This article provides an overview of spine surgery in older people and reviews outcome and novel techniques. Improvements in pain, disability, and quality of life can be expected following surgery and demand for surgery of this type is likely to increase as the mean age of the population increases. Novel techniques and improved intsrumentation offer surgical treatments for conditions that were previously untreatable and show encouraging early results.

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.

The incidence of most haematological malignancies increases with age. Given that those aged >65 years represent the fastest growing segment of Western populations, these cancers may commonly present to medical teams with an interest in older patients. Over the last 20 years there have been dramatic improvements in the outlook for patients diagnosed with haematological cancers, but there is evidence that many of these improvements have been restricted to younger patients. It is therefore important that older patients with haematological malignancies are rapidly diagnosed and promptly treated with the best available therapies. Clinical trials that specifically encompass older patients are clearly important. In this review, the presentation and management of common haematological malignancies will be discussed, including myelodysplasia, acute leukaemia, lymphoproliferative disorders and myeloma.

The vast majority of cardiac pacemakers are implanted in older people. Pacing is a safe and effective treatment for patients with symptomatic bradyarrhythmias. This review provides a clinician's guide to the essential aspects of modern pacemaker therapy in older patients, including aetiology and epidemiology of bradycardia. We discuss some barriers to access to pacing. We review indications for pacemakers, and describe pacing system function, including the different types of pacemakers used. We also review clinical outcomes following pacing, follow-up requirements and problems encountered in clinical practice. Finally, we discuss ethical and end of life considerations with these devices.

The scale of foot problems in the population is high, and highest in older people. Whilst podiatry is solely concerned with the foot, other professions with a broader remit are also involved in foot care, as not only the foot may be at risk but also there may be serious systemic sequelae. Foot problems can be usefully viewed from a functional, hierarchical perspective. The interventions required are suggested by considering problems according to this hierarchy. Many approaches exist for the management of foot conditions from educated self-care to surgery. In managing such conditions, multi-disciplinary approaches are required. Podiatry has developed considerably over the years, has a growing research base, an extensive scope of practice and anticipated developments. The profession can develop further, particularly in its preventative role, in terms of professional autonomy and in further increasing its evidence base.

Alzheimer's disease (AD) is the commonest form of dementia, estimated to affect 37 million people worldwide. Currently there is nothing to halt the progression of AD – treatment focuses largely on slowing the development of symptoms. More recently disease-modifying interventions, such as immunotherapy, have been investigated as their aim is to halt or even reverse symptoms by removing β-amyloid (Aβ) pathology. This paper assesses the developments made in this particular field, offers critical appraisal of important papers and assesses the viability of this potential form of treatment.

The prevalence of falls and associated injuries increases with age and dependency. The highest occurs among individuals living in long-term care institutions. Preventing falls results in reduced physical and psychological morbidity as well as having cost-saving implications. This review explores both uni- and multifactorial approaches to reducing fall rates and risk in individuals in long-term care, as well as highlighting the differences in this group from community-dwelling individuals.

Ageing is creating policy challenges for most developed countries and increasing the pressure on health and social care systems. The health status of patients is best described based on their own reports and quantitative data concerning factors such as functional disability, psychological status, pain, falls or cardiovascular risk, are critical to follow changes in patients’ condition and response to therapy. Standardized information concerning health status and co-morbidity risks can be collected easily and effectively from a ‘patient reported outcome measures (PROMs) questionnaire’ completed by the patient. Such data allow accurate description, months or years later, of changes in status. Without such records, neither the patient nor the health professional can remember the patient's earlier status reliably. This article will discuss the concept of PROMs and how they can be implemented into standard clinical practice.