Identifying what makes people vulnerable to developing Alzheimer's disease (AD) is at the forefront of many research programmes, while early diagnosis is the goal in clinical practice. What individuals themselves tell their general practitioners (GPs) is clearly important because these subjective complaints may be a clue that something is wrong. More specifically, subjective cognitive complaints (SCC) may be the first sign of AD in individuals whose cognitive performance on standard neuropsychological tasks is normal for their age. The challenge for researchers in this field is twofold: (a) determining when SCC do or do not predict current cognitive functioning and future dementia; and (b) estimating how relevant they are for patients and their proxies. The current article addresses these issues, while guidelines are also provided in an attempt to help clinicians interpret and make treatment decisions about their patients’ SCC.

Increasingly, the term ‘dignity’ is becoming a part of contemporary discussions of health care. Phrases such as ‘respect for human dignity’, ‘treatment with dignity’, ‘death with dignity’ and the ‘right to dignity’ are so commonplace as to have almost become clichés. This is especially so in the context of older people. In the UK, the NHS Plan uses the term ‘dignity’ on a number of occasions (Chapter 15 is entitled ‘Dignity, security and independence in old age’) and the National Service Framework for Older People explicitly mentions dignity in relation to person-centred care. However, practice has often failed to measure up to this much-cited aspiration.

The increase in the ageing population has generated much interest and research into what constitutes normal ageing. By identifying normal ageing processes it is hoped it will be possible to distinguish risk factors for the development of abnormal or premature ageing.

This review discusses biological, structural and mechanical changes in the cardiovascular system with ageing that are thought to increase the risk of cardiovascular disease with ageing. Contributory factors are thought to be genetic and lifestyle related. Measurements of biological as opposed to chronological ageing such as vascular stiffness are explored as a possible useful predictor of cardiovascular morbidity and mortality, indicating its possible utilization as a non-invasive screening tool in older people.

The identification of those at risk of cardiovascular disease and modification of risk factors may minimize interactions of the ageing process and therefore reduce the incidence of cardiovascular disease within the UK population.

The quality of life (QoL) of older people is of increasing interest in China, due to its ageing population. A systematic review of published QoL studies was undertaken to examine different measurements and related factors of QoL of older people in China. Papers were identified by searching the following electronic databases: Web of Science, PsycINFO, MEDLINE, PubMed, CINAHL, China Academic Journal and VIP Database for Chinese Technical Periodicals. Fifteen studies were included in the review, using eight different QoL measurement tools. Health status, psychological well-being, social well-being, housing and socio-demographic factors were identified as important related factors of QoL. Further studies are needed using valid measurement tools to explore more factors, especially culturally specific contributors, to the QoL of older people.

The use of the term ‘family (informal) carer’, as it is currently conceptualized, is recent and is largely the product of increased attention in the academic and policy literature over the last two decades. Despite their fairly late arrival on the scene, family carers now occupy centre stage in UK government policy, having being described by the Prime Minister, Tony Blair, as the ‘unsung heroes’ of British life, who are essential to the fabric and character of Britain. Such recognition stems from the growing realization that family carers are the lynchpin of community care, providing 80% of all the care needed at an estimated saving to the UK government of some £40 billion annually.

This article provides information about the projected need for specialist dementia care environments in the United Kingdom. It summarizes the adverse effects of poorly designed environments and acknowledges that, despite a range of residential models, none has been shown or agreed to be the best. It considers current efforts in the UK that might influence future care environments positively.

Active lifestyles are associated with better health and lower rates of mortality from all causes. Increasing activity levels also have positive effects on many of the risk factors for developing chronic disease and on mortality rates (see Figure 1).

Evidence to support these claims, at least for middle-aged men, has accumulated steadily over the last 20 years. This review presents evidence that physical activity can contribute to health and wellbeing in old age.

Dysphagia represents a salient concern in many conditions prevalent in older people. There are direct implications for morbidity and mortality. The importance of recognizing and managing dysphagia in hospital and the community also extends to psychosocial impact and quality of life, as well as health, economic and ethical-legal issues. This review outlines reasons for the importance of recognizing and treating dysphagia. It then proceeds to look at recent developments in our understanding of the nature, assessment and management of dysphagia in older people. Whilst there are well-established practices in assessment and management, ongoing work continues to challenge the validity and reliability of many methods. These concerns are covered and directions for future developments highlighted.

