Colorectal cancer (CRC) is a commonly diagnosed cancer and a leading cause of cancer deaths in Canada and the industrialized world. According to cancer registries, incidence varies by age, geographical location, site, and time. CRC screening reduces both CRC incidence through removal of premalignant polyps and CRC deaths through early detection and treatment. Health Canada considers CRC an ideal target for mass screening of individuals 50 years of age and older. This article reviews the epidemiology of CRC and the reasoning behind the development of screening guidelines for persons 50 years of age and older. Various Canadian and U.S. guidelines are detailed. Routine screening of average-risk individuals is advocated. Finally, the review highlights trends in patient utilization of CRC screening as well as the role of screening in an aging population.
Keywords: aging, colorectal cancer, epidemiology, screening, adenomatous polyps.
The need for physicians to manage cancer in older patients is increasingly common. Cytotoxic chemotherapy for lymphoma, cancers of the breast, of the colorectum, and of the lung may be as effective in older individuals as in younger adults provided that patient selection is individualized on the basis of life expectancy and functional reserve rather than chronologic ages; the doses of chemotherapy are adjusted to the Glomerular Filtration Rate (GFR); prophylactic filgrastim or pegfilgrastim are utilized to prevent neutropenic infections; and hemoglobin is maintained at 120gm/l.
Keywords: Cancer, aging, older adult, chemotherapy, toxicity.
Coronary heart disease is a major cause of morbidity and mortality in older patients. For this population cardiac rehabilitation offers an improvement in functional capacity, alleviation of symptoms, enhanced mood state and quality of life, and a modification of coronary risk factors. The components of a comprehensive programme specific to older adults are the same as for younger patients, with exercise training the mainstay. However, the changes that accompany the aging process require some modification in both the aerobic and resistance exercise programmes. Unfortunately, the referral rate of older patients, particularly women, is poor. Hopefully, this could be rectified if physicians come to realize that this segment of the population is the most likely to benefit from cardiac rehabilitation.
Key words: cardiac rehabilitation, aging, exercise training, coronary heart disease, referral patterns.
Vision and hearing impairments are common in older people. They not only impact on the quality of life and independent living of affected individuals, but also contribute to the overall burden of aged care. Although current evidence supports screening for age-related vision and/or hearing impairments, good- quality evidence on the effectiveness of sensory interventions (e.g., treatment for eye conditions or rehabilitation for hearing loss) is lacking. Evidence from community-based randomized controlled trials is needed before implementing community-wide screening. Case-finding during primary health care can be considered. Strategies to reduce the overall burden from common disabilities, including sensory impairments, among older people are keys to achieving the goal of “aging well, aging productively.”
Key words: aging, screening, vision, hearing, sensory impairment.
The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme
Syncope is a common presenting complaint in the older adult population. Unfortunately, cognitive issues and the fact that most falls are not witnessed in older adults can make the separation of falling and syncope quite difficult. In fact, about one third of older adults will have amnesia for faints, even if they are cognitively normal. A systemic approach can help separate cardiac from neurocardiovascular causes and avoid future mortality and morbidity.
Key words: syncope, aging, neurocardiovascular instability, Holter monitoring, tilt table testing.
Contemporary technologies, including digital imaging of the brain during life and quantative microscopy (unbiased stereology) for estimating histological features postmortem, have resulted in important new knowledge about changes in the brain that accompany healthy aging, including evidence that grey matter atrophies with an anterior-posterior gradient. Neurons shrink but numbers are preserved; however, there is moderate reduction in dendritic spines and in synapses that have altered function. This is to be interpreted in the light of evidence for neurogenesis continuing into late life. White matter volume increases into maturity, but in aging there is a marked reduction due mostly to a loss of small myelinated fibres. Cell inclusions characteristic of neurodegenerative disease are commonly found postmortem in the healthy aged.
Key words: brain, aging, morphometry, imaging.
Parkinson’s disease (PD) is a neurodegenerative disorder that can significantly impact older patients’ quality of life. Although there are many pharmacologic options to treat PD, the clinician needs to know the indications and potential adverse effects of new medications in the older patient population. Carbidopa/levodopa remains the gold standard for treatment, and new formulations and levodopa-extenders fill specific niches. This article reviews the pros and cons of these medications in older PD patients, and demonstrates therapeutic strategies through case presentations.
Key words: Parkinson’s disease, treatment, levodopa, COMT inhibitor, aging.
The prevalence of cardiac arrhythmia increases within a continuously aging population. This is illustrated by the projection of a 2.5-fold increase in the number of cases of atrial fibrillation (AF) in the United States by 2050. Approaches to arrhythmia management have changed considerably in recent years; this is, in part, related to the better understanding of effects of the existing drug therapy in patients with arrhythmia, and the advances of catheter ablation and complex device therapies for selected older patients.
In this review, we have broadly classified arrhythmias into brady- and tachyarrhythmias (AF, paroxysmal supraventricular tachycardias, and ventricular arrhythmias) and followed by highlighting the contemporary therapies for these arrhythmias in older adults.
Key words: aging, arrhythmia, drug, ablation, devices.
One important goal in the field of DNA repair is to use current knowledge of DNA damage and repair mechanisms in normal young and adult cells and animal models in the chemoprevention and chemotherapeutics of DNA damage-related diseases. However, such a translation into a true in vivo setting can prove difficult. No doubt, the scope of human in vivo studies is currently restricted by the complexity of this setting and by the relatively limited availability of safe and effective in vivo chemopreventive and chemotherapeutic substances, as well as tremendous ethical responsibility. This article’s focus is on human and human skin organ-culture studies and outlines possible future directions for the field of photobiology in “translational” applications.
Key words: aging, DNA repair, UV, skin tumour, T-oligos.
Lung cancer is the leading cause of cancer-related mortality in North America and most commonly affects older patients. Patterns of investigation and treatment in older individuals differ, which may compromise outcome. Older patients should be carefully evaluated, using comprehensive geriatric assessment, to assess for function, functional reserve, comorbidities, polypharmacy, and other issues. Fit patients with few or no comorbidities should be offered standard treatments such as surgical resection for early-stage lung cancer with adjuvant chemotherapy, combined modality treatment (chemotherapy and radiation) for locally advanced disease, and systemic chemotherapy with supportive care for metastatic disease. Frail patients should be reviewed to optimize function and comorbid illnesses, and then considered for other treatment alternatives aimed at minimizing toxicity while still trying to maximize the curative or palliative potential of lung cancer therapy depending upon disease stage.
Key words: lung cancer, aging, chemotherapy, surgery, radiation, treatment.
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