This study investigates the activities and interactions of elderly patients in an acute medical geriatric unit and a psychiatric unit. The Clifton Assessment Procedures for the Elderly were used to measure cognitive and behavioural functioning, and the 24 subjects studied were divided into three groups: lucid, confused, and demented. Information about subjects' activities and interactions with nursing staff was gained from time sampling by non-participant direct observation. The results reveal very low levels of staf-patient interaction outside of expected routines of patient care. At no time during the observation periods did staff engage patients in social activities or prolonged informal conversations. Yet 306 nurses, of various grades, completed a questionnaire in which they ranked talking to patients as ‘enjoyable’, ‘important’, ‘rewarding’, and an ‘objective’ for themselves and the unit.