Rhonda Witte, BSc

Many alterations occur within the cardiovascular system with age. Structural changes can be noted through the pathological examination of aged hearts. The identification of such changes has helped us better understand the aging process. Research is also being conducted to reveal the changes in the aging heart at the cellular level.

Young adult heart (left) with the aging heart (right)

Growth and Structural Changes

Dr. Jagdish Butany of the Department of Laboratory Medicine and Pathobiology at The Toronto Hospital, General Division, outlined findings about age-related growth and structural changes associated with hearts of otherwise healthy, physically inactive persons over 65 years of age. In an interview, Dr. Butany stated that there does not appear to be any age-related changes at the ultrastructural level. Age-related changes can, however, be noted at the microscopic level.

Cardiac Valves

As one ages, changes in the valves are noticeable, particularly those concerning the aortic and mitral valves. An increase in the thickness of the aortic and mitral valves can be seen from decade to decade.

D'Arcy L. Little, MD
Chief Resident, Family Medicine, Sunnybrook Health Science Centre, North York, Ontario.

The proportion of the population over the age of 65 is growing rapidly. Currently over 12% of the population is in this age category, and by the year 2016 this proportion will increase to almost 16% (Statistics Canada). The incidence of coronary heart disease increases with age and is the leading cause of death among the elderly. In addition, elderly patients have on average a fourfold greater mortality from first and subsequent acute myocardial infarctions (AMI) than do younger patients. As summarized by Milzman in "An Introduction to Resuscitating the Ages" (Emergency Medicine Clinics of North America, February 1996) and Rich in "Therapy for Acute Myocardial Infarction" (Clinics in Geriatric Medicine, February 1996), some of this mortality can be attributed to age, as it is an independent negative predictive factor, and to various co-morbid illnesses which often accompany age. However, recent studies indicate that much of the increase in morbidity and mortality incurred by the elderly patient experiencing an AMI may be related to under-aggressive resuscitation and management.

ABCs

The presentation of AMI in the elderly is influenced by age-related changes and pre-existing disease.

The Canadian Society of Geriatric Medicine (CSGM) now has a homepage, which can be viewed at www.canger.org. The homepage has links to several hundred other internet sites specific to geriatric clinical care and research. Educational materials and cases, geared to physicians in geriatric practice are provided, as is a listing of recent job postings for geriatricians in Canada. A bibliography of all recent peer-reviewed publications by CSGM members is posted, as is the GAIN (Geriatric Assessment and Intervention Network) database.

GAIN is a clinical trials network for members of the CSGM. It is meant to facilitate and coordinate multisite clinical geriatric research in Canada by geriatrics trained physicians, residents and fellows in geriatric medicine, recognizing that most geriatric centres have at least some assessment and research infrastructure in place. Apart from individual projects, such as the Canadian Study of Health and Aging, collaborative geriatric research in Canada has been limited to date.

GAIN is NOT meant to focus geriatric research in particular areas, but instead to facilitate geriatric research that may currently be limited by lack of funding, insufficient sample size, lack of local interest, etc.

How GAIN Works

The CSGM website allows access to GAIN. The CSGM website will promote the exchange of information, scientific skills and research ideas across the country. Research ideas and research protocols can be securely posted at the website. Research ideas can be considered 'fishing expeditions', to attract additional help with developing a research protocol, or to determine general interest in a particular project by other CSGM members. For example, CSGM members interested in a particular project would communicate by e-mail to further develop protocols and compile results.

Access to posted GAIN research ideas and protocols is limited to CSGM members, as is access to the csgm membership and the e-mail addressbook.

Membership costs $50/year and is open to Phds and physicians whose primary focus is research and/or care of the elderly.

Contact Dr. Gary Naglie, at gary.naglie@utoronto.ca, CSGM secretary treasurer to join.

Teaching cases or educational materials, monthly columns, evidence based reviews of geriatric literature and other relevant material can be posted directly on the home page, or by contacting Dr. John Puxty at puxtyj@pccc.kari.net, Dr. Mike Newnham at miken@biostats.uwo.ca, or Gaetane Blom glblom@brktel.on.ca.

Please visit the CSGM home page at www.canger.org for more details.

The United Nations General Assembly decided to observe the International Year of Older Persons "in recognition of humanity's demographic coming of age" and the promise that holds for "maturing attitudes and capabilities in social, economic, cultural and spiritual undertakings" (General Assembly resolution 47/5, 1992).

For more information, visit the United Nations website at:

www.un.org/dpcsd/dspd/iyop.htm

The following are some quotes taken from the website:

Situation of older persons

"...the transition to a positive, active and developmentally oriented view of ageing may well result from action by elderly people themselves, through the sheer force of their growing numbers and influence. The collective consciousness of being elderly, as a socially unifying concept, can in that way become a positive factor" (International Plan of Action on Ageing, 1/para. 32).

Life-long individual development

"Ageing is a life-long process and should be recognized as such. Preparation of the entire population for the later stages of life should be an integral part of social policies and encompass physical, psychological, cultural, religious, spiritual, economic, health and other factors" (International Plan of Action on Ageing, para. 25 (i)).

Multi-generational relationships

"The respect and care for the elderly, which has been one of the few constants in human culture everywhere, reflects a basic interplay between self-preserving and society-preserving impulses which has conditioned the survival and progress of the human race" (International Plan of Action on Ageing, para. 27).

Development and the ageing of populations

"Countries should recognize and take into account their demographic trends and changes in the structure of their populations in order to optimize their development" (International Plan of Action on Ageing, para.13).

