The world's older population is projected to rise to some two billion people in the next 50 years. The health of older adults deteriorates with increasing age and creates greater demand for healthcare resources. Prevalence of the metabolic syndrome in older adults is causing concern due to its interplay between type 2 diabetes, obesity and associated morbidity and mortality. This call to action discusses comorbidities associated with type 2 diabetes and obesity in the older population and its impact on patients. We cover several topics to consider when designing prevention and treatment strategies for older adults and areas for improvement in our care of this special population are discussed. We know that dietary, exercise and weight-loss interventions are effective. However, these strategies require effort by both patient and physician. If all parties responsible in patient care take action, a change in lifestyle can lead to longer, healthier lives in older adults.

Over a lifetime, the human lung is exposed to a multitude of factors capable of altering its structure and function. The frequency of acute, self-limiting lung disease, exposure to environmental pollutants and previous tobacco consumption in elderly people makes it difficult to identify pulmonary changes that can be attributed to ‘normal aging’ alone. It is likely that all these factors may have some influence on both lung structure and function.

The transformation of human immunodeficiency virus (HIV) from a rapidly fatal disease to a chronic manageable illness has resulted in annual increases in the numbers of people living with HIV. The HIV cohort is therefore ageing, with numbers of older adults with HIV climbing, through both prolonged survival and late acquisition of the disease. Associated with ageing is an accumulation of HIV-associated non-AIDS related co-morbidities, creating a complex patient group affected by multi-morbidity along with polypharmacy, functional decline and complex social issues. With this in mind, this review seeks to explore areas where HIV (diagnosed or undetected) may impact on the work of clinical geriatricians.

Orthostatic hypotension (OH) is a clinical condition which frequently results in troublesome symptoms such as dizziness, giddiness, blurred vision and light-headedness. It is a common disorder associated with an increased risk of falling, especially in older individuals. OH is the presenting haemodynamic manifestation of several different and diverse underlying pathological conditions, including disorders of blood pressure (BP) regulation and disorders leading to reduced intravascular volume. In younger and middle-aged adults, the presence of OH should not be considered a primary diagnosis in itself but rather a starting point in the diagnostic pathway before the primary underlying abnormality has been identified. In older patients however, asymptomatic blood pressure drops are very frequently encountered so that, in certain cases, an exhaustive diagnostic search for an underlying cause is not warranted. However, reversible causes of OH do frequently exist in older patients. Prominent among these are the use of several commonly prescribed cardiovascular drugs and vitamin B12 deficiency.

Urinary incontinence is a highly prevalent yet largely ignored condition that affects older women. Conservative treatment options are widely under-used and containment methods more widely prescribed. This study sought to review the efficacy of conservative approaches and identify which should be recommended. It was found that there is a strong evidence base in support of pelvic floor muscle and behavioural training with biofeedback as a useful adjunctive treatment. The use of therapeutic electrical stimulation was difficult to evaluate due to the different combinations of treatment available and a paucity of evidence of its use with older women. Lifestyle intervention and complementary therapies both demonstrated some positive outcomes. In conclusion it was felt that there is a place for conservative treatments in the management of urinary incontinence rather than relying on containment products. A combination of different treatment approaches is felt to be the most beneficial.

Rehabilitation can be described either as a set of technologies, akin to drug treatment, or as a person-centered process. We will use both frames of reference in this review. Our orientation in Part 1 will be technological, with initial consideration of the pathophysiology of parkinsonian impairments, before examining the rationale for non-drug interventions in Parkinson's disease (PD). In Part 2 we describe how the process of rehabilitation can be applied in a progressive disease such as PD.

The expansion of e-learning in medical education is a reflection of the inherent advantages that technology can bring to teaching and learning. Geriatric medicine has taken advantage of some of the benefits associated with e-learning in terms of undergraduate education, specialty training and interdisciplinary training. However, there are further opportunities and challenges to be met for geriatric medicine to make the very most of e-learning. This review outlines the terminology associated with e-learning, summarizes the advantages and potential problems, and considers the evidence base for the efficacy of e-learning. Current use of e-learning amongst professional groups is summarized and recommendations made for expanding the use of e-learning for all healthcare professionals working with older people.

Over the last decades of the twentieth century survival after stroke has increased considerably, with the greatest effect being in patients over 75 years. As a result, stroke is now affecting tissues and organs previously regarded as being of little relevance. The skeleton is one body system that in the longer term is affected by stroke, with fracture now becoming a significant complication. Bone loss can now readily be measured, and therapies that may be able to prevent bone loss and fracture are available for clinical trial. This review examines the direct and indirect factors that influence the relationship between fracture and stroke.

Unilateral spatial neglect is a disorder that has, for many years, intrigued and frustrated researchers and clinicians working in the area of stroke rehabilitation. A vast literature exists on the subject of neglect, much of it published by neuropsychologists and neurologists. Many of these papers aim to identify the underlying causal mechanisms, in terms of the neuroanatomical structures and cognitive processes involved. More recently, research has focused on evaluation of rehabilitation strategies to reduce the disabling effects of neglect. Various research designs have been used to examine whether a particular approach is effective or not. These range from single-case experimental designs (where the individual acts as their own control) through to randomized controlled trials (RCTs). In the latter, comparisons are made between (typically) two groups, one randomly assigned to receive the therapy approach under investigation and the other assigned to the control treatment.