Editorial

Whilst preparing this editorial, I was struck by the ambivalent attitudes displayed towards older people in Western society. In London, for example, the crowds thronging the Mall and cheering the Queen Mother for reaching her centenary belied the fact that society generally treats its older members with disdain. That is, until they reach 100 years and then everyone wants to know the secret of their success.

Aging processes are time-dependent, deteriorative functional changes. These functional changes lead to a progressive loss of the organism’s ability to withstand both internal and environmental stresses, causing the failure of cellular homeostasis. Among the modern hypotheses, the ‘Oxidative Stress Hypothesis’ offers the best mechanistic elucidation of aging phenomena. Based on the ‘Free Radical Theory of Aging’, this hypothesis has gained popularity among researchers in the field of gerontology as well as other biomedical fields. Its primary premise proposes that aging and its related disease processes are the net result of free radical-induced damage, asserting further that an organism’s inability to produce counterbalancing antioxidative defences, i.e. defences that offset disturbances in the redox state, underlies its cause.

Introduction

In 1995, Safe reviewed the major advances in the investigation and management of upper gastrointestinal tract (UGT) disorders over the previous 25 years. Further research over the past five years, particularly in the field of the ethics of nutrition in the elderly, has stimulated this review of the literature. Rather than attempt a comprehensive review, however, we focus on areas where the approach to the management of UGT disease has been significantly influenced. The following topics are covered: gastrooesophageal reflux disease (GORD); peptic ulcer disease (PUD); the management of non-steroidal drug-induced mucosal injury; UGT bleeding; UGT cancer and the ethics of artificial nutrition support.

Introduction

This is the last in a series of three papers reviewing 69 patient-based outcome measures that have been developed specifically for use in older people, or that have been administered to populations that include older people. The previous papers described how the measures were identified, and provided brief descriptions of measures of general health status and quality of life, instruments assessing mental status, measures of depression, and measures of psychological wellbeing. In this paper we describe six pain measures, 12 measures of physical disability and handicap, and eight measures of social health (see Tables 1–3). References in the text which include a copy of the questionnaire are marked with a # sign. Otherwise, a copy can be obtained from the address provided. It is recommended, however, before using any of the questionnaires to contact the authors to obtain permission to use them.

Introduction

Dementia is a syndrome which involves progressive disturbance of multiple cognitive functions, emotional control and social behaviour in clear consciousness (International Classification of Diseases, ICD-10).1 Alzheimer’s disease (AD) accounts for more than 50% of all dementias and hence is the most widely studied. Although Alzheimer’s first description of the condition included noncognitive features like hallucinations, delusions and screaming,2 most research has focused on the cognitive features, i.e. memory loss, perceptuo-motor skills and language disturbance.

Introduction

Physical therapy has been found to improve sensorimotor function following stroke.–5 Early intervention might be better than late6 but even late poststroke physical therapy may be beneficial.3,7–9 Increased intensity of physical therapy may bring increased benefit,10–12 but this might not always be the case,13 as the severity of motor impairment may influence response to additional treatment.14 Not surprisingly, the content of physical therapy might also influence sensorimotor response,15 but at present, choice of treatment by physiotherapists appears to be mostly determined by the treatment approach which was prevalent during their training.16,17 As there are several different physical therapy approaches (Partridge18 describes nine), the potential for variation is extensive. Variation also arises from location of groups of therapists, e.g. the emphasis on the Movement Science Approach in Australia and the emphasis on the Bobath approach in the UK. There is a strong impression that physiotherapy practice has often been shaped by fashion, underpinned by clinical intuitions, based on uncontrolled observations and rationalized by quasi-scientific theories. An example of this is the Bobath approach, which we shall use as an illustration of the current inadequate scientific basis for commonly-used physical therapies.

Introduction

Across the world, population structures are changing, with particularly rapid growth in the numbers of very old people. For example, in the USA, the number of people aged 85 or over is now around 4.6 million, having grown at nearly 4% per annum since 1980.1 It appears that human longevity has been increasing gradually over many years, with centenarians only appearing as a relatively recent phenomenon about 1800,2 the age of 110 being reached in the mid-20th century and 115 only by 1990. There is no sign of this extension of longevity slowing down towards a presumed biological maximum. In addition to the increase in the maximum age, there is a decrease in mortality rates in almost all age groups, and there has been a considerable rise in the chances of surviving from age 60 to 80 over the last century, which will further increase the numbers of very old people. Furthermore, the death rate in England and Wales for people aged 85 or over has decreased throughout the twentieth century.3