Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

One of the challenges faced by those of us who practice geriatric medicine or through another specialty is helping family members understand the hodgepodge of medical literature especially as it is reported by internet/Google searches rather than careful reviews of the peer reviewed literature. Even in the latter there is a wide range of opinions which even for physicians sometimes presents a challenge in how we make our recommendations. This is especially the case when dealing with dementia.
Keywords: dementia, burden, stress, fear, guilt, families.

Liesel-Ann Meusel¹, PhD, Ekaterina Tchistiakova^2,3, BSc, William Yuen^4,5, BSc, Bradley J Macintosh^2,3, PhD, Nicole D Anderson^1,6, PhD, and Carol E Greenwood^4,5, PhD
¹Rotman Research Institute, Baycrest Centre, Toronto, ON. ²HSF Centre for Stroke Recovery, Sunnybrook Research Institute, Toronto, ON. ³Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON.
⁴Kunin-Lunenfeld Applied and Evaluative Research Unit, Baycrest Centre, Toronto, ON. ⁵Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON. ⁶Departments of Psychology and Psychiatry, University of Toronto, Toronto, ON.

Abstract
Type 2 diabetes mellitus is increasingly common, and previously unrecognized complications are emerging; namely, cognitive impairment and dementia. The mechanisms that link these factors together are still unknown, but likely result from the interplay of several variables, including vascular change, poor glycemic control, inflammation, and hypothalamic pituitary adrenal overactivity. At present, it is still too early to propose best practices related to the management of diabetes-induced cognitive change. All things considered, however, patients should be aware that proper management of metabolic and vascular complications may minimize the adverse effects of type 2 diabetes on cognitive function and quality of life.
Keywords: type 2 diabetes, cognition, dementia, vascular, metabolic.

Andrew M. Johnson, PhD, Associate Professor, School of Health Studies, Faculty of Health Sciences, The University of Western Ontario, London, ON.
Jeffrey D. Holmes, MSc(OT), PhD, Assistant Professor, School of Occupational Therapy, Faculty of Health Sciences, The University of Western Ontario, London, ON.
Kevin Wood, BHSc, Research Assistant, Health and Rehabilitation Sciences, Faculty of Health Sciences, The University of Western Ontario, London, ON.
Mary E. Jenkins, BSc(PT), BEd, MD, FRCPC, Associate Professor of Neurology, Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON.

Abstract
“Accidents” (specifically falls) are a major contributor to death among older adults (defined as individuals over the age of 65). Falls contribute to ongoing mobility issues, and make it difficult for individuals that have sustained a fall, or who are at significant risk for a fall, to live independently.
Keywords: cognition, falls, dual-task interference

Many people have come to view cardiopulmonary resuscitation (CPR) as a routine intervention following cardiac arrest, and they insist on CPR for their loved ones even when the physician explains its likely futility. Physicians who refuse a family member’s request to perform unwarranted CPR risk becoming the center of media, legal, and disciplinary scrutiny. Although CPR is largely perceived as a benign life-saving intervention, it inflicts indignity and possibly pain on a dying patient and should not be used when it is unlikely to succeed or to benefit the patient if successful. The growing acceptance of do-not-resuscitate orders for patients with advanced cancer has not spread to families of patients suffering from the late stages of other degenerative or terminal illnesses. Having blunt discussions about the true consequences and risks of CPR might foster greater willingness to abstain from administering CPR to patients unlikely to benefit.

This article was originally published by HMP Communications LLC (Annals of Long-Term Care: Clinical Care and Aging), 05/16/2011.

Kaitlyn Roland, MSc, Research Assistant, Interdisciplinary Graduate Studies, The University of British Columbia, Kelowna, BC.
Andrew M. Johnson, PhD, Associate Professor, School of Health Studies, Faculty of Health Sciences, The University of Western Ontario, London, ON.
Mary E. Jenkins, BSc(PT), BEd, MD, FRCPC, Associate Professor of Neurology, Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON.

Abstract
Burden is a psychological concept, a subjective interpretation by caregivers of the extent to which the caregiving experience impacts on one's health, social life, or financial status. In this article, we examine some of the predictors of caregiver burden, and look specifically at the burden experienced by caregivers of individuals with Parkinson's disease.
Keywords: Parkinson's disease, psychological health, physical health, caregiver burden

Lovingly Quitania Park, PhD, Alzheimer’s Disease Center, Department of Neurology, University of California, Davis, CA.
Sarah Tomaszewski Farias, PhD, Assistant Professor, Department of Neurology, University of California, California, CA.

Abstract
Mild Cognitive Impairment (MCI) is a term used to describe the transitional stage between normal aging and dementia, wherein changes in cognitive abilities are limited enough to maintain independence. Although the degree of functional impairment present does not yet warrant a diagnosis of dementia in MCI, there are subtle changes in everyday activities that may indicate the presence of an underlying neurodegenerative condition. The goal of this paper is to review the types of functional changes that are detectable in MCI and the prognostic value of assessing everyday functioning in this population.
Keywords: MCI, Functional Impairment, ADL, Dementia, Aging.

Fatemeh Akbarian, MD, Research Fellow, University of Toronto, Toronto, ON.
Hatim Al Lawati, MD, FRCPC, Cardiology Resident, Division of Cardiology, Faculty of Medicine, University of Toronto, Toronto, ON.
Mohammad Ali Shafiee, MD, FRCPC, General Internist, Nephrologist, Department of Medicine, Toronto General Hospital, University Health Network; Clinician Teacher, University of Toronto, Toronto, ON.

Abstract
Proteinuria can create one of the greatest challenges in primary practice, especially in the geriatric population. It is typically detected by dipstick urinalysis, an ordinary, non-invasive test. Proteinuria is frequently a marker of unsuspected kidney disease, progressive atherosclerosis or a systemic disease. There is a strong correlation between urinary protein excretion and progression of renal failure. Furthermore, Proteinuria is a strong and independent predictor of increased risk for cardiovascular disease and death, especially in people with diabetes, hypertension, chronic kidney disease, and the elderly. This article will review the clinical significance of proteinuria in adults, especially in the elderly population, and provide a practical diagnostic approach in addition to a summary of non-specific antiproteinuric therapy.
Keywords: Proteinuria, Microalbuminuria, Macroalbuminuria, elderly, Risk Factor.

Michael Gordon, MD, MSc, FRCPC, FRCP Edin, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System; Professor of Medicine, University of Toronto, Toronto, ON.

Abstract
Not all families work in harmony. Health care providers look to families for direction and support for those we care for especially when the patient is no longer able to make decisions for themselves. This is usually the result of a medical condition that affects the brain such as dementia, a common occurrence in those who require long-term care. When there is conflict between family members, health care and social service professionals must use their best communalization skills and sensitivities to help families resolve their differences so that the best possible care can be provided to those they love.
Keywords: sibling rivalry, conflict, decision-making.