Scott RA Walsh, MD, PhD, Division of Dermatology, Sunnybrook and Women’s College Health Sciences Centre, University of Toronto Medical School, Toronto, ON.

Madhuri Reddy, MD, MSc, FRCPC, Divisions of Dermatology and Geriatric Medicine, Department of Medicine, Sunnybrook and Women’s College Health Sciences Centre, University of Toronto Medical School, Toronto, ON.

Psoriasis is a chronic, recurring T-cell- mediated skin disease that causes significant morbidity. The disease is often life-long and thus prevalence is highest in older adults. Severe clinical variants are also more frequent. Complicating psoriasis presentation and treatment in older adults are issues related to polypharmacy, including a higher frequency of drug-induced or drug-exacerbated disease and potential drug interactions. Treatment should be tailored to the individual with his/her respective limitations and reflect disease severity. This review examines suitable treatment protocols, including patient education and topical and systemic medications in older populations coping with psoriasis.

Key words: psoriasis, older adults, complications, treatment, immunologic disease

Naveen Arya, MD, FRCP(C), Resident, Gastroenterology sub-specialty training program, Univerity of Toronto, Toronto, ON.
Peter G. Rossos, MD, FRCP(C), Staff Gastroenterologist, University Health Network; Program Director, Division of Gastroenterology, University of Toronto, Toronto, ON.

Introduction
With advancing age, the use of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of arthritis, pain and headache increases. Although there are many benefits of NSAIDs for their analgesic and anti-inflammatory properties, there are also potential serious side effects. The side-effect profile includes dyspepsia, gastrointestinal mucosal ulceration and bleeding, cardiac dysfunction, renal toxicity and platelet dysfunction (Table 1). Chronic use of NSAIDs is associated with serious gastrointestinal (GI) toxicity, which severely restricts the use of these medications. In the United States, adverse events associated with NSAIDs result in 103,000 hospitalizations and 16,500 deaths per year.¹ In the United Kingdom, it is estimated that 1/2000 NSAID prescriptions lasting for two months will result in death.²

The average cost of both over-the-counter and prescription NSAID use in the United States is approximately $5-10 billion dollars (U.S.) per year.³ Despite significantly increased costs of therapy, newer COX-2 inhibitors are frequently prescribed in an effort to reduce complications.

Jeffrey Zonder, MD
Ulka Vaishampayan, MD
Division of Hematology/Oncology,
Department of Medicine
Wayne State University School of Medicine/Barbara Ann Karmanos Cancer Institute
Detroit, MI, USA.

Introduction
The incidence of hematologic malignancies, especially lymphoma, is steadily rising in the elderly. These diseases and their complications pose specific problems for older patients. Factors that contribute to increased toxicity in the elderly include diminished marrow reserve, impaired renal and hepatic metabolism and, perhaps most importantly, poor performance status as a result of comorbidities.¹ This article will focus on the management of common complications of hematologic malignancies, particularly as they pertain to older patients.

Febrile Neutropenia

Risk of Neutropenia in the Elderly
The incidence of life-threatening neutropenia (absolute neutrophil count, ANC, <0.5x 10⁹/L) in elderly patients following chemotherapy for hematologic malignancies is 40% or higher.² The risk of infection is affected by the duration and severity of neutropenia with a steep rise in infection incidence at a neutrophil count of less than 0.5x 10⁹/L.