people living in the community. The prevalence is higher amongst those with Parkinson's disease and, unsurprisingly, amongst those attending a syncope clinic. The aetiology and pathophysiology of OH have been comprehensively discussed in a previous article in this journal.

The development of intermediate care services, aimed predominantly at older people, formed a significant part of the UK Department of Health's National Service Framework (NSF) designed to guide the development of services for older people at the beginning of the 21st Century. The stated intention was to provide a more appropriate environment of care for some of the large number of elderly patients who occupied acute beds ‘inappropriately’. The goal was to prevent unnecessarily extended stay in acute care, to improve the outcome of the transition between acute and community care and prevent ‘excess’ dependence, including unnecessary hospitalization and iatrogenic dependence. Despite such positive statements of intent, the plan to create 5000 intermediate care beds in the UK by 2004 led some to voice concern that this heralded a return to ‘workhouse’ wards. Fears were expressed that patients would experience inadequate rehabilitation and diagnostic failure due to lack of proper assessment.

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.

There is strong indirect evidence that free radical production appears to be an important mechanism of brain injury after exposure to ischaemia and reperfusion. Although significant brain damage occurs during an ischaemic episode, new cerebral damage can occur after reperfusion. One proposed mechanism for the brain damage that occurs during reperfusion involves generation of free radicals. Body defences against free radicals depends on the balance between free radical generation and the antioxidant protective defence system. Many of these protective antioxidants are essential nutrients or have essential nutrients as part of their molecule that has to be obtained from diet.

The cochleovestibular system is unique in that the peripheral labyrinth subserves two senses, hearing and balance, while the central auditory and vestibular connections diverge within the central nervous system and interact with a multiplicity of information from other sensory inputs. During the seventh decade of life, approximately 40% of people in Great Britain have a significant hearing impairment while in the eighth decade of life this figure rises to 60%. By the age of 65, 35% of people have experienced episodes of dizziness and by the age of 80, two-thirds of women and one-third of men have suffered episodes of vertigo. The elderly population is reported to be increasing by approximately 30% every 20 years and the prevalence of vertigo and hearing loss has been reported to rise in parallel with advancing age.