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older adults

Paranoid Symptoms Among Older Adults

Paranoid Symptoms Among Older Adults

Teaser: 

Muzumel A. Chaudhary, MD, Psychiatry Resident, University of British Columbia, Vancouver, BC.
Kiran Rabheru, MD, CCFP, FRCP, ABPN, Clinical Associate Professor, Department of Psychiatry, University of British Columbia; Geriatric Psychiatrist, Vancouver General, University of British Columbia, and Riverview Hospitals, Vancouver, BC.

New-onset paranoid symptoms are common among older individuals. They can signify an acute mental status change owing to medical illness, correspond to behavioural and psychological symptoms of dementia, or equate to an underlying affective or primary psychotic mental disorder. The implications of paranoid symptoms are considerable and affect patients, families, and caregivers alike. Accurate identification, diagnosis, and treatment of late-life paranoid symptoms present a unique clinical challenge as issues of morbidity and mortality are inherent both to the illness state and available treatment approaches.
Key words: paranoia, delusions, etiology, older adults, atypical antipsychotic.

Older Adults and Mental Health

Older Adults and Mental Health

Teaser: 

The focus of this month’s journal is Older Adults and Mental Health. This area is one of paramount importance to those who care for older adults, and the greatest challenge lies in managing Alzheimer’s disease and its complications. Our CME article this month, “Paranoid Symptoms among Older Adults” by Dr. Muzumel Chaudhary and Dr. Kiran Rabheru, is on a common syndrome with numerous underlying causes. Dr. Svante Östling contributes an article on “Presentation of Psychosis,” an issue that may not come to mind automatically for the nonpsychiatrist assessing an older adult. Dr. Keri-Leigh Cassidy and Dr. Neil Rector provide an intriguing article “The Silent Geriatric Giant: Anxiety Disorders in Late Life.” This article should force all of us to pause before writing our next prescription for benzodiazepines. We all complain about our memory at times, but Dr. Mario Masellis and Dr. Sandra Black advise us on what to do when our patients similarly complain in their article “Assessing Patients Complaining of Memory Impairment.”

Rounding off this issue we have an article on “Management of Cardiovascular Disease Risk Factors among Older Adults with Peripheral Arterial Disease” by Nicholas Giacomini and Dr. Roberta Oka, and one on a recent pharmacological controversy, “Thiazolidinediones and Cardiovascular Disease: Balancing Benefit and Harm” by Dr. Sonal Singh and Dr. Yoon Loke.

Our journal has consistently focused on practical articles that physicians can immediately use to help their older patients. However, an esteemed colleague of mine (and regular reader of Geriatrics & Aging) recently commented to me that physicians face their own challenges as they age. I am currently trying to find someone with expertise to write an article on the problems that older physicians (myself included) experience. I would appreciate any comments, anecdotes, and experiences that you, our readers, might contribute to this topic. If you have anything you would like to share, please contact our Managing Editor Andrea Németh by email (anemeth@geriatricsandaging.ca), by fax (416-480-9449), or by regular mail (162 Cumberland Street, ste. 300, Toronto, Ontario, M5R 3N5).

Enjoy this month’s articles,
Barry Goldlist

Benzodiazepine Use among Older Adults: A Problem for Family Medicine?

Benzodiazepine Use among Older Adults: A Problem for Family Medicine?

Teaser: 

Steve Iliffe, FRCGP, Professor of Primary Care for Older People, Research Department of Primary Care, University College London, UK.

Long-term benzodiazepine use in older adults with sleep disorders is potentially hazardous, but it is also becoming easier to manage as approaches to withdrawal become feasible in primary care, without adverse consequences. This article reviews the evidence and describes practical approaches to reducing consumption of benzodiazepine hypnotics.
Key words: benzodiazepines, insomnia, older adults, primary care, hypnotics.

Aspiration Pneumonia among Older Adults

Aspiration Pneumonia among Older Adults

Teaser: 

R.A. Harrison, MD, FRCPC, Department of Internal Medicine and Division of Infectious Diseases, University of Alberta, Edmonton, AB.
T.J. Marrie, MD, FRCPC, Department of Internal Medicine and Division of Infectious Diseases, University of Alberta, Edmonton, AB.

