Addressing the Nation’s Leading Health Problem

This month I am writing my editorial while attending on a general medical unit in an acute teaching hospital. As usual, the service is very busy, and this morning’s intake resulted in a total of 25 patients on my team. Two things struck me as I started rounding with my team at 6:30 this morning. First, it is hard to distinguish a general medical service from a geriatric service. Although we do admit patients of all ages on our service, there are relatively few young admissions, and their length of stay is so short that the overwhelming majority of patients on the service at any one time are older adults. The second observation was that cardiac problems were the commonest reason for admission, and even those who were admitted for other reasons had significant cardiovascular issues. Thus, it is always appropriate when cardiovascular disease is our theme topic, as it is this month.

The article “When Is a Systolic Murmur Important?” by Dr. Michael Borger and Dr. Tirone David is particularly important, as over 50% of older patients will have an audible systolic murmur. Clinical acumen is required to decide which patients require further investigations. Considering that it is the single most common reason for admission to hospital for older patients in North America, the article “Congestive Heart Failure: A Brief Review” by Drs. Molly Thangaroopan, Anusha Jegatheeswaran, Vivek Rao, and Jagdish Butany will be useful for me during my month of general medical attending! The article “Primary Presentations of Syncope in the Older Adult Population” by Dr. Kenneth Madden is not only part of our focus on cardiovascular disease, it is also the theme of our CME exercise this month. Even our book review this month, “Cardiovascular Disease in the Elderly” (3rd Edition, Revised and Expanded. Edited by Wilbert S. Aronow, Jerome L. Fleg) reviewed by Dr. Jagdish Butany is part of our cardiac focus. I am proud to note that one of the authors of this textbook, Dr. Wilbert Aronow, is one of the world’s leading authorities on geriatric cardiology and has also been a frequent contributor to Geriatrics & Aging.

As usual, we also have several articles on other themes. We now have modestly effective drug treatments for dementia, but so much research is in progress that there is great optimism for the future. New possibilities are highlighted in the article “Emerging Drug Therapies for Dementia” by Dr. Edward Zamrini. In our drugs and aging column, the topic “Hormone Replacement Therapy in the Older Adult” is reviewed by Karin Humphries and Dr. Janet McElhaney. As a further reminder that endocrine concerns are not exclusive to the aging female we have the article “Erectile Dysfunction in Older Males: Why Not Investigate and Treat It?” by Dr. Peter Pommerville. It is an unfortunate reality that in the past physicians, mostly male, defined the health priorities of women, including older women. This is fortunately rapidly changing, and some of the data on what older women are actually concerned about is highlighted in the article “A Review of Older Women’s Health Priorities” by Drs. Cara Tannenbaum & Deborah Radcliffe-Branch. Finally, our ever-important palliative care column by Drs. Wendy Duggleby and David Popkin addresses the issue of “Effective Physician-Patient Communication at the End of Life: What Patients Want to Hear and How to Say It.”

Enjoy this issue,

Barry Goldlist