Dear colleagues,

Industrialized countries are faced with an aging population. By the end of this decade, the baby boomer generation will be older than the age of 65. As a result, the proportion of people over 80 years will double by the middle of this century. Although life expectancy continues to increase, multimorbidity is more prevalent since modern medicine reduces disease-associated mortality which leads to additional chronic medical conditions.

Frailty and sarcopenia are core challenges in geriatric medicine, resulting in a state of higher vulnerability and susceptibility of worse outcome and increased mortality. The main goal is, therefore, to prevent muscle loss and functional decline by early diagnosis and adequate intervention.

In daily practice, the comprehensive geriatric assessment (GCA) is indispensable to record the functional status of our patients. Walter Schippinger focuses on this multidimensional and interdisciplinary diagnostic process which is the basis for our therapeutic approach. He also outlines that the GCA is a good instrument to improve prognosis and clinical outcome.

Multimorbidity is another typical condition in geriatric patients and is often accompanied by a polypharmacological therapeutic approach. Peter Dovjak discusses this topic in this issue pointing out that the management of comorbidities often lacks disease-specific guidelines. De-prescribing methods are sparse and have to be enforced in clinical science and as well as in daily routine care of the elderly.

Within multimorbidity, delirium is the most common acute disorder of cognitive function in older patients. Various pathological causes can induce delirious states, but also many pharmacological interventions are associated with anti-cholinergic adverse drug reactions. Bernhard Iglseder reviews the current clinical practice for the diagnosis and treatment of delirium in geriatric patients.

Finally, geriatric medicine is by far not only a matter of “end of life” care. Very often, it is a tightrope walk between nihilism and complacency requiring decisions in which medical–biological and ethical perspectives must be equally included.

Hans Jürgen Heppner discusses the needs of older critically ill patients and shows the challenges for the treatment and management of geriatric intensive care patients—when acute illness or age are not the only decisive factors, rather the existing multimorbidity and functional limitations of these vulnerable patients.

We hope that this “geriatric” issue of the journal brings new insights and perspectives to the readers. Awareness is one of the most important actions to achieve the best medical care for our patients.