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Falls may lead to functional impairment, fear of falling, decreased quality of life, high health care costs and mortality. A case of an older adult presented in this article, illustrates the multifactorial nature of risk of falling and fall prevention strategies. Recently, meta-analyses were performed to determine the effectiveness of interventions to prevent falls and to explore the effect of intervention components in reducing fear of falling. The single interventions whole body vibration, exercise and quality improvement strategies are associated with a reduction in number of fallers. Common components of multiple interventions significantly associated with a reduction in number of fallers are exercise, assistive technology, environmental modifications, quality improvement strategies and basic falls risk assessment. Interventions with meditation, holistic exercises or body awareness are more effective in reducing fear of falling than interventions without these components. The patient's risk evaluation and personal preferences should be taken into account when developing a treatment plan.

- Treatment options for patients with dementia are limited. This article provides an overview of possible interventions, both pharmaceutical and non-pharmaceutical, for Alzheimer's disease, vascular dementia and mixed dementia.- Pharmaceutical treatment options include cholinesterase inhibitors, memantine and experimental medication. Cholinesterase inhibitors are only recommended for Alzheimer's disease and mixed dementia, not for vascular dementia or mild cognitive impairment. There is no proof of effectiveness for the other pharmaceutical options.- Interventions towards cardiovascular risk factors do not slow down cognitive decline.- Evidence is still lacking for other non-pharmaceutical interventions such as memory training and dietary supplements. Physical exercise may have a positive effect on dementia, but research is still ongoing.- Many patients with dementia exhibit behavioural changes such as agitation and depression. We recommend non-pharmaceutical interventions as a first step to lower the burden of this behaviour for both patients and caregivers.

Objective: Inventarisation and evaluation of the incidence, risk factors, and prognosis of postoperative delirium in patients with a fractured hip admitted to a surgical ward., Design: Descriptive study of patient records., Method: All patients with a fractured hip admitted to the surgical ward of the Jeroen Bosch Hospital, Den Bosch, the Netherlands, in 2004 were included and evaluated. Active multidisciplinary interventions for the recognition and treatment of delirium by non-pharmacological and pharmacological means take place in this surgical ward. The records of all patients from the surgical and geriatric wards were evaluated and the data were analysed statistically by means of univariate and multivariate logistic 'step-forward' regression analysis., Results: 114 patients were included. The incidence of postoperative delirium was 37%. Older age was a significant risk factor for the development of delirium in both the univariate and the multivariate analysis after correcting for overestimation (p < 0.01). Several other factors, including sex, type of surgery, and medical history, had no effect on the risk of delirium., Conclusion: Delirium after a hip fracture is not rare; the most important risk factor is older age.

Objective: To describe and interpret trends in cardiovascular morbidity and mortality among the Dutch population from 1980 to 2000, in particular the decline in hospital admissions for cardiovascular disease during the second half of the 1990s., Design: Descriptive., Method: An analysis of trends in hospital admissions and cardiovascular mortality for the period 1980 to 2000 was performed using Dutch hospital admissions and mortality data, specified according to age and sex. These data were taken from the National Medical Register of hospital admissions maintained by Prismant and from the national statistics on the causes of mortality maintained by Statistics Netherlands., Results: Since the 1970s, the mortality due to cardiovascular diseases has gradually declined. The age-adjusted mortality has declined by 36% for men and 33% for women. The decline is evident for both acute and chronic diseases. After an initial increase, hospital admission rates for cardiovascular disease showed a marked decline during the second half of the 1990s. The age-adjusted hospital admission rate has declined by 15% for men and 13% for women. This decline was seen in all age groups and for both acute and chronic diseases., Conclusion: The recent decrease in hospital admissions for cardiovascular disease during the second half of the 1990s appears mainly to be the consequence of a shift from hospital admissions to day care and outpatients' clinics.