General perspectives on the aged gut.

It is pertinent to ask what clinical conditions would geriatricians most want gastroenterologists to solve. I believe that the three most important are transfer dysphagia, constipation and diarrhea, and fecal incontinence. With transfer dysphagia, the older patient with central nervous system disease simply has forgotten how to swallow. Is it possible, with sensory retraining techniques, to make an impact upon this disabling problem? Although the healthy elderly appear to perceive constipation more often than they actually suffer from it, evacuation clearly is disturbed in hospitalized and nursing-home residents. Can we develop better prokinetic agents to alleviate this problem? Incontinence, more than any other gastrointestinal condition, leads to the transfer of patients from a protected home environment to a chronic-nursing facility. Can we study the pathophysiology of incontinence intensively, as Dr. Nicholas Read's group in Sheffield, England, has done, and develop approaches to managing this important problem? The presentations in this issue of Clinics in Geriatric Medicine may not provide all of the solutions for clinical problems in the elderly that we seek, but it should be a step in the right direction by making salient new information readily available.