It seems self-evident that the effectiveness of rehabilitation services requires well-organized, co-ordinated, multidisciplinary services, if only because no one discipline has the range of skills needed for rehabilitation. For one major service, at least, a problem-oriented approach has been shown to be effective.

The overall burden of stroke is well known. It is the third commonest cause of death in developed societies, and the commonest cause of severe acquired physical disability in old age. The incidence of stroke is approximately 1–2 per 1000 population per year in the United Kingdom, that approximates to a ‘stroke a day’ in most typical district general hospitals. As such, it is something all who take part in emergency medicine should know a great deal about, even more so for geriatricians as stroke becomes increasingly common with old age. Recent work from Oxford, England has demonstrated that although the age-specific incidence of stroke has fallen by 30% in the last 20 years, the overall incidence of stroke in the population has remained constant due to the increasing proportion of the population in the stroke-prone age. This suggests that the types of patient who have stroke will differ in time, as the population ages, and stroke will be seen more frequently in frailer older people. This could have profound influence for the organization and management of patients, as treatments that appear beneficial for a younger, more robust patient may have a different balance of risk and benefit in the frailer older person. Geriatricians must continue to contribute their patients to stroke research (or collaborate very closely with their neurological colleagues) if we are to keep an appropriate evidence base for the older patient with stroke.

Since the last review of hypertension in older patients in this journal in 1999, there has been an enormous expansion in the available evidence for management of hypertension. Blood pressure treatment is only one part in an overall strategy of cardiovascular risk reduction. The actual prevalence of hypertension depends on the level of blood pressure used to define when treatment should be started and thus varies between patients depending on their degree of risk. A publication from the University of York NHS Centre for Reviews and Dissemination quoted a figure of over 50% of older people as being hypertensive in 1999. Newer guidelines tend to be encouraging treatment at lower blood pressure levels than previously and some authors now suggest that around 70% of the elderly population could be considered as hypertensive.

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.

Parkinson's disease (PD) is one of the most common neurodegenerative diseases and occurs in all ethnic groups, affects both sexes, and becomes increasingly common with advanced age. With population aging, the impact of PD in human, social and economic terms is growing.

Vertigo and dizziness are common problems in older patients visiting primary health care centres. Dizziness is often used as a non-specific term to describe many sensations, including vertigo, presyncope, disequilibrium and lightheadedness. In another sense, dizziness can be described more specifically as a feeling of unsteadiness or a mild intoxication, or as if the ground is rocking, or the affected person has to take side-steps to keep balance. Vertigo, by comparison, is often described as a feeling of rotation; the room or surroundings are spinning around like a carousel. Presyncope is often described as sensation of impending fainting or sense of falling. Lightheadedness is a much more vague description of dizziness, difficult to define. Disequilibrium, on the other hand, can be described almost in the same terms as dizziness: a feeling of unsteadiness or loss of balance.

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.

The population of the UK is aging, with a fifth of the population of England now over 60years old. Between 1995 and 2025, the number of people over the age of 80 is set to increase by almost half, and the number of those over 90 will double. While there is some decline in cognitive function as a result of normal aging, most older people do not develop dementia. Only about 2% of people aged between 65 and 75 have some form of dementia, and this is thought to rise to 20% in those over 80. Thus there are some 670000 people with dementia in the UK, and this figure is expected to rise to nearly 1000000 by 2021. The cost of dementia care, at 5.6% of total healthcare costs, is almost equal to that of the combined costs of cancer (3.2%) and coronary heart disease (2.5%). Twenty-five per cent of the costs of caring for this group may be attributable to the time carers spend helping with eating and drinking. Eating and drinking involve the co-ordination of complex physical and mental activity. These activities are often affected by aging as well as the progressive impairment of memory, thinking, perception, planning, organization, communication and skilled movement that characterize dementia. Consequently eating and drinking may be affected by tooth and mouth problems, poor hand-to-mouth co ordination, poor concentration, apparent food refusal, wandering away during mealtimes and the side-effects of individual drugs, polypharmacy and dysphagia.