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Non-pharmacological Management of Diabetes: The Role of Diet and Exercise

Non-pharmacological Management of Diabetes: The Role of Diet and Exercise

Teaser: 

D'Arcy Little, MD, CCFP, Lecturer and Academic Fellow, Department of Family and Community Medicine, University of Toronto; Director of Medical Education, York Community Services; 2002 Royal Canadian Legion Scholar in Care of Elderly, Toronto, ON.

Diabetes is a common disease in the elderly. While pharmacological management is important, the need for and benefits of non-phamacological therapy should not be underestimated in this population. Such therapy includes nutrition therapy, physical activity, smoking cessation and diabetic education. This article reviews, in detail, current recommendations for nutrition therapy and physical activity in elderly patients with Type 2 diabetes, including specific recommendations for all types of food groups and specific recommendations for pre-exercise evaluation.
Key words: elderly, diabetes mellitus Type 2, nutrition therapy, diet, physical activity, exercise.

Treatment of Hypertension in the Elderly

Treatment of Hypertension in the Elderly

Teaser: 

Anne-Sophie Rigaud, Hôpital Broca, CHU Cochin-Port-Royal, Paris, France.
Bernard Forette, Centre Claude Bernard de Gérontologie, Hôpital Sainte Périne, Paris, France.

Abstract
Diastolic blood pressure is considered an important risk factor for the development of cerebrovascular disease, congestive heart failure and coronary heart disease. However, it is now clear that isolated systolic hypertension and elevated pulse pressure play an important role in the development of these diseases, which are the major causes of cardiovascular morbidity and mortality among subjects aged 65 years and older. The benefit of antihypertensive therapy in reducing the incidence of cardiovascular and cerebrovascular complications has been shown for systolic and systolo-diastolic hypertension in all age groups. Because of the higher risk of cardiovascular disease in the elderly, the effect of antihypertensive treatment appears greater in patients over 60 or 65 years when expressed as an absolute risk reduction.

Definition
Essential (i.e. primary) hypertension is the main cause of hypertension in the elderly population. However, secondary, especially renovascular hypertension is more common in older than in younger adults. The incidence of hypertension in the elderly is high. In an ambulatory population aged 65-74, the overall prevalence is 49.6 % for stage 1 hypertension (140-159/90-99 mmHg), 18.2% for stage 2 (160-179/100-109 mmHg), and 6.