In caring for older people, geriatricians have always adopted a multi-domain approach, and this article reflects on the diverse aspects covered by journals in general medicine, geriatric medicine and gerontology in 2013. Topics were selected that represented developing or controversial areas that are important to care of increasingly frail older people. These include the increasing use of single physical performance measures in assessment, optimal body mass index, assessment of frailty and sarcopenia, dementia, diabetes treatment goals, end-of-life care, management of complexity and design of health and social services to meet complexity. The increasingly important role of patient and carer engagement in management of disease and syndromes is highlighted. In particular, two eloquent articles from prominent physicians who have been experiencing the ageing process and demands of being a dementia carer provide a timely reminder of what the reality is in grappling with the inexorable decline that occurs with ageing, and caregiving as the central core to what medicine is all about. Looking towards the future, the potential of robotic technology, modifying the physical and social living environment in improving quality of care and quality of life is described.