Among older adults, aspiration pneumonia is associated with higher rates of morbidity and mortality than community-acquired pneumonia. Individuals admitted to acute care from continuing care facilities are at increased risk for aspiration pneumonia. Risk factor assessment forms a cornerstone in diagnosing aspiration pneumonia syndromes. Monitoring for timely clinical response to therapy and for potential complications is an important step in the care of patients with aspiration pneumonia. Further high-quality research is needed to better delineate the effects of risk factor modification on the incidence of aspiration pneumonia. Aiming to prevent aspiration pneumonia poses health care providers with an opportunity for ongoing development, study, and implementation of preventive strategies for older adults.
Key words: aspiration, pneumonia, older adults, geriatric, risk factor.

Low-Dose Acetylsalicylic Acid and the Use of Gastroprotectors among Older Adults

Low-Dose Acetylsalicylic Acid and the Use of Gastroprotectors among Older Adults

Teaser: 

Neeraj Bhala, MBChB, MRCP, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Clinical Medicine, Oxford, UK.
Angel Lanas, MD, PhD, Service of Gastroenterology, Instituto Aragones de Ciencias de la Salud, University Hospital, CIBERehd. Zaragoza, Spain.

Low-dose acetylsalicylic acid (ASA) is widely used in the prevention of cardiovascular events but can be associated with upper gastrointestinal (GI) complications, including ulcers. In this article, the range of effects of GI toxicity and the epidemiology of ASA-associated events are discussed, as well as risk factors, such as increasing age, that predict bleeding. Strategies to minimize upper GI events in older adults include the use of mucosal protectants such as proton pump inhibitors. The use of alternative antiplatelet agents including clopidogrel or Helicobacter pylori infection eradication may not provide sufficient protection in at-risk individuals who need low-dose ASA.
Key words: low-dose ASA, upper gastrointestinal events, older adults, gastroprotection, proton pump inhibitor.

Chorea among Older Adults

Chorea among Older Adults

Teaser: 

Bhaskar Ghosh, MD, DNB, DM, MNAMS, Movement Disorders Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB.
Oksana Suchowersky, MD, FRCPC, FCCMG, Movement Disorders Program, Department of Clinical Neurosciences; Department of Medical Genetics, Faculty of Medicine, University of Calgary, Calgary, AB.

Chorea is a hyperkinetic movement disorder characterized by nonsustained, rapid, and random contractions that may affect all body parts. Chorea is hypothesized to be due to an imbalance between the direct and indirect pathways in the basal ganglia circuitry. Important causes of chorea among older adults include medications, stroke, and toxic-metabolic, infective, immune-mediated, and genetic causes. The history and clinical examination guide appropriate investigations and help determine an accurate diagnosis. In secondary causes, removal of the precipitating cause is the mainstay of treatment. If the chorea is persistent or progressive, drug therapy may be instituted. Genetic counselling is important in hereditary chorea.
Key words: movement disorders, chorea, older adults, diagnosis, treatment.

An Update on the Role of Digoxin in Older Adults with Chronic Heart Failure

An Update on the Role of Digoxin in Older Adults with Chronic Heart Failure

Teaser: 

Ali Ahmed, MD, MPH, FACC, FAHA, FESC, associate professor, Division of Gerontology, Geriatric Medicine, and Palliative Care, Department of Medicine, School of Medicine and Department of Epidemiology, School of Public Health, University of Alabama at Birmingham; director, Geriatric Heart Failure Clinics, Veterans Affairs Medical Center, Birmingham, AB, USA.

Heart failure (HF) is the leading cause of hospitalization among older adults. Digoxin has been shown to reduce hospitalization due to worsening HF. However, at the commonly prescribed dose of 0.25 mg/day, digoxin does not reduce mortality. New data suggest that at low doses (0.125 mg/day or lower) digoxin not only reduces hospitalization due to HF, but may also reduce mortality. Further, at lower doses, it also reduces the risk of digoxin toxicity and obviates the need for routine serum digoxin level testing. Digoxin in low doses should be prescribed to older adults with symptomatic HF.
Key words: chronic heart failure, older adults, treatment, digoxin, update.