Michael J. Borrie, BSc, MB, ChB, FRCPC
Chair, Division of Geriatric Medicine, The University of Western Ontario

Prevalence studies of urinary incontinence in the elderly report widely-varying rates from 4.5-44% in healthy, elderly women to 4.6-24% in healthy, elderly men. The prevalence in institutionalized people ranges from 22-90%.¹

Choice of definition, wording of the questionnaire and study population contribute to this variability. The International Continence Society has defined incontinence as a condition in which involuntary loss of urine is a social or hygienic problem and is objectively demonstrated.² Based on the symptom complex, urinary incontinence is characterized as urge, stress, mixed, overflow, functional, or iatrogenic.

Urgency urinary incontinence is the most common type and is divided into sensory or motor urgency. Ambulatory or longer-term urodynamic studies have demonstrated involuntary detrusor contractions and calls into question the notion of sensory urgency. A new classification of overactive bladders has been proposed but has not yet been resolved.³ Detrusor instability is commonly associated with neurologic conditions such as stroke or Parkinson's Disease. It can also accompany prostatic obstruction.

Chris Daniels

Canada's only national brain bank is "functioning at 50 per cent capacity right now", says the medical director of the bank.

Because of the recession and provincial cuts to research agencies, the bank went from collecting 120 brains a year to 60, director Dr. John Wherrett said of Canada's largest provider of brain tissues.

For fifteen years, the brain bank at the Toronto General Hospital, Western Division, has provided researchers brain tissue for studying neurodegenerative diseases like Alzheimer's Disease (AD) and Parkinson's Disease.

But for the last few years, the bank has been experiencing growing pains. Its main sources of income, the Medical Research Council, voluntary agencies, and the Ontario Mental Health board, had to reduce their commitment because of difficulty raising funds. This lack of funding has left the bank with fewer tissues for researchers and, without diseased tissues as well as controls for the studies, research has been moving more slowly, said Dr. Wherrett.

"We've had to pick and choose what we do," he said. "There has been a slow down in research in recent years because of massive cutbacks on top of the recession."

It's a trend he thinks will soon change.

Agustinus S. Suhardja, MD

Introduction

Dementia is reported to affect 3-11% of the population over 65 years of age, with a greater propensity among institutionalized residents.¹

Due to the increasing number of dementing illnesses in the elderly population, the prevalence of dementia can be expected to continue to rise. The evaluation and care of patients with dementia could ultimately become a major component of the health care delivery system.

Dementia by definition, is the loss of intellectual abilities previously attained. Even though memory loss is the cardinal feature, the diagnosis of dementia according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), requires at least one more intellectual deficit (language, perception, visuospatial function, calculation, judgment, abstraction, and problem solving skills) which leads to impairment in day to day functioning.

Within the last two decades, some authors have proposed that as many as 10% of dementias are potentially treatable.² It is more likely that treatable dementias occur in less than 5% of cases.

Robin Dwarka, BSc, BAA

The incidence of depression among the elderly has been widely documented in recent studies. Approximately 2% of the population over 65 years of age who remain in the community have major depression, while up to 15% show significant depressive symptoms. In institutional settings, the figures jump to over 10% having major depression, and symptoms.

With the proportion of Canadians over 65 growing rapidly, recognition and treatment of depression in senior citizens is of growing concern.

Recognizing depression in the elderly poses a unique problem because of its symptomatic links to Alzheimer's Disease (AD), according to geriatric psychiatrist Dr. Richard Shulman of Sunnybrook Health Science Centre in Toronto.

Kim Wilson, BSc, MSc

Cataract patients may now choose to have a multifocal implantable lens which corrects for distance, intermediate and near vision. During surgery, the patient's cataract or cloudy crystalline lens is removed and replaced by the foldable multifocal lens which then unfolds once positioned in the eye.

"This lens is significant to the elderly", said Dr. Allan Slomovic, Clinical Director of the Cornea and External Ocular Diseases at the Toronto Hospital (Western Division), and the Program Director in the Department of Ophthalmology at the University of Toronto. Dr. Slomovic is one of eleven ophthalmologists originally performing this surgery in Canada, and he says "this foldable lens allows for a very small incision of about 3.2 mm, which allows the eye to heal faster and the patient recovers their vision quickly."

Other foldable lenses are available, but the multifocal lens has the added advantage of correcting for distance, intermediate and near vision. The multifocal lens has a series of zones with different refractive powers, allowing the patient to see a range of distances. Each zone has different refractive powers, with zones one, three and five allowing the eyes to focus on objects at a distance, while zones two and four allow focusing of near objects.

The multifocal lens was developed by Allergan Inc. in California.

Rhonda Witte, BSc

The process of aging is familiar to every individual. Yet, despite this familiarity, it remains one of the greatest biological mysteries. We embark on the aging journey from the very moment we are born and proceed passively until our deaths. It is a concept that some find difficult to comprehend, perhaps because it is seemingly inevitable--beyond one's control.

A multitude of theories has been proposed regarding the aging process. The question "Why do we age?" has sparked interest in many research disciplines. Of particular interest are the neurological aspects of aging. Numerous examinations of the aging brain have been performed, particularly those concerning the neurodegenerative diseases of the elderly. Interestingly, studies using animal models have suggested that estrogen replacement therapy may have a role in both the treatment and prevention of dementia by assisting the regeneration and preservation of neuronal structures.¹ Close attention has also been given to the "normal" aging brain and the events that occur over a lifetime.

Along with the heart and striated muscle, the brain is the oldest part of the mammalian body. The neurons of the brain are postmitotic once differentiated and are unable to renew themselves. Thus, the brain is highly susceptible to any cellular damage that may occur with age.