Gemini Tanna, MD, FRCPC, Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Sarbjit Vanita Jassal, MB, BCh, MD, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada

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Chronic kidney disease (CKD) is increasingly common among older adults. In the older individual, the presence of CKD is predictive of cardiovascular death, increased all- cause mortality, and progression to end-stage renal disease and the need for dialysis. Early identification of these high-risk individuals may prevent or delay such adverse outcomes. The Canadian Society of Nephrology (CSN) released a position statement in September 2006 suggesting that screening be limited to those at high risk. We recommend that clinicians follow the CSN algorithm for screening for CKD among older adults.
Key words: chronic kidney disease, estimated glomerular filtration rate, older adults, renal function, screening.

Lynne T. Shuster, MD, Women’s Health Clinic, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
Sharonne N. Hayes, MD, Women’s Heart Clinic, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
Mary L. Marnach, MD, Women’s Heart Clinic, Department of Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Virginia M. Miller, PhD, Departments of Surgery and Physiology and Biomedical Enginering and Office of Women’s Health, Mayo Clinic College of Medicine, Rochester,MN,USA.

Women in the Western world may expect to spend a significant portion of their lives in postmenopause. After menopause, women are at increasing risk for several conditions associated with aging that may or may not be related to declining hormone levels. Caring for women seeking advice and treatment for menopausal concerns presents a golden opportunity to not only identify individuals at risk for early intervention but also to address prevention and screening strategies important to sustaining health.
Keywords: cancer, cardiovascular disease, menopause, osteoporosis, screening.

Maida J. Sewitch, PhD, Assistant Professor, Department of Medicine, McGill University, and the Divisions of Gastroenterology and Clinical Epidemiology, The Research Institute of the McGill University Health Centre, Montreal, QC.
Caroline Fournier MSc, Research Associate, Division of Clinical Epidemiology, The Research Institute of the McGill University Health Centre, Montreal, QC.

Colorectal cancer (CRC) is a commonly diagnosed cancer and a leading cause of cancer deaths in Canada and the industrialized world. According to cancer registries, incidence varies by age, geographical location, site, and time. CRC screening reduces both CRC incidence through removal of premalignant polyps and CRC deaths through early detection and treatment. Health Canada considers CRC an ideal target for mass screening of individuals 50 years of age and older. This article reviews the epidemiology of CRC and the reasoning behind the development of screening guidelines for persons 50 years of age and older. Various Canadian and U.S. guidelines are detailed. Routine screening of average-risk individuals is advocated. Finally, the review highlights trends in patient utilization of CRC screening as well as the role of screening in an aging population.
Keywords: aging, colorectal cancer, epidemiology, screening, adenomatous polyps.

Jie Jin Wang, MMed, PhD, Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, Australia.
Jennifer L. Smith, BA, PhD, Australian Health Policy Institute, University of Sydney, Australia.
Stephen R. Leeder, BSc (Med), MB, PhD, Australian Health Policy Institute, University of Sydney, and The Menzies Centre for Public Health Policy, Australia.

Vision and hearing impairments are common in older people. They not only impact on the quality of life and independent living of affected individuals, but also contribute to the overall burden of aged care. Although current evidence supports screening for age-related vision and/or hearing impairments, good- quality evidence on the effectiveness of sensory interventions (e.g., treatment for eye conditions or rehabilitation for hearing loss) is lacking. Evidence from community-based randomized controlled trials is needed before implementing community-wide screening. Case-finding during primary health care can be considered. Strategies to reduce the overall burden from common disabilities, including sensory impairments, among older people are keys to achieving the goal of “aging well, aging productively.”
Key words: aging, screening, vision, hearing, sensory impairment.

Barbara Resnick, PhD, CRNP, FAAN, FAANP, Professor, University of Maryland School of Nursing, Baltimore, MD, USA.
Marcia G. Ory, PhD, MPH, Professor, Social and Behavioral Health; Director, Active for Life National Program Office, School of Rural Public Health, The Texas A & M University System, College Station, TX, USA.
Michael E. Rogers, PhD, CSCS, FACSM, Associate Professor, Department of Kinesiology and Sport Studies, Center for Physical Activity and Aging, Wichita State University, Wichita, Kansas, USA.
Phillip Page, MS, PT, ATC, CSCS, Manager, Clinical Education & Research, The Hygenic Corporation, Akron, OH, USA.
Roseann M. Lyle, PhD, Purdue University, Department of Health and Kinesiology, West Lafayette, IN, USA.
Cody Sipe, MS, Program Director, A.H. Ismail Center, Purdue University, West Lafayette, IN, USA.
Wojtek Chodzko-Zajko, PhD, Professor, Department Head of Kinesiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
Terry L. Bazzarre, PhD, Senior Program Officer, Robert Wood Johnson Foundation, Princeton, NJ, USA.

