The Gold Standard in Caring for Older Adults

Every time I write an introduction for Geriatrics & Aging, I seem to stress how important the focus of this particular issue is for the care of older adults. Often I compare the condition with heart disease to emphasize its importance. This month we address the gold standard for what is important in caring for older adults, namely vascular disease. Vascular disease is still the most common cause of death among older adults, and vascular disease is often the final end for many other common problems faced by older adults, such as diabetes mellitus or chronic renal disease. Vascular disease is frequently a cause or a contributor to dementia in old age as well. Traditionally, February is the month to be aware of the heart and it is only fitting, therefore, that we make this month our heart month as well.

From a public health point of view, control of hypertension and smoking cessation are two of the most important interventions that doctors can pursue with their patients. Some estimates conclude that one third or more of all older adults have hypertension, and persuasive evidence exists to control hypertension even in extreme old age (although data for those over 80 are very limited). However, some individuals have difficult-to-control hypertension, and this topic is addressed by Dr. Mohammed Shafiee, Dr. Fatemeh Akbarian, and Dr. Vahid Ghafarian in their article “Treatment-Resistant Hypertension among Older Adults.” This article is also the basis for this month’s CME program. Another of our cardiovascular features is “Essentials of Hypertrophic Cardiomyopathy” by Gursharan Soor, Adriana Luk, Dr. Anna Woo, Dr. Anthony Ralph-Edwards, Dr. Heather Ross, and Dr. Jagdish Butany. The commonest reason for hospital admission for older adults in North America is heart failure. This statistic suggests that our current management paradigms could be improved, which is the point of the article “Heart Failure: Old Disease, Older Adults, Fresh Perspective” by Drs. George Heckman, Catherine Demers, David Hogan, and Robert McKelvie. I recently had the pleasure of hearing Dr. Heckman present grand medical rounds on this topic, and I think you will be just as impressed with the article as I was with the presentation. Cardiology is the most technical of internal medicine specialties, and some of that technology is discussed in the article “The Role of Implantable Cardiac Devices in the Prevention of Sudden Cardiac Death” by Dr.Vikas Kuriachan and Dr.Robert Sheldon. Our Drugs & Aging column this month also has a cardiac focus, namely, “An Update on the Role of Digoxin in Older Adults with Chronic Heart Failure” by Dr. Ali Ahmed.

As usual, our nonfocus articles are also superb. Dr. Bhaskar Ghosh and Dr. Oksana Suchowersky present in the Movement Disorders column the article “Chorea among Older Adults.” Our Women’s Health column, “Pelvic Organ Prolapse among Older Women” is by Dr. Emily Saks and Dr. Lily Arya. Our GI Disorders column this month is on the topic “Low-Dose Acetylsalicylic Acid and the Use of Gastroprotectors among Older Adults” and is written by Dr. Neeraj Bhala and Dr. Angel Lanas.

Enjoy this issue,
Barry Goldlist