The majority of hospital in-patients are older people, and many of these are at increased risk of readmission, which can be an adverse outcome for the patient. Currently there is poor understanding as to how best to reduce the risk of readmission. We searched MEDLINE, EMBASE and the Cochrane library for high quality review articles about readmissions. Each review was quality assessed by two reviewers. Grouped data and evidence from original papers is cited with 95% confidence intervals when possible. Nine review studies of sufficient quality were included. Two addressed risk factors for readmission, which included: age, poor functional status prior to admission, length of stay during the index admission, depression, cognitive impairment, malnutrition, social support and social networks/support. The seven other reviews addressed interventions to reduce readmission, which included: discharge planning, post-discharge support, post-discharge case management, and nutritional supplementation. It is possible to identify older people at risk of readmission using well-established risk factors; discharge planning, post-discharge support and nutritional interventions appear to be effective in reducing readmission. Combined interventions appear to be more effective than isolated interventions.

For those of us who have been working in the elder abuse movement for a decade or more, progress towards understanding and prevention of elder abuse has been exceptionally slow. This situation may be attributed as much to the complexities of elder abuse as to the importance given to the problem by national governments. However, one trend in the past five years is particularly noteworthy. The increased awareness of elder abuse among the nations of the world, underscored by an ‘“explosion” of interest’ in the UK, has been the most salutary accomplishment. The purpose of this paper is to review the status of the field with specific reference to the past five years. Of necessity, this review is selective and thus may omit worthy research and policy achievements. As with an earlier paper (see Rev Clin Gerontol 1992; 2: 269-76), this review is limited to elder abuse in domestic settings.

The maintenance of independence by older people is seen as a priority by health and social services, and by people themselves. This review explores the constructs of independence and dependence in relation to aging, and considers the ways that discourses surrounding these topics affect our thinking about growing older.

Whilst there is a considerable literature surrounding predictors of depressed mood in stroke survivors, much less research has been directed towards identifying the impact of a stroke on primary informal carers and the nature of the relationship between patient and carer characteristics, stroke consequences and carer distress. This review attempts to elucidate such relationships so that implications for health and social care provision can be drawn.

The increasing number of old people is becoming a growing policy concern. Negative attitudes towards old people raise questions about the extent to which discrimination against old people exists and elder abuse occurs. This paper describes the occurrence of discrimination against old people and elder abuse, as well as the factors related to it, based on a review of (scientific) literature, official documents and the actions of legal bodies.

Frequent or regular age discrimination, as experienced by old people themselves, is reported by a quarter of European citizens. Data on elder abuse vary and are often not representative; the same goes for data on inequality. Nevertheless, the analysis shows that discrimination against old age and elder abuse occurs regularly in the ‘western world’. Vulnerable old people are especially at risk. National and regional, multi-component action plans are recommended to combat discrimination against old people.

A stroke typically results in a variety of impairments that are primarily unilateral, with the severity of symptoms and resultant disabilities dependent on the site and extent of the insult. While the overall goal of rehabilitation after a stroke is to maximize the individual's functional independence at home and in the community, improved walking function is the treatment goal most often stated by patients following a stroke.

This review examines the relationship between unsteadiness, falling and anxiety, and their combined impact on the lives of older people. Over one in four people over 69 fall each year, and a higher proportion of those over 74. Although only one in ten incur serious injury as a direct result of the fall, fear of falling can often lead not only to psychological distress but also to restriction of activity and an unnecessary and undesirable loss of independence. Naturally, symptoms of unsteadiness constitute a key risk factor for falling. As many as one in three older people have suffered from unsteadiness and/or dizziness at some time. Like falling, dizziness and unsteadiness are also associated with distress and restriction of activity.

Obesity is a major public health problem with increasing prevalence worldwide. It is well recognized as a risk factor for cardiovascular morbidity and mortality in adult populations. Obesity prevalence is also increasing with age, and this may be particularly important in an ageing population. Ageing is associated with an increase in visceral fat and a progressive loss of muscle mass. Sarcopenia has been defined as the age-associated loss of skeletal muscle mass and has been associated with metabolic impairment, cardiovascular disease (CVD) risk factors, physical disability and mortality. Sarcopenia is often associated with obesity. Sarcopenic obesity is a new category of obesity in older adults who have high adiposity coupled with low muscle mass. Thus sarcopenia with obesity may synergistically increase their effect on metabolic disorders, CVD and mortality. This review focuses on the effects of sarcopenic obesity on the risk of cardiovascular disease and mortality in older adults.

Dietary, biochemical and anthropometric data indicate good nutritional status, in general, in community-dwelling, healthy elderly people, at least in the USA. In a sample of 209 men over 65 years of age without acute disease-related nutritional risk factors, mean intake of nutrients generally met or exceeded the recommended dietary values, with the exception of calories, although 7% of subjects consumed inadequate amounts of thiamine, vitamin A, vitamin C and calcium. Few subjects were extremely underweight or obese, although body fat, as assessed by skinfold thickness, fell over the two years of evaluation. The prevalence of malnutrition in patients with chronic disease living in the community in the UK is estimated to be around 8%, however. In this study of more than 11 000 men and women aged 18 years or over, consultation rates in general practice and prescription rates were lowest amongst patients with a body-mass index between 20 and 25. Hospital outpatient referral rates were not related to nutritional status, but both hospital admission rates and mortality were greatest in people with a body-mass index(BMI) (kg/m2) below 20, and declined as BMI increased.

