Natasha B. Leighl, MD, FRCPC, Assistant Professor of Medicine, Division of Medical Oncology, Princess Margaret Hospital/University Health Network; Department of Medicine, University of Toronto, Toronto, ON.

Lung cancer is the leading cause of cancer-related mortality in North America and most commonly affects older patients. Patterns of investigation and treatment in older individuals differ, which may compromise outcome. Older patients should be carefully evaluated, using comprehensive geriatric assessment, to assess for function, functional reserve, comorbidities, polypharmacy, and other issues. Fit patients with few or no comorbidities should be offered standard treatments such as surgical resection for early-stage lung cancer with adjuvant chemotherapy, combined modality treatment (chemotherapy and radiation) for locally advanced disease, and systemic chemotherapy with supportive care for metastatic disease. Frail patients should be reviewed to optimize function and comorbid illnesses, and then considered for other treatment alternatives aimed at minimizing toxicity while still trying to maximize the curative or palliative potential of lung cancer therapy depending upon disease stage.
Key words: lung cancer, aging, chemotherapy, surgery, radiation, treatment.

Robert D. Helme, PhD, FRACP, FFPMANZCA, Barbara Walker Centre for Pain Management, St. Vincent’s Hospital, Melbourne, Australia.

Narcotics are commonly required for the treatment of severe pain due to malignancy at all ages. In recent years, it has been recognized that they may also benefit older people with nociceptor pain that is unresponsive to other management strategies. In this circumstance, narcotic treatment should be undertaken in the full knowledge of relevant laws and potential for side effects in patients who are fully informed and involved in their treatment program. The choice of narcotic depends on the preference and experience of the clinician. It must be recognized that both benefits and side effects of narcotics occur at lower doses in older people than in younger cohorts.
Key words: aging, pain, narcotics, comorbidity, side effects.

D’Arcy Little, MD, CCFP, Lecturer, Department of Family and Community Medicine, University of Toronto, Toronto, ON.

The few studies that have been done suggest that the prevalence of allergies in the older adult population is underestimated. Geriatric rhinitis is also underdiagnosed and under-treated. Though allergy must be considered in this population, therapy must be appropriately tailored.

Key words: allergy, rhinitis, aging, adult, skin testing, treatment.

Arto Herno, MD, PhD, Senior Consultant, Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland.

The degeneration of the lumbar spine is strongly associated with aging, but this does not mean that pain is an unavoidable accompaniment (though the recorded incidence of low back pain suggests otherwise). Recently, more attention has been drawn to the problem of changes related to the aging of our musculoskeletal system and the associated socioeconomic implications. We now have advanced equipment to examine patients and our store of knowledge is enormous, but the application of this knowledge to a working practical plan at the individual level is problematic. Understanding the automatism of the normal function of the lumbar spine is essential for treating mechanical low back pain because the main goal is to correct this functional disorder. However, the long-term goal of treatment should be to involve patients in their back disorder management.

Key words: aging, degeneration, lumbar spine, low back pain, exercise.

Lynn McNicoll, MD, FRCPC, Department of Internal Medicine, Brown University School of Medicine, Providence, RI.

Delirium in older hospitalized persons in non-critical care settings is associated with higher morbidity, mortality, and worse long-term outcomes. Delirium in critically ill persons is a growing field of research. This article presents recent research indicating a high frequency of delirium in critical care. Several studies have shown that delirium in critical care is associated with poor short-term as well as long-term outcomes, including increased length of stay, persistent cognitive deficits, and hospital and one-year mortality. Further research on strategies to prevent delirium in critical care may improve short- and long-term outcomes.

Key words: delirium, critical care, aging, outcomes, older adults.

Mitchell Sabloff, MD, Assistant Professor of Medicine, Ottawa Hospital, Ottawa, ON.

Non-Hodgkin’s lymphoma is on the rise in the older population. Traditional therapies have had limited impact upon this illness because they are compromised by toxicity and, in many cases, patients’ performance status is suboptimal at initial presentation. There has been some progress recently in addressing these issues with novel therapeutic options, permitting the delivery of more effective therapy while still limiting the toxicity.

