The first thing to note in this edition of Geriatrics & Aging is that the term used for our focus is “Stroke.” The unusual term “cerebrovascular accident” was never endorsed by neurologists; it reflected the usual medical penchant to substitute an obtuse term for one that patients might actually understand (stroke). In this particular case, the medical term was in fact misleading as most strokes are not accidents but rather the end result of identifiable (and often modifiable) risk factors. The modern emphasis on stroke prevention and treatment is a clear triumph for patient-centred healthcare. Physicians are now finally interested in a common and devastating condition that is high on the list of our patients’ concerns. When I was a resident, stroke care often consisted of diagnosis, followed by not-so-benign neglect.
In 2004, fortunately, stroke prevention and therapy are no longer viewed as unimportant. In Ontario a long process of consultation and review has resulted in the formation of a comprehensive stroke strategy that encompasses prevention, secondary prevention, acute management, rehabilitation, and follow-up. It remains to be seen whether the guidelines that have been developed will be achieved, but at least the process has now started. In this issue, Dr. L. Creed Pettigrew’s article “Medical Therapy for Stroke Prevention in the Older Patient: What to Do When Aspirin Isn’t Enough” begins the discussion on stroke prevention. This topic is continued by Dr. David Fitchett in his article “How New Clinical Trials May Change Cholesterol Management Guidelines.” It should be remembered that, because of the intimate relationship between Alzheimer’s disease and vascular disease, measures that prevent stroke might also delay the presentation of both Alzheimer’s dementia and vascular dementia. Drs. Jorge Ricardo and Robert G. Robinson tackle the important issue of “Post-Stroke Depression” in their article, while Dr. Robert Teasell, a world leader in the area of stroke rehabilitation, and his colleague Dr. Jeffrey W. Jutai review “Rehabilitation in the Older Stroke Patient.” Dr. Colin Derdeyn’s article “Aging and the Brain Vasculature” examines some of the age-related risks for stroke. As these articles suggest, there is now level-one evidence for the benefits of stroke rehabilitation, even in older adults.
We also have our usual diverse array of interesting topics. Before HIV, Kaposi’s sarcoma was considered a disease of older men. Dr. Irving E. Salit reviews the topic in his article “Kaposi’s Sarcoma: Diagnosis and Treatment.” Drs. Christopher B. Johnson and Kwan-Leung Chan review the “Diagnosis and Management of Endocarditis in Older Adults” in their article, and Dr. David Hogan reviews community management of dementia in “Home, Safe Home: Minimizing the Risks for the Cognitively Impaired in the Community.” The revolution in management of COPD is reviewed by Drs. Shawn D. Aaron and George P. Chandy in their article “Treatment of Chronic Obstructive Pulmonary Disease in Older Adults.” Finally, Drs. Isabelle Dionne and Martin Brochu review the implications and management of the current epidemic of obesity in their article “Obesity in Older Adults.”
Enjoy this issue.
Barry J. Goldlist
