In their summary of changes in renal function with age, Porush and Faubert do not mention one of the most troublesome and least understood: the reversal of the circadian rhythm of water and electrolyte excretion. Young adults normally excrete the greater part of their 24-hour urine volume during the day and have a low night output. This rhythm has been shown to weaken by the age of 50 years and to be lost or apparently reversed by the eighth decade. Increased urine production is probably the principal cause of the need to get up at least once at night experienced by practically all elderly people. Together with bladder hyperreflexia, it is also an important cause of nocturnal incontinence.

‘Cerebral small vessel disease’ is common in older adults and is an important cause of morbidity, functional impairment and cognitive decline. Small vessel disease is a collective term used to describe a number of underlying pathological processes and neuroimaging findings, such as lacunar infarcts, white matter lesions and microhaemorrhages.

With readily available neuroimaging, diagnostic accuracy has improved; however, the management of small vessel disease and prevention of cognitive decline remains uncertain. Treatment of conventional vascular risk factors may be appropriate, but future research is required to provide definitive answers. We have conducted a comprehensive literature review of cerebral small vessel disease in older adults. This highlights the clinical sequelae and underlying pathological processes, whilst discussing novel diagnostic neuroimaging and therapeutic strategies.

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 prevalence of undernutrition in older individuals, living independently in a community setting, or living in a supported setting, is considerable. The negative health effects of undernutrition are wide ranging, with implications for quality of life (QOL), well-being and general health, through to the individual's ability to recovery from acute disease. There are a number of key measures that indicate both nutritional status and the effectiveness of any intervention. These include conventional anthropometric and biochemical measures of nutrient status, as well as measures of QOL, well-being and depression. The latter have huge importance to the life of the individual, and to date appear to have undergone only preliminary investigation. This review suggests that the efficacy of interventions to address undernutrition and improve health in older people living in a variety of settings is highly variable, and that considerable opportunities for research in this area exist.

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 the elderly, 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 the elderly are treatable, but the commonest, inclusion body myositis, is not, and incorrect diagnosis and inappropriate use of steroids may compound morbidity.

Population aging is conventionally understood to refer to increases in the percentage of the population aged 65 and over. Developed economies have for some time shown evidence of this and it is projected that they will continue to experience aging over at least the next 20 years. As the population ages, so the level and pattern of demand for health care is likely to change, and difficulties in financing care to increase. Older persons, for example, tend to consume more health care than those in younger age cohorts, as well as different types of care (for example more long-term care). By the same token, older persons (who are often retired) tend to have less income than those in younger age cohorts. A consequence of this is that they are less able to meet the costs of health care directly (i.e. out of pocket) or contribute through direct taxation to meeting the costs of publicly funded health care. These two factors – growing demand and diminishing income among those for whom demand is expanding – will present challenges to the future finance and delivery of care.

This review discusses the role that the APOE gene plays in cognitive dysfunction both in demented and non-demented elderly people. The increasing problem of cognitive impairment in developed countries makes finding new and effective treatments a research priority. Understanding the biological basis of this impairment is therefore paramount. APOE has received much attention in the field of cognitive genetics due to it being a major susceptibility gene for Alzheimer's disease, which itself is characterized by a rapid and irreversible loss in memory function. Over the past 14 years this has generated a considerable number of publications that have produced conflicting findings, making it difficult for the reader to interpret whether the APOE gene regulates cognition or not. This review attempts to summarize the mass of information on this gene in relation to cognition, by weighting the pros and cons of the methodologies used, and offers suggestions for future study designs.

At times providing pain relief in elderly patients can prove troublesome. Their tolerance and perception of pain can differ from that of younger patients, while the incidence of pain is above that found in those of less advanced years.

Conventional approaches to providing pain relief can be successful, but the tolerance to the side-effects of those drugs used to provide pain relief can be less. Furthermore, polypharmacy can have implications for the range of analgesic drugs that can be considered. Fortunately there are an increasing range of medicinal products with reduced potential for side-effects that can be considered when treating older patients with pain.

The prevalence of obesity is increasing, both in developed and developing, countries. Since obesity is a major factor in the pathogenesis of chronic diseases including type 2 diabetes and cardiovascular disorders, the dramatic increase in obesity prevalence in recent years has major implications for the health of individuals and for the health economy. The number of aged individuals and their longevity is also increasing. Age is a major factor in the pathogenesis of chronic diseases.

‘Syncope’ is derived from the Greek words ‘syn’ (meaning ‘together’) and ‘koptein’ (meaning ‘cut’). It is a syndrome characterized by transient loss of consciousness resulting from temporary and self-limited cerebral hypoperfusion, most often the result of systemic hypotension.

Successful aging seeks to counteract and replace the old ‘decline and loss’ paradigm that views aging as a series of individual decrements or losses to which both older people and society needed to adapt or adjust. This new gerontology, based on the concept of successful aging, adopts a preventive model: modify individual behaviours throughout life in order to avoid the decrements and losses. Research has led to the development of a variety of models for successful aging, which share the fundamental assumption that successful aging is a result of a lifelong developmental process that involves the combination or interaction of traits or predispositions present at birth or in early life and cumulative life experiences. Successful aging builds on a life history of successful adaptation, which in turn, is a result of interactions among inherited and learned personality attributes and levels of adversity or advantage and resources. Research driven by the successful aging theorist is turning attention to the development of indicators that might explain and predict successful old age. A number of factors are already well known to promote well-being, for instance regular exercise, cognitive stimulation, friendship and the presence of a confiding relationship. However, little is known on how persons from different age groups perceive the preparation of a good old age. In this exploratory study we attempt to expand this topic, since it will allow the understanding of how these perceptions can influence, in a positive or negative way, the achieving of a good old age.

Meta-analyses of randomized controlled trials have reported the efficacy of dose-adjusted warfarin therapy (target International Normalised Ratio (INR) 2–3) in reducing stroke risk in atrial fibrillation by 68%, with aspirin reducing relative risk by 22%. Absolute benefit for an individual patient depends on the presence of the risk factors for stroke; these include previous stroke, transient ischaemic attack, hypertension, diabetes, valvular heart disease, heart failure and advanced age. In spite of reported benefit, many people with atrial fibrillation and a high risk of stroke are not receiving anticoagulation: disappointingly, risk stratification is not being sufficiently used to guide treatment.

Constipation is a common complaint in geriatric patients, especially when older people are asked specifically about their bowel habits. It can cause serious complications, such as recurrent urinary tract infections, urinary incontinence, faecal incontinence and even bowel obstruction and perforation. As a result of the tremendous advances in understanding of the epidemiology and pathophysiology of constipation in the older patient, the definition of constipation has changed considerably, leading to the development of new treatment options.