Infectious Disease and the Aging Adult

In the early days of antibiotic therapy, clinicians started predicting the end of the plague of infectious diseases that had beset humankind for its entire history. Of course, medical science was completely wrong. We did not count on the adaptability of microorganisms, the medical interventions that increase immune deficiency, the global transmission of pathogens, and many other confounding difficulties. Most importantly, we forgot that the background microbial flora within which we live is essential for our survival, and that the prevention of illnesses from these pathogens is more dependent on broad public health measures (sanitation, water purification, nutrition) than the use of antibiotics in specifically affected individuals, even though antibiotic use is life-saving in certain circumstances. Notably, we are seeing more unusual infections in older people who are not immunosuppressed, and the reasons for this are quite simple. The population is aging, and older adults travel to unusual places. Novel infections are often transported to our country in a variety of ways.

Our CME article with this edition’s focus is ”Common Skin Infections in the Older Adult” by Chamandeep Thind and Dr. Simone Laube. The article ”West Nile Virus: A Pathogen of Concern for Older Adults,” by Drs. Michael A. Drebot and Harvey Artsob, reviews a disease that is new to Canada and has had a substantial impact on the health of older Canadians. It has certainly changed the summertime habits of many Canadians of all ages. Several travel companies now specialize in adventure travel for older adults, and if your patients are among those adventurous seniors, you will appreciate Dr. Patrice Bourée’s article ”Safe Foreign Travel for the Older Adult.”

We have our usual columns featuring articles on other topics. Our Cardiovascular column this month is “The Role of Revascularization in Older Patients with Acute Coronary Syndromes” by Anna J.M. van de Sande, Dr. Paul W. Armstrong, and Dr. Padma Kaul. Our skin article is entitled ”Nonmalignant Photo Damage” by Drs. Joseph F. Coffey and Gordon E. Searles. Ever since the APOE 4 allele, involved in lipoprotein metabolism, was discovered to have a relationship to Alzheimer’s disease, hypotheses as to the relationship of cholesterol and dementia have been explored. For those interested in cognitive impairment, the article ”Is Cholesterol a Memory Thief?“ by Dr. D. Larry Sparks, will be particularly interesting. Our Cancer column features the second part of Patricia K. Long and Dr. David Ollila’s article entitled “Cutaneous Melanoma, Part Two: Management of Patients with Biopsy-Proven Melanoma.” Neuropathic foot ulcers are a serious issue for diabetic older adults, and Drs. Timothy Daniels and Evan Timir review “Surgical Treatment of Diabetic Foot Complications.” As well, this issue features a book review, ”Evidence-Based Medicine Guidelines” by Meteb Al-Foheidi.

Enjoy this issue,
Barry Goldlist