It is well known that older adults consume many more prescription drugs than would be expected from their proportion of the population. In Ontario, where about 13% of the population is over age 65, about 40% of prescription drugs are consumed by that group.

I therefore find it strange when some media agencies advise us that pharmaceutical companies they represent do not advertise in journals such as ours because they do not target physicians who provide geriatric care. They cite the “negative” connotations of the word geriatrics in the title as a justification for not supporting the journal with advertising. I have always found this to be counterintuitive: advertising should be directed at those doctors who actually see and prescribe for older adults. Advertising is an important source of revenue that allows our journal to keep publishing the timely information that physicians need, but it’s also a tool for introducing physicians to medications that may help their patients.We value the support provided by the progressive companies and agencies that regularly advertise with Geriatrics & Aging.

What can we do to eliminate the stigma that not only prevents advertisers from investing in journals that serve health professionals who care for aging adults, but also undermines the appeal of geriatric medicine in our medical schools and the agencies and institutions we must work with to improve elder care? The comments you see in this issue are a few responses we were able to include, sent in by our partners in the Canadian Geriatrics Society and Canadian Academy of Geriatric Psychiatrists, but we’d like to hear from you, our eleven thousand (!) readers, who are also working on the front lines with many aging adults. I strongly encourage you to add your thoughts to our online forum at www.geriatricsandaging.ca/links/calltoarms/

One final note: as a founding member of the Canadian Geriatrics Society, I’m inviting all our readers to attend the CGS 2009 Annual General Meeting, a great opportunity to talk with peers, learn the latest research in geriatric care, and develop new skills for offering the best possible care for older adults. As the population ages, these skills will become all the more valuable: why not join CGS now and add your name to the list of professionals working to improve the care of aging Canadians?

For more information about the Annual CGS Meeting please visit: www.canadiangeriatrics.com/meeting.

Enjoy this issue,
Barry Goldlist, MD, FRCPC, FACP, AGSF
Editor In Chief
Geriatrics & Aging

Bejoy C. Thomas, PhD, Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Cancer Board; Department of Oncology, University of Calgary, Calgary, AB.
Barry D. Bultz, PhD, Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Cancer Board; Department of Oncology, University of Calgary, Calgary, AB.

Geriatric care is undoubtedly complex. A cancer diagnosis in itself creates significant concerns, irrespective of age, for the patient, and these concerns may be compounded by stresses related to moving into later life. Despite the scarce literature on geriatric oncology, the numerous challenges are acknowledged. Substantial evidence is offered on the benefits to the patient as well as the treating institution (cost off-sets, for example) on the benefits of psychosocial care. However, psychosocial care does not necessarily begin only at the cancer centre. Screening for the sixth vital sign, emotional distress, should begin at the primary care physician’s office. This not only benefits the primary care practice but also enables the tertiary referral centre to streamline resources to the specific needs of the patient, thereby ultimately improving the patient experience across the disease trajectory.
Key words: geriatric, chronic disease, emotional distress, screening, sixth vital sign.

Siamak Moayedi, MD, Assistant Professor, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Mercedes Torres, MD, Instructor, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.

Dyspnea is among the most frequent complaints among older adults. The prevalence of comorbid medical conditions combined with physiological changes of aging present significant challenges to the diagnosis. The initial approach to the older adult with dyspnea mandates consideration of a broad range of diagnoses. Failure to consider life-threatening medical conditions presenting with dyspnea, such as pulmonary embolism, acute coronary syndromes, congestive heart failure, asthma, obstructive pulmonary disease, pneumothorax, and pneumonia, can lead to significant morbidity and mortality. This review focuses on the rapid assessment and approach to the older adult with acute dyspnea.
Key words: dyspnea, shortness of breath, approach, geriatric, older adults.

Robert E. Coffee, MD, MPH, Clinical Instructor, Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, USA.
Tara A. Young, MD, PhD, Assistant Professor, Jules Stein Eye Institute, David Geffen School
of Medicine, University of California, Los Angeles, USA.

