IntroductionThe population is ageing, and old people are found in all wards. This review, written from the viewpoint of senior registrars in training, focuses on issues which we deem important.The organisation ofhospital services reflects past political decisions. Our specialty (geriatric medicine) exists because, at the start of the National Health Service, government placed responsibility for the chronic sick on the hospitals. From that decision our specialty, without a system or diagnostic base, emerged. In making choices we recognized that other disciplines may see our world differently. Nevertheless, the pot-pourri of topics that we have selected reflects our interests.Geriatric medicine is a service discipline. Accepting that, it was tempting to begin this collection of reports with service organization. Yet we recognize the interest of our readers and begin with clinical matters. Those who reach the end will find we conclude with service matters, but between there and now, are contributions on skin ageing, pressure sores and fractures and metabolic bone disease; dementia and thrombolytic therapy and angiotensin converting enzyme (ACE) inhibitors.These medical topics are then complemented by reviews of current practise relating to screening, stroke rehabilitation and the problem of carers.Finally, the paper concludes with contributions on the organization of services and medical audit and we hope that our readers get as much enjoyment out of reading this review as we gained in writing it. It is common to attribute the changes of extrinsic ageing to those of intrinsic ageing, as the latter occurs on readily visible skin and becomes more pronounced with advancing age.3 Intrinsic ageingThere is a flattening of the interdigitations between the dermal-epidermal interface and thus reduced adherence between the two surfaces, predisposing the ageing skin to blistering.3 Age-related skin changes include reduced proliferative activity in the epidermis and a slowed healing rate. Attenuated microvasculature predisposes to hypothermia, hyperthermia and prolonged or persistent contact dermatitis due to delayed clearance ofallergens and irritants.3 Reduced sensation occurs and diminished elasticity due to changes in collagen predispose to tear-type injuries.Langerhans' cells, which act as skin macrophages, are reduced in aged skin and further in chronically sun-exposed.3 The resultant impaired cell-mediated response increases the susceptibility to skin infections, particularly viral and fungal, though it reduces the potential for allergic contact dermatitis. The reduced cell-mediated immunity reduces the inflammatory response and patch tests reactions. Patch test sites for suspected allergic contact dermatitis should be assessed 3 weeks after application, in the elderly, as well as the routine follow-up at one week.3 The reaction of the tuberculin test is also reduced.4Reduced immunosurveillance may account for a recently recognized increased susceptibility to cutaneous neoplasia. This is probably a result of

No abstract

No abstract