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Zinc Deficiency among Older Adults—A Clinical Update

Zinc Deficiency among Older Adults—A Clinical Update

Teaser: 

Maitreyi Raman, MD, FRCPC, Assistant Professor, Department of Medicine, Division of Gastroenterology, University of Calgary, Calgary, AB.
Elaheh Aghdassi, PhD, Scientific Associate, University of Toronto, Toronto, ON.
Johane P. Allard, PhD, Associate Professor, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON.

Zinc is one of the essential micronutrients and has an important role in the maintenance of human health. Older adults are particularly vulnerable to zinc deficiency due to poor intake of zinc-rich foods. Zinc deficiency may result from poor intake due to alterations in both olfactory and gustatory sensations in addition to difficulty in mastication from poor dentition, or due to inadequate absorption resulting from excess consumption of phytate-containing products that inhibit the absorption of zinc. This review focuses on the clinical consequences associated with zinc deficiency among older adults.
Key words: zinc, deficiency, older adults, clinical manifestations.

Fever in the Returning Traveller

Fever in the Returning Traveller

Teaser: 

Alberto Matteelli, MD, Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
Anna Cristina Carvalho, MD, Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
Veronica Dal Punta, MD, Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.

The number of international travellers is steadily increasing, paralleled by the number of persons with travel-related diseases. Fever in the returning traveller should always raise suspicion of severe and potentially life-threatening infections. Therefore, physicians should be familiar with the most common syndromes, relevant diagnostic procedures, optimal treatment regimens, and referral criteria. This review gives a general overview of the pathogens causing fever in the returning traveller, their clinical presentation, and standard management procedures.
Key words: fever, travel, older adults, tropical diseases, vaccination.

Diagnosis and Management of Mitral Valve Disease in Older Adults

Diagnosis and Management of Mitral Valve Disease in Older Adults

Teaser: 


Indranil Dasgupta, MD, MPh, MBA, Clinical Assistant Professor of Medicine, Division of Cardiology, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.
Marc A. Tecce, MD, Clinical Assistant Professor of Medicine, Division of Cardiology, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.
Bernard L. Segal, MD, Professor of Medicine and Director, Division of Cardiology, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.

Disorders of the mitral valve such as mitral valve prolapse (MVP), mitral regurgitation, and, to a lesser degree, mitral stenosis are relatively common forms of heart disease. According to the Women’s Heart Foundation, MVP is the most common condition of the heart valves, and while it is more frequently diagnosed in young women, data from the Framingham study suggest that, overall, MVP affects equal numbers of men and women. These conditions often progress over years, frequently causing symptoms among affected older adults. Understanding the etiology, diagnosis, management, and treatment of mitral valve disease is vital for this population. Medical advances and other factors have allowed the general population to live longer, making mitral valve disease significantly more prevalent. An understanding of the details of the physical exam, ECG changes seen in these disorders, x-ray findings, and echocardiographic and catheterization data are critical to providing the necessary standard of care for older adults.
Key words: mitral regurgitation, mitral stenosis, mitral valve prolapse, older adults, heart failure.

Support for Caregivers of Older Adults with Chronic Conditions: A Canadian Perspective

Support for Caregivers of Older Adults with Chronic Conditions: A Canadian Perspective

Teaser: 


Lili Liu, PhD, Associate Professor and Associate Chair, Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB.
Alison Barnfather, MSc, Co-Director, Social Support Research Program, University of Alberta, Edmonton, AB.
Miriam Stewart, PhD, Scientific Director, Institute of Gender and Health, Canadian Institutes of Health Research; Professor, Faculties of Nursing, Medicine and Dentistry, and School of Public Health; Principal Investigator, Social Support Research Program. University of Alberta, Edmonton, AB.

In Canada, older adults are the most likely of all age groups to experience chronic health conditions. Most Canadians living with disabilities or chronic conditions and most older adults are supported by family members or close friends. Caregivers frequently describe the emotional, physical, and financial burdens associated with the caregiver role. Accessible support programs can improve health outcomes for family/friend caregivers of older adults with chronic conditions. Practitioners can use the strategies presented to help caregivers access timely and accessible support resources.
Key words: family caregivers, caregiver support, older adults, home care, chronic conditions.

HIV and the Older Adult: Challenges in Prevention and Treatment

HIV and the Older Adult: Challenges in Prevention and Treatment

Teaser: 

Susan L. Eldred, RN, BScN, MBA, PhD candidate, University of Ottawa, Ottawa, ON.
Wendy A. Gifford, RN, PhD candidate, University of Ottawa, Ottawa, ON.

HIV/AIDS is rapidly increasing among adults age 50 and older. However, limited research has been conducted to understand the issues associated with HIV/AIDS in advancing age. This paper describes issues related to the transmission and contraction of HIV/AIDS among older adults, their complex clinical picture, and management of antiretroviral therapy, as well as social considerations. Cognizance of polypharmacy and comorbidities common with advanced age as well as the double stigmatization of age and HIV/AIDS is essential. Further research is needed to better understand the interactions between HIV/AIDS and age, and to determine effective, safe treatments and appropriate highly active antiretroviral therapy dosing in older adults.
Key words: HIV, AIDS, sexually transmitted diseases, older adults, highly active antiretroviral therapy.

