I am writing this editorial while attending on a general medical service at Mount Sinai Hospital in Toronto. Whenever I do this, my first impression is that general medicine is really acute geriatric medicine, and I am incredibly thankful for my background in geriatrics. It is also amazing how often gastrointestinal (GI) problems are affecting these patients, regardless of the reason for their admission. In the past 10 days, I have seen two older patients with massive upper GI bleeds, a patient with unexplained weight loss over a few months, and a seemingly limitless number of patients with constipation severe enough to affect their medical condition and require aggressive management. One of the patients admitted last night required digital disimpaction, unfortunately--for the patient and the medical student who performed it alike. This edition of Geriatrics & Aging, with a focus on gastrointestinal disease, has come at the perfect time for me. I am describing hospitalized patients, but these problems are even more common among older community-dwelling adults, and in the outpatient setting, GI complaints are even more likely to be the chief complaint, rather than just an associated (albeit important) problem.
This issue covers most of the GI problems I have been facing over the last four weeks. Having had two admissions with GI bleeds severe enough to cause syncope in the last week alone, I was particularly pleased to receive our CME article by Drs. Constantine Soulellis and Carlo Fallone on “Peptic Ulcer Disease in Older Adults.” The topic of constipation-predominant IBS is covered by Drs. Richard Saad and William Chey in their article “Irritable Bowel Syndrome with Constipation in Older Adults.” Drs. Shabbir Alibhai, Helene Payette, and Carol Greenwood, along with Karen Smith tackle a common, and vexing issue in their article “An Approach to the Nonpharmacologic and Pharmacologic Management of Unintentional Weight Loss among Older Adults,” which is the second part of the series following their initial discussion of the prevalence, screening for, and diagnosis of unintended weight loss that appeared in Geriatrics & Aging’s November/December 2006 issue.
For our CVD column this month, Drs. Anita Asgar, Renee Schiff, and Reda Ibrahim provide a state-of-the-art update in their article, “Management of Hypertension among Older Adults: Where Are We Now?” Next, Sylvia Davidson tackles a common and ever-growing area of dementia management in her article on “A Systematic Approach to Understanding Behaviour.”
Our other columns this month are tied into our theme’s focus: Our “Biology of Aging” column this month is by Dr. Karen Hall and concerns “General Changes in GI Functioning with Age.” Finally, our palliative care column is also linked to our issue’s theme: Drs. Esmé Finlay, Joseph Straton, and Jonathan Gavrin discuss “Nausea and Vomiting: An Overview of Mechanisms and Treatment in Older Patients.”
Enjoy this issue,
Barry Goldlist