Key words: non-Hodgkin’s lymphoma, immunotherapy, treatment, aging.

Pauline T. Truong, MDCM, FRCPC, Radiation Therapy Program, Vancouver Island Centre, British Columbia Cancer Agency and the University of British Columbia, Victoria, BC.

Rohit Pai, BSc, Radiation Therapy Program, Vancouver Island Centre, British Columbia Cancer Agency and the University of British Columbia, Victoria, BC.

Ivo A. Olivotto, MD, FRCPC, Radiation Therapy Program, Vancouver Island Centre, British Columbia Cancer Agency and the University of British Columbia, Victoria, BC.

Breast conserving surgery (BCS) and postoperative radiation therapy (RT) achieve local control and survival equal to mastectomy in women with early stage breast cancer. The incidence of breast cancer increases with age and the number of older women in Canada continues to rise, but the under-representation of older women in BCS trials limits the evidence on which to base optimal therapy decisions. This article reviews breast conservation in older women, with a focus on the necessity of radiation therapy. Multiple randomized trials with and without age subgroup analyses demonstrate that RT after BCS should be considered standard therapy. A low-risk subset in whom radiation therapy may be omitted without compromising local control has not been defined. In women with early breast cancer, age alone should not preclude treatment that optimizes local control. Efforts to include representative samples of older breast cancer subjects in modern clinical trials with endpoints that include cancer control, survival, function, and quality of life are needed.

Key words: age, breast conserving surgery, breast cancer, breast conservation, radiotherapy.

Amit Morris, BSc, School of Medicine, Queen's University, Kingston, ON; Department of Psychiatry, Sleep and Alertness Clinic, Toronto Western Hospital, University of Toronto, Toronto, ON.

Colin M. Shapiro, MBBCh, PhD, FRCP(C), Department of Psychiatry, Sleep and
Alertness Clinic, Toronto Western Hospital, University of Toronto, Toronto, ON.

Insomnia is very common among older adults and may have serious consequences. The assessment of insomnia can be challenging, given the number of possible causes and the fact that insomnia is often not a presenting complaint. Inquiring about patients’ sleep and performing a thorough evaluation of any concerns will allow a rational and targeted approach to treatment.

Key words: insomnia, sleep, older adults, aging, diagnosis.

Muammer Kendirci, MD, Tulane University, School of Medicine, Department of Urology, Section of Andrology and Male Infertility, New Orleans, LA, USA.
Wayne J. G. Hellstrom, MD, FACS, Tulane University, School of Medicine, Department of Urology, Section of Andrology and Male Infertility, New Orleans, LA, USA.

Sexual dysfunction in the older man is common and has a significant impact on quality of life. In the aging man, erectile dysfunction (ED) has been encountered frequently due not only to associated comorbidities such as heart disease, hypertension, medications, diabetes, smoking, and depression, but also as a result of the aging process itself. Aging may impair molecular and structural components of erectile function. The introduction of effective oral erectogenic drugs has led to increased awareness of sexual issues and advancement in the methods used by clinicians to diagnose ED. Over the last twenty years, the approach for identification and evaluation of ED has transformed from invasive techniques to patient self-reporting and minimally invasive office procedures.

Key words: erectile dysfunction, aging, diagnosis, evaluation.

Jill Hightower, MA, Hightower and Associates, Halfmoon Bay, BC.

Violence against older women involves physical, emotional, sexual and financial abuse and denial of human rights, often in combination with one another. Abuse is gender- and age-based. The gender-neutral focus of the elder abuse field does not address the key issues of abuse of women in later life. Community-based women’s advocacy and services in the past have failed to recognize and address the needs of older women. By developing an appreciation of issues of gender- and age-based violence, health professionals have increased opportunities to help older women find support and assistance.
Key words: elder abuse, gender violence, women, aging, older women.