Age-related macular degeneration (AMD) is the leading cause of blindness among older adults in North America. This article reviews the clinical spectrum, risk factors, pathophysiology, and potential therapeutic options for this disease. Despite significant advances in the treatment of certain forms of AMD, there is currently no cure for this degenerative condition. The substantial personal, social, and economic burden of AMD requires that those who provide care to older adults have a general understanding of this cause of blindness. It is important for the ophthalmologist and primary care physician to address modifiable risk factors for the progression of AMD such as poor cardiovascular status and smoking, which may worsen visual loss. In addition, educating patients and their families regarding risk factors and potential treatment options may greatly benefit those affected by AMD.
Key words: blindness, geriatric, age-related macular degeneration, choroidal neovascularization, ranibizumab, bevacizumab.

Kristen Davidge, MD, Plastic Surgery Resident; Candidate, Master of Surgical Science, Department of Surgery, University of Toronto, ON.
Joel Fish, MD, MSc, FRCS(C), Burn Surgeon, Ross Tilley Burn Unit, Sunnybrook Health Sciences Centre; Chief Medical Officer, St. Johns Rehab Hospital; Associate Professor, Department of Surgery, University of Toronto; Director of Research, Division of Plastic Surgery, University of Toronto, Toronto, ON.

Burn injury among older adults will result in significant morbidity and mortality despite the many advances in burn treatment. Many adult burn units in North America admit and treat a significant number of older adults so understanding the issues and problems specific to this age group is important. Older adults experience specific problems with wound care, and if the injury is large, they will require critical care interventions during the course of treatment. Despite the advances in wound care and critical care that have occurred, the mortality rates of older adults with burn injuries remain quite high. This article reviews the literature on specific issues for older adults that need to be considered when treating older adults with burn injury.
Key words: burn injury, burn depth, older adults, geriatric, mortality.

R.A. Harrison, MD, FRCPC, Department of Internal Medicine and Division of Infectious Diseases, University of Alberta, Edmonton, AB.
T.J. Marrie, MD, FRCPC, Department of Internal Medicine and Division of Infectious Diseases, University of Alberta, Edmonton, AB.

Among older adults, aspiration pneumonia is associated with higher rates of morbidity and mortality than community-acquired pneumonia. Individuals admitted to acute care from continuing care facilities are at increased risk for aspiration pneumonia. Risk factor assessment forms a cornerstone in diagnosing aspiration pneumonia syndromes. Monitoring for timely clinical response to therapy and for potential complications is an important step in the care of patients with aspiration pneumonia. Further high-quality research is needed to better delineate the effects of risk factor modification on the incidence of aspiration pneumonia. Aiming to prevent aspiration pneumonia poses health care providers with an opportunity for ongoing development, study, and implementation of preventive strategies for older adults.
Key words: aspiration, pneumonia, older adults, geriatric, risk factor.

Nikolai Steffenhagen MD, Calgary Stroke Program, University of Calgary, Calgary, AB.
Michael D. Hill, MD, MSc, FRCPC, Calgary Stroke Program, University of Calgary, Calgary, AB.

The majority of strokes occur among the older adult population. Typically, ischemic stroke can be classified by mechanism, and this is the most practical way to think about stroke since it has a direct bearing on the approach to prevention. It is not enough to simply consider that a past stroke implies a need for antiplatelet therapy or anticoagulant therapy without consideration of cause. In this article, we discuss the use of preventive strategies within the context of antithrombotics and according to stroke mechanism.
Key Words: stroke prevention, geriatric, octogenerian, vascular risk factors, carotid stenosis, atrial fibrillation.

Hannah I. Lipman, MD, Hertzberg Palliative Care Institute, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY, USA.

Diane E. Meier, MD, Hertzberg Palliative Care Institute, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY, USA.

Nausea and vomiting are common problems in the care of the older palliative care patient. Depending on the population studied, incidence is as high as 60%. Distress associated with nausea and vomiting may be relieved in the majority of cases by careful determination of the underlying cause and selection of one or more antiemetic agents. Pathophysiology of nausea and vomiting involves complex interactions among multiple neurotransmitter systems. Antiemetic agents work via modulation of neurotransmitter signalling. Pharmacologic agents are reviewed and geriatric dosing recommendations are made.

Key words: palliative, end of life, geriatric, nausea, vomiting