The aims of psychosocial intervention for people with early-stage dementia are essentially those of rehabilitation. That is to say, the focus should be an attempt to optimize functioning and wellbeing, and to support the person’s social system, thus facilitating continued engagement and participation. It can be argued that a focus on rehabilitation is consistent with the person-centred approach advocated by Kitwood, emphasizing the potential disabling effects of negative social environments and the importance of attempting to counter the resulting excess disability and thus support the selfhood of the person with dementia.

Salt and electrolyte disturbances are commonly encountered in older patients. A sound understanding of the underlying physiological and pathological mechanisms underpinning the predisposition of older people to the common electrolyte imbalances can help clinicians minimize their considerable associated morbidity and mortality. This review focuses on the more common and clinically relevant salt and electrolyte disorders of older people. The epidemiology, causes, symptoms, diagnosis and treatment of hyponatraemia, hypernatraemia, hyperkalaemia, hypokalaemia and calcium and phosphate imbalance in old age are covered from a clinician's perspective.

Acute stroke is a commonly-used term in clinical practice and in standard texts, but tends to reinforce a widely-held perception of stroke as a short-term condition. Arguably, this brief, time-limited approach to stroke care has become more dominant, with the reliable evidence that hospital-based stroke care, using the model of a stroke rehabilitation unit, confers improved patient outcomes. For patients disabled by stroke, however, the substrate for longer-term problems is obvious, and stroke as a chronic condition is a more helpful and user-centred health care paradigm.

In many developed and developing countries, life expectancy has greatly increased over the last two decades. However, this seemingly favourable change raises new questions concerning the quality of the years of life gained, particularly in the elderly. Do the individuals who escape death accumulate disabilities, sequelae of accidents or consequences of chronic diseases? The concept of disability-free life expectancy, and more widely that of health expectancy, has been developed in order to answer this question.

Insomnia and other sleep disturbances are common in older people, with up to 40% reporting some difficulty sleeping. Insomnia is a syndrome with multiple causes including medications, other illnesses and environmental factors. An accurate diagnosis is needed for effective management. Sleep disturbances are associated with functional and cognitive impairment and excess mortality. Management should initially be non-pharmacological including sleep hygiene education and behavioural therapy. Medications, including benzodiazepines (BZDs), are second-line with little evidence to support long-term usage. BZD usage in older people is associated with a range of disorders including falls, accidents and cognitive impairment. The management of insomnia in specific situations such as residential care, those with dementia and depressed older people can be challenging. Additional research is needed, particularly on the risks/benefit of long-term pharmacotherapy and to determine whether therapy reduces the consequences of sleep disturbances.

A person who has a dropped foot is unable to lift the toes clear of the ground during the swing phase of walking. Such a problem is seen in people who have either a peripheral nerve lesion, as a result of trauma or disease, or an upper motor neuron les ion. It is the latter that responds to neuromuscular stimulation; lesions of the lower motor neurons result in destruction of the neural pathway so that muscle contraction can be achieved only through direct stimulation of the muscle fibres.

Exercise and physical activity are thought to be among the most important lifestyle factors for the maintenance of health and prevention of premature disease and mortality. Yet sedentary lifestyles are common. Many people avoid exercise, and have done so across their lifespan. Exercise and physical activity are also considered important for positive psychological functioning; however, this has received limited research attention. This mini-review discusses the effects of exercise and physical activity on mental health and well-being in later life. It draws on international peer reviewed research, summarized in systematic reviews and/or meta-anlaysis, and presents the key findings. Systematic reviews and meta-analyses generally confirm the importance of exercise for mental well-being; however, there is a lack of good quality research. The review discusses some of the barriers to exercise, and identifies strategies that may facilitate uptake and adherence in later life. Limitations in the current evidence are discussed. Based on the current evidence, it is recommended that health practitioners should encourage exercise or physical activity of low to moderate intensity, and leisure time activity such as walking, especially at retirement. Future intervention research would benefit by focusing on people who have not self-selected into studies so as to understand the causal direction, and include theory driven approaches to behaviour change.