Michael Gordon, MD, MSc, FRCPC,
Geriatric Consultant, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.
The current medical technologies that appear each year must be examined within the context of the demographic imperative: the reality of an increasingly aging population that wishes to stay active and engaged within their community beyond comparative ages of previous generations. The focus on using medical advances to improve quality of life for this population affords possibilities that are novel and promising to the current and likely future senior community.
In this special educational supplement, Dr. Alfonso Fasano's first article focuses on the prevalence normal pressure hydrocephalus (NPH) which occur in aging populations: yet are under-diagnosed and under-treated. His article emphasizes that "NPH is one of the few reversible chronic neurological conditions which causes dementia": the success of recent trials of shunt surgery in ameliorating or even reversing patient symptoms points to the importance in identifying this condition. He advocates greater clinician awareness that could in turn lead to early diagnosis and treatment which could improve outcomes in selective members of the aging patient populations.
Dr. Fasano's second article addresses Deep Brain Stimulation (DBS) in which he notes that exciting advances in neuromodulation technologies that have provided clinicians with improvements in targeting, programming, and management of a number of conditions with heretofore limited options of other treatments. It follows that refining the procedures has made patient selection more directed. Additional studies of this procedure will hopefully improve these the elements necessary to select patient and thereby provide symptom relief for patients currently and in the future using this exciting, technologically advanced therapy.
Dr. Phillip Chan's article considers the preponderance of opiate use to alleviate chronic pain, which is recognized in North America where these drugs are misused and abuse has reached almost epidemic proportions. He proposes and alternative: The use of Spinal Cord Stimulation (SCS). Dr. Chan champions a progressive model of pain management and highlights the necessity of a multidisciplinary approach for treating chronic pain.
Dr. Allan Ho's article revisits the perpetual problem of hearing loss in aging patients: offering a glimpse at how effectively technological advances in hearing aids can improve quality of life for patients who have had limited improvement with conventional hearing devices. Dr. Ho outlines how to best determine which patients could benefit from bone-conduction hearing devices, a patient group that might have not had such an efficacious solution in decades past, but who can now enjoy improved hearing.
Dr. Dean Elterman discusses the employment of sacral neuromodulation (SNM) as an innovative way to treat overactive bladder (OAB) and fecal incontinence when other more conventional therapies prove unsuccessful. Using SNM to treat fecal incontinence was only approved by the FDA in 2011 and thus has a shorter history than using the same procedure to treat OAB. Several large studies have consistently demonstrated a marked improvement in symptoms for patients. Both disorders can be debilitating and can severely limit quality of life for the aging patient. Elterman notes that SNM technology has provided many with a significant improvement of their symptoms.
Drs. Edward P. Abraham and Hamilton Hall carefully examine the issue of the degenerating spine and consider how best to diagnose and treat the many and varied conditions that can affect the aging patient and impact quality of life. Abraham and Hall emphasize how much today's aging patient wishes to stay active and engaged well into their eighties and nineties. They advocate thoughtful diagnoses, a multidisciplinary approach to support those with spinal degeneration, and careful preoperative counselling—including exercise, diet, and managing co-morbid conditions—should surgery prove necessary. Theirs is a whole-patient approach and draws from the very best of innovative patient-management models.
The authors whose rigorous work is included in this educational supplement are experts in their fields, and all incorporate the very best in medical technological advances to advocate for superior medical care. With their approach to using the most innovative medical breakthroughs to shape their research and clinical practice, this group of specialists is leading the way to providing superior patient care for our aging population.