Diagnosis and Current Management of Abdominal Aortic Aneurysm

Diagnosis and Current Management of Abdominal Aortic Aneurysm

Teaser: 


Oren K. Steinmetz, MDCM, FRCSC, Associate Professor of Surgery, McGill University; Chief, Division of Vascular Surgery, McGill University Health Centre, Montreal, QC.
Peter I. Midgley, MD, FRCSC, Vascular Surgery Fellow, McGill University, Montreal QC.

Abdominal aortic aneurysms are a common cause of death among older adults in North America. Most commonly they are asymptomatic until they rupture. Rupture of an abdominal aortic aneurysm is usually lethal, so effective treatment to prevent rupture depends on accurate diagnosis on physical exam or one of various imaging modalities such as ultrasound, CT scan, or magnetic resonance imaging. Once the diagnosis is made, choice of treatment will depend on several factors including patient age and comorbidity, and aneurysm diameter. If elective treatment is contemplated there are currently two main options available to most patients: open surgical repair and endovascular repair. The fundamental differences between these two treatment options are outlined in this review.
Key words: abdominal aortic aneurysm, open surgical repair, endovascular aneurysm repair, older adults, aortic rupture.

Insomnia and Benzodiazepine Dependency among Older Adults

Insomnia and Benzodiazepine Dependency among Older Adults

Teaser: 

Philippe Voyer, RN, PhD, Associate Professor, Faculty of Nursing, Laval University; Researcher, Laval University Geriatric Research Unit,St-Sacrement Hospital, Quebec, QC.
Michel Préville, MD, Associate Professor, Faculty of Medicine, Université de Sherbrooke; Researcher, Research Centre on Aging, Sherbrooke Geriatric University Institute, Sherbrooke, QC.
and Researchers of the Étude sur la santé des aînés team.

Sleep complaints by older adults constitute a very common situation faced by health care providers. However, not all professionals respond to the complaint the same way. Some will briefly assess the complaint and resort rather quickly to medication while others will assess the complaint carefully in order to exclude the diagnosis of primary insomnia and prescribe alternative interventions to improve sleep. When medicine is prescribed, the type of compound often selected is benzodiazepine. However, benzodiazepine carries a significant risk of adverse reaction, including drug dependency, both of which are clinical problems that should not be underrated, especially when treating a subjective complaint and not a specific diagnosis.
Key words: insomnia, benzodiazepine, dependency, addiction, older adults.

Smoking Cessation in Older Adults: A Review

Smoking Cessation in Older Adults: A Review

Teaser: 

Victoria A. Walker, MD, Department of Internal Medicine, Division of Geriatric Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Heather E. Whitson, MD, Department of Internal Medicine, Division of Geriatric Medicine, Duke University Medical Center, Durham, North Carolina, USA.

Smoking is the leading cause of preventable death worldwide. Though older adults are the segment of the population least likely to smoke, they incur significant morbidity and mortality from tobacco use and can benefit from quitting. Older smokers have beliefs regarding smoking and motivating factors for cessation that differ from younger adults. Clinicians should understand these unique factors and can then use strategies to assist the older adult in smoking cessation.
Key words: smoking cessation, tobacco, epidemiology, older adults, prevention.

Older Adults and Illegal Drugs

Older Adults and Illegal Drugs

Teaser: 

Katherine R. Schlaerth, MD, Fellow, American Academy of Pediatrics; Fellow, American Academy of Family Practice; Fellow, Pediatric Infectious Disease Society; Associate Professor, Department of Family Medicine, Loma Linda University School of Medicine, Loma Linda, California; Associate Professor Emeritus, Departments of Family Practice and Pediatrics, University of Southern California School of Medicine, Los Angeles, California, USA.

Most practitioners assume that the use of illegal or “street” drugs is confined to the young. However, a recent phenomenon has been the use of such drugs by individuals above the age of 50. Social trends play a part: many older addicts began using in the 1960s. Others share the use of illegal drugs with other family members as a mode of family recreation. The latter trend is probably more common in inner cities where drugs are more easily obtained. Older men are twice as likely to use illegal drugs as are older women, though the latter outnumber the former demographically. Many illegal drugs, especially cocaine, methamphetamines, and even marijuana have cardiovascular effects that are especially dangerous when they occur in older individuals who may already have underlying cardiovascular disease. Practitioners must be vigilant about querying patients about their use of illegal drugs, no matter what their age, and especially if cardiovascular illness is involved.
Key words: older adults, illegal drugs, cardiovascular disease, cocaine, methamphetamines.

Unhealthy Alcohol Intake among Older Adults

Unhealthy Alcohol Intake among Older Adults

Teaser: 

Ann Schmidt Luggen, PhD, GNP, Professor Emeritus, Northern Kentucky University, Highland Heights, Kentucky, USA.

The number of older adults who drink to excess is not known, partly because primary health practitioners seldom screen for this problem. The signs of alcohol abuse are vague prior to late-stage liver failure and many of them are attributed to normal aging. Two types of alcohol dependence are commonly seen in older adults: type I is a late-onset alcohol dependence in which depression, chronic illness, or life changes such as retirement precipitate drinking, while type II is mainly genetic and reflects lifelong drinking that has not been previously identified by health professionals. Pharmacologic agents such as naltrexone and acamprosate have been shown in a number of clinical trials to be useful in care. A great many others are still in testing phases. Nonpharmacologic management is also effective, especially when teamed with drug therapy. Some of these are cognitive behavioural therapy, motivational enhancement therapy, and counselling that the primary care physician can do in the office, also known as the brief intervention approach. There is much that can be done if alcohol dependence is recognized.
Key words: alcohol, aging, older adults, dependence, liver disease.