Jill M. Watanabe, MD, MPH, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Christina M. Surawicz, MD, FACG, Department of Medicine and Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, USA.

The principal causes of diarrhea are infectious and inflammatory in origin, but the diagnosis and management of diarrhea in older patients may be complicated by age-related vulnerabilities and comorbidities. Several studies have indicated that the bacterial composition of feces may change with increasing age¹ and that immune response at the mucosal surface may also diminish.² Outbreaks of infectious diarrhea, including Escherichia coli 0157:H7 and viral origins, have occurred in the long-term care setting.^3,4 It is also known that a wide spectrum of medications can cause diarrhea through various mechanisms. Older patients are at greater risk of developing mesenteric or colonic ischemia due to underlying atherosclerotic disease and risk of embolic events from atrial fibrillation, valvular heart disease, or cardiomyopathies.^7,8 This article highlights the age-related considerations for the diagnosis and management of diarrhea in the older adult.

Key words: mesenteric ischemia, ischemic colitis, Escherichia coli 0157:H7, Clostridium difficile, microscopic colitis, radiation colitis

Christopher B. Johnson, MD, FRCPC, University of Ottawa Heart Institute, Ottawa, ON.

Older patients have a high prevalence of heart valve disease and prosthetic heart valves, and are therefore at particularly high risk for endocarditis. Streptococcus viridans and Staphylococcus aureus are the most common pathogens in older patients with endocarditis. While antibiotics may cure endocarditis, surgery is required on occasion to treat complications of endocarditis such as heart failure due to valvular regurgitation, systemic and cerebral emboli, and persistent bacteremia. Endocarditis can be accurately diagnosed in aging patients using clinical, microbiological, and echocardiographic criteria. Early diagnosis and prompt institution of antibiotic therapy can result in excellent outcome among older patients with endocarditis.

Key words: endocarditis, older adults, echo, heart valve, bacteria.

David F. Mobley, MD, Department of Urology, Memorial City Hospital, Houston, TX, USA.
Neil Baum, MD, Associate Clinical Professor of Urology, Tulane Medical School, New Orleans, LA, USA.

Abstract
Benign Prostatic Hyperplasia (BPH) is a pervasive condition associated with the aging process. Causes of BPH include stimulation of the alpha receptors located in the prostate gland and bladder neck, or an increase in epithelial cell proliferation, resulting in enlargement of the prostate gland and subsequent passive compression of the urethra. Medical treatment consists of alpha-blockers or 5-alpha-reductase inhibition. This article will review the evaluation and the medical treatment for patients with mild to moderate BPH and provide suggestions for urologic referral.

Key words: BPH, prostate, alpha blockers, 5-alpha-reductase inhibitors, PSA.