BMJ No 7115 Volume 315 Saturday 25 October 1997 This Week in BMJ | Editor's Choice | Press releases Editorials 1029 Aging: a subject that must be at the top of world agendas Sally Greengross, Elaine Murphy, Lois Quam, Paula Rochon, Richard Smith 1030 There is no such thing as aging Richard Peto, Richard Doll 1031 Richard Doll at 85 Richard Smith 1032 Will you still need me, will you still screen me, when I'm past 64? Graham C Sutton 1033 Including elderly people in clinical trials Jerry Avorn 1034 The debate of the age Jessica Westall News 1035 Nobel prize winners unravel aging process Mornings are best for older shift workers Training in care of elderly needs to improve NHS and social services should work together Older smokers left out of smoking policies Alzheimer's disease drug is not recommended South East Asia's rapidly aging population Julia Alvarez, the UN's ambassador on aging In brief Papers 1039 Randomised controlled trial to evaluate early discharge scheme for patients with stroke Anthony G Rudd, Charles D A Wolfe, Kate Tilling, Roger Beech 1044 An experience that shaped my career: My first diagnosis James Horsfall 1045 Association between features of the insulin resistance syndrome and Alzheimer's disease independently of apolipoprotein E4 phenotype: cross sectional population based study Johanna Kuusisto, Keijo Koivisto, Leena Mykkä3nen, Eeva-Liisa Helkala, Matti Vanhanen, Tuomo Hänninen, Kari Kervinen, Y Antero Kesäniemi, Paavo J Riekkinen, Markku Laakso 1049 Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies D Oliver, M Britton, P Seed, F C Martin, A H Hopper 1053 Impact of mild cognitive impairment on survival in very elderly people: cohort study J Gussekloo, R G J Westendorp, E J Remarque, A M Lagaay, T J Heeren, D L Knook 1054 Foot morbidity and exposure to chiropody: population based study Ian Harvey, Stephen Frankel, Ronald Marks, David Shalom, Maria Morgan 1055 Mortality related to cold weather in elderly people in southeast England, 1979-94 G C Donaldson, W R Keatinge 1056 Endpiece: Alternative definitions 1057 Adverse drug reactions in elderly patients as contributing factor for hospital admission: cross sectional study Cyndie K Mannesse, Frans H M Derkx, Maria A J de Ridder, Arie J Man in 't Veld, Tischa J M van der Cammen 1058 Breast examinations in older women: questionnaire survey of attitudes of patients and doctors Eugene Haigney, Rosemary Morgan, Debra King, Branwell Spencer 1059 Exclusion of elderly people from clinical research: a descriptive study of published reports G Bugeja, A Kumar, Arup K Banerjee General practice 1060 Acute viral infections of upper respiratory tract in elderly people living in the community: comparative, prospective, population based study of disease burden Karl G Nicholson, Julie Kent, Victoria Hammersley, Esperanza Cancio 1065 Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women A John Campbell, M Clare Robertson, Melinda M Gardner, Robyn N Norton, Murray W Tilyard, David M Buchner 1069 Effectiveness of influenza vaccination policy at targeting patients at high risk of complications during winter 1994-5: cross sectional survey John Watkins Clinical review 1071 Recent advances: Geriatric medicine Marco Pahor, William B Applegate 1070 Endpiece: Scientific distinction hampers private practice? Education and debate 1075 Geriatric medicine: a brief history John Grimley Evans 1078 Molecular biology's impact on our understanding of aging David M A Mann 1082 Population aging and health Robert N Butler 1085 Coronary heart disease: an older woman's major health risk Nanette K Wenger 1090 Healthy aging Kay-Tee Khaw 1094 Resolutions when I come to be old Jonathan Swift Medicine and the media 1096 Optimising drug treatment for elderly people: the prescribing cascade Paula A Rochon, Jerry H Gurwitz 1096 Tales from retirement: A senior's lecture tour E J M Campbell Views & reviews Soundings 1100 Old men at play Colin Douglas Personal views 1100 Please don't make a fuss, dear Michael J Chamberlain If I can do it anyone can Katherine Harris Medicine and the media 1102 Old fools, rogues, lovers, and sages Colin Currie Medicine and books 1103 Ageing Europe Alan Walker, Tony Maltby Michael Gordon Caring for the Fourth Age: A Practical Guide to Medical Problems in Old Age J J Oram W J MacLennan Minerva 1104 S2 Career Focus Classified supplement Life, your career and the pursuit of happiness... Carl Gray Editor's choice Aging: on a full sea we are now afloat The process that led to this theme issue of the BMJ on aging began some two years ago, but the issue is published at a time when aging is everywhere. This is not coincidence. Something is up. Shakespeare, who wrote so powerfully about aging in King Lear, tells us how to respond. There is a tide in the affairs of men, Which, taken at the flood, leads on to fortune.... On such a full sea are we now afloat, And we must take the current when it serves, Or lose our ventures. The first "coincidence" is that the British Geriatrics Society is 50 years old this month. Geriatrics is one medical specialty where Britain has led the way, as the American expert on aging Robert Butler mentions in his survey of how aging is a crucial issue in both the developed and the developing world (p 1082). Professor Butler is speaking in London as part of the British Geriatrics Society's celebrations. Sir John Grimley Evans describes the development of geriatrics (p 1075), and he himself has this month delivered the Harveian Oration - Britain's premier medical lecture. He warned that the NHS is failing elderly people and must do better. Last week also saw the publication of an important report on the impact of aging on acute medical practice (p 1036). The report recognises the kinds of deficiencies described in a personal view on p 1100 and calls for action from all parts of the health service. The authors propose a year 2000 audit - like the Domesday census after the Norman conquest - to give a clear picture of the care of older people in Britain today. It will be a bleak picture. This call to arms comes shortly before the launch of the Debate of the Age, which will try to bring home to everybody in Britain the broad implications of the rapid aging of society (p 1034). The last month has also seen the launching of a campaign by the Observer newspaper to ensure that older people are treated with dignity in Britain's hospitals. The campaign began after the paper received a huge response to a powerful piece describing how an 88 year old woman went 10 days without a drink in a hospital in Bath. "The good society," says the Observer, "cannot allow the old to become disposable commodities living at the margins...it is in all our interests to promote the dignity and self respect of the elderly." No better example than Richard Doll can be found of how the elderly can contribute to our society. Sir Richard, who was one of the first to establish the link between smoking and lung cancer, is 85 this month - and he coauthors an editorial explaining how aging and disease are not inevitable companions (p 1030). Surely, we can "take the current" and respond to the challenge of aging, not just in Britain but everywhere. 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