Comprehensive geriatric assessment (CGA) has been defined as ‘a multidimensional, often interdisciplinary, diagnostic process intended to determine a frail elderly person’s medical, psychosocial, and functional capabilities and problems, with the objective of developing an overall plan for treatment and long-term follow-up’. Evidence from recent meta-analyses of clinical trials of the effectiveness of CGA programmes suggest that older persons may experience a variety of health benefits from these comprehensive services.

Frailty is a central concept in geriatric medicine, but without a clear definition. Many regard it as a syndrome with its own clinical manifestations and pathophysiology, whilst others consider it to be the result of the accumulation of age-related deficits that predict adverse changes in health. We analysed, through a systematic review, the definitions and markers of the frailty syndrome. Twenty-five articles were included and divided, according to design, into observational, intervention, review and qualitative studies. There was a predominance of operational definitions that used only physical markers to identify frailty. The only qualitative study found that health professionals chose a multidimensional definition that took into account factors other than just the physical. We conclude that there is still no standard definition or agreement about markers of the frailty syndrome.

Patients with difficult venous access or oral intolerance and clinical situations with inadequate response to oral therapy have generated the need for alternative routes of delivery for drugs and fluids.

The purpose of this study was to conduct a systematic review examining the evidence for subcutaneous (SC) administration of drugs and/or fluids.

We used a broad search strategy using electronic databases CINAHL, EMBASE, PubMed and Cochrane library, key terms and ‘Medical Subject Headings’ (MeSH) such as ‘subcutaneous route’, ‘hypodermoclysis’ and the name/group of the most used drugs via this route (e.g. ‘ketorolac, morphine, ceftriaxone’, ‘analgesics, opioids, antibiotics’).

We conclude that the SC route is an effective alternative for rehydration in patients with mild–moderate dehydration and offers a number of potential advantages in appropriately selected scenarios. Experience of administering drugs by this route suggests that it is well tolerated and is associated with minimal side-effects.

This review examines the relationship between dysequilibrium, falling and anxiety, and their combined impact on the lives of elderly people. More than one in four people aged over 69 fall each year, and a higher proportion of those over 74. Although only one in ten incurs serious injury as a direct result of the fall, fear of falling can often lead not only to psychological distress but also to restriction of activity and an unnecessary and undesirable loss of independence. Naturally, symptoms of imbalance constitute a key risk factor for falling.

Falls, once thought to be an inevitable consequence of aging are now known to be the result of multiple pathological, psychological and social factors. Moreover, well-conducted research has shown that they can be prevented. Initially it appeared that multiple interventions by a multi-disciplinary team would be the most sensible and indeed the only effective approach. However, single interventions may sometimes be appropriate and on cost grounds would be preferable, provided that they are effective. This is clearly the case in the use of pacemakers for patients who are falling because of cardioinhibitory syncope. However, home modification, a seemingly obvious and intuitively correct intervention, has not been shown to prevent falls, although advice from an experienced occupational therapist can reduce falls, especially in those who have fallen previously. Whether balance training on its own is effective in reducing falls, or needs to be combined with muscle-strengthening exercises and other interventions, will be examined.

Survival to discharge after in-hospital cardiopulmonary resuscitation (CPR) is about 20% in those aged 65–69 years, declining with advancing age to about 10% in those aged 90 years or more. There are conflicting reports on whether or not advanced age, independent of the severity of acute and chronic illness, is a determinant of outcome. Recognition that the outcome of CPR in hospital patients is often poor has prompted extensive debate regarding the appropriate use of this procedure. In particular, there has been concern about unnecessary CPR in extended-care and hospice settings. Conversely, there has also been evidence that doctors and families may be prone to underestimate the quality of life and likelihood of benefit from CPR in older people and to make resuscitation decisions without considering the preferences of older people themselves. Recent guidelines have attempted to strike a balance between ensuring patient participation whenever possible but without offering illusory choices where CPR is very unlikely to succeed.

This narrative review of hearing, cognitive impairment and aging considers studies reported in English that have used objective assessment or manipulation of hearing and cognitive performance in participants aged 50 years and above. Its purpose is to provide a general overview of an increasingly technical literature. The lower age limit is arbitrary. For the present purpose, hearing is defined as the detection and interpretation of auditory stimuli, and cognitive impairment is defined as implicit or explicit decline in cognitive function. Existing general overviews of the area are not current, whilst more recent reviews tend to be fairly specialist in scope.

The proportion of older people becoming frail will increase with the expanding older population. Apart from poor health, frailty is associated with loss of strength and functional dependency. Building on previous work in this area, this review investigates the effectiveness, sustainability and adverse effects of exercise interventions on muscle strength and physical performance in frail older people. Randomized controlled trials reporting physical outcomes in frail older people were identified from seven electronic databases. Thirteen trials involving 1652 participants met the inclusion criteria. There was wide heterogeneity in degree of frailty, types of intervention, outcome measures and results. However, evidence from this review suggests that exercise and some physical activity programmes, particularly moderate intensity and multi-component programmes, are safe and can improve strength and function in the majority of frail older people except highly frail individuals with multiple co-morbidities. There was limited evidence on transferability of improvements into everyday life, and sustainability could not be determined.