The Role of Implantable Cardiac Devices in the Prevention of Sudden Cardiac Death

The Role of Implantable Cardiac Devices in the Prevention of Sudden Cardiac Death

Teaser: 


Vikas Kuriachan, MD, FRCP(C), Fellow, Cardiac Arrhythmia, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB.
Robert Sheldon, MD, PhD, FRCP(C), Professor, Cardiac Sciences, and Associate Dean of
Clinical Research, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB.

The implantable cardioverter defibrillator (ICD) plays an important role in primary and secondary preventions of sudden cardiac death. Several trials conducted in the past few years have shown the superiority of ICDs over drug therapy. Cardiac resynchronization therapy (CRT) is also emerging as an adjunctive treatment for heart failure, with some survival benefits as well. This article reviews the major recent clinical trials of ICD and CRT devices and summarizes their importance in contemporary cardiology.
Key words: cardioverter defibrillator, cardiac resynchronization, older adults, sudden cardiac death, cardiology.

Essentials of Hypertrophic Cardiomyopathy

Essentials of Hypertrophic Cardiomyopathy

Teaser: 


Jagdish Butany, MBBS, MS, FRCPC, Department of Pathology, Toronto General Hospital, University Health Network; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON.
Gursharan S. Soor, BSc, Department of Pathology, Toronto General Hospital, University Health Network, Toronto, ON.
Adriana Luk, BSc, Department of Pathology, Toronto General Hospital, University Health Network, Toronto, ON.
Anna Woo, MD, FRCPC, FACC, Hypertrophic Cardiomyopathy Program, Division of Cardiology, Toronto General Hospital; Department of Medicine, University of Toronto,Toronto, ON.
Anthony Ralph-Edwards, MD, FRCSC, Division of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON.
Heather Ross, MD, FRCPC, Department of Medicine, Division of Cardiology, University of Toronto, Toronto General Hospital, Toronto, ON.

Hypertrophic cardiomyopathy (HCM) is an uncommon disease with significant consequences. Since the 1950s, major strides in understanding its etiology and pathogenesis have led to improved management and patient survival. Hypertrophic cardiomyopathy is associated with various mutations in several cardiac sarcomeric genes. Due to the complications of HCM, such as left ventricular outflow tract obstruction, diastolic dysfunction, arrhythmias, increased risk of stroke, infective endocarditis, and, most importantly, sudden cardiac death, appropriate and timely diagnosis is critical. This review summarizes current knowledge about HCM and the most appropriate investigations for persons suspected of having HCM. Treatment strategies for the disease and its complications are presented briefly.
Key words: hypertrophic cardiomyopathy, cardiomyopathy, sudden cardiac death, older adults.

Heart Failure: Old Disease, Older Adults, Fresh Perspective

Heart Failure: Old Disease, Older Adults, Fresh Perspective

Teaser: 


George A. Heckman, MD, MSc, FRCPC, McMaster University, Hamilton General Hospital, Hamilton, ON.
Catherine Demers, MD, MSc, FRCPC, McMaster University, Hamilton, ON.
David B. Hogan, MD, FCRPC, University of Calgary, Calgary, AB.
Robert S. McKelvie, MD, PhD, FRCPC, McMaster University, Hamilton, ON.

The burden of heart failure is rapidly rising. Heart failure is associated with substantial mortality, morbidity, and economic cost, which disproportionately affect older adults. Heart failure among older individuals is frequently complicated by geriatric syndromes, including frailty, functional decline, cognitive impairment, and atypical clinical presentations. Understanding the nature of these geriatric syndromes and their impact on the assessment and management of heart failure is a critical component to diagnosing and delivering appropriate care to these patients. In this article we review the geriatric aspects of heart failure.
Key words: geriatric syndrome, heart failure, older adults, diagnosis, frailty.