Physical activity helps to maintain function, health, and overall quality of life for older adults. It is challenging, however, for health care providers and others who work with older adults to know what type of activity to encourage older adults to engage in, and how to motivate them to initiate and adhere to physical activity and exercise over time. The purpose of this piece is to provide an overview of physical activity for older adults and provide the resources needed to evaluate older adults and help them establish safe and appropriate physical activity programs, as well as providing motivational interventions that will eliminate the barriers to exercise and optimize the benefits.
Key words: exercise, screening, motivation, self-efficacy, outcome expectations.

S. Gogov, MD, Department of Medicine, University Health Network, Toronto, ON.
Shabbir M.H. Alibhai, MD, MSc, FRCPC, Department of Medicine, University Health Network; Departments of Medicine and Health Policy, Management, and Evaluation, University of Toronto, ON.

Prostate cancer remains the most common malignancy in men. Screening remains controversial due to a lack of evidence from randomized trials that it decreases mortality. Treatment decisions are based on assigning patients to one of three risk groups (low, intermediate, or high) based on stage, tumour grade, and prostate-specific antigen level, and considering remaining patient life expectancy (affected by age and comorbidity). Men with low-risk disease can consider expectant management, surgery, or radiotherapy (either external beam or brachytherapy). In intermediate-risk patients, all options except expectant management are associated with excellent long-term survival. In high-risk patients, combining either radiation or surgery with androgen deprivation has emerged as the best option. There is no role for primary androgen deprivation for most patients.
Key words: prostate cancer, screening, treatment, surgery, radiotherapy.

Shobha Rao, MD, Assistant Professor, Department of Family Practice and Community Medicine, UT Southwestern, Dallas, TX, USA.

Impaired glucose tolerance and impaired fasting glucose (prediabetes) form an intermediate stage in the natural history of diabetes. People with prediabetes are at high risk for developing diabetes and thus are a key target group for primary prevention of the disease. A structured program of lifestyle interventions that includes weight loss and regular exercise has demonstrated benefit in delaying or preventing diabetes among people with prediabetes. Lifestyle interventions are most effective. Pharmacotherapy with metformin, acarbose, orlistat, and thiazolidinediones has also shown success in preventing diabetes, although cost effectiveness of these agents in managing prediabetes has not been assessed.

Key words: prediabetes, screening, primary prevention, impaired glucose tolerance, impaired fasting glucose.

Heather H. Keller, RD, PhD, Associate Professor, Dept. Family Relations and Applied Nutrition, University of Guelph, Guelph, ON.

Although the prevalence of malnutrition and, specifically, undernutrition are unknown among Canadian seniors, nutritional risk has been identified as a common problem. As nutritional risk can lead to malnutrition and all of its sequelae, efforts are needed to identify nutrition problems early in their course to improve the quality of life of seniors. The following article provides a variety of approaches for identifying nutritional problems, from simple indicators to a simplified and standardized nutritional assessment. Suggestions also are provided on how the practitioner can seek assistance with intervening and helping the senior to overcome these problems.
Key words: nutrition, older adults, screening, intervention, risk, weight.

Amish Parikh, MD and I. George Fantus, MD, FRCPC, Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, ON.

Microvascular complications of both Type 1 and Type 2 diabetes mellitus (DM) can be classified into three major categories: retinopathy, nephropathy and neuropathy. Numerous studies have consistently shown that the development of complications in both Type 1 and Type 2 diabetes is related to several factors. The most important ones, however, include glycemic control (as measured by hemoglobin A1c) and the duration of diabetes. This article reviews the details of screening and management of diabetic microvascular complications in older adults. It incorporates guidelines from both the Canadian and American Diabetes Associations, as well as reviews of recently published literature.
Key words: diabetes mellitus, retinopathy, nephropathy, neuropathy, screening, management.

Yoanna Skrobik, MD, FRCP(C), Director, Adult Critical Care Training Program, Université de Montreal; Associate Professor, Faculty of Medicine, Université de Montreal, Montreal, QC.

Delirium is a morbid and common complication in the critically ill patient. Its recognition is made more difficult by the inability to interview the intubated patient, and by the presence of drugs and confounding comorbidities. Delirium screening (described with the ICDSC and the CAM-ICU) with tools specifically designed for the acute care setting can help the nurse or clinician identify its presence. Risk factors for delirium in the critical care setting differ from those described in other populations. Treatment is currently empiric.
Key words: delirium, critical care, outcomes, intensive care, screening.