Aileen Burford-Mason, PhD, President, Holistic Health Research Foundation of Canada, Toronto, ON.

Accumulated research evidence suggests that vitamin D deficiency or insufficiency has profound implications for health and well-being, compromising immune responses and increasing the risk for osteoporosis, arthritis, diabetes, depression, cancer, and cardiovascular disease. Older adults, especially those who are housebound, are at increased risk for vitamin D deficiency. In addition to sun avoidance and the use of sunscreen, age, ethnicity, and obesity are risk factors for vitamin D deficiency. This article discusses the use of serum 25-hydroxyvitamin D to assess vitamin D needs and outlines current recommendations on appropriate interventions to improve vitamin D status in older adults.
Key words: vitamin D, older adults, supplements, UVB exposure, immunity.

Ann Kolanowski, PhD, RN, FAAN, Elouise Ross Eberly Professor of Nursing, The Pennsylvania State University, University Park, PA, USA.
Donna M. Fick, PhD, RN, GCNS-BC, Associate Professor of Nursing, The Pennsylvania State University, University Park, PA, USA.
Linda Buettner, PhD, LRT, CTRS, Professor of Recreation Therapy/Gerontology, Department of Recreation, Tourism, Hospitality Management, University of North Carolina, Greensboro, NC, USA.

Few clinicians have an educational grounding in the use of nonpharmacological therapies for people with dementia. In this article, we explore the utility of recreational activities as one nonpharmacological intervention that has demonstrated effectiveness for reducing the behavioural symptoms of dementia. The implementation of effective recreational activities involves three components: understanding the evidence for this approach; acknowledging the need to reduce medications that have the potential to interfere with activity effectiveness; and individualizing activities so that the maximum benefit from the intervention is obtained.
Key words: dementia, activities, nonpharmacological interventions, potentially inappropriate medications, individualized care.

Jason Andrade, MD, Division of Cardiology, University of British Columbia, Department of Medicine, Vancouver, BC.
Aneez Mohamed, MD, Division of Cardiology, University of British Columbia, Department of Medicine, Vancouver, BC.
Chris Rauscher, MD, Division of Geriatric Medicine, University of British Columbia, Department of Medicine, Vancouver, BC.

Infective endocarditis (IE) is a rare but potentially devastating clinical entity with a well-delineated pathogenesis. While previously thought to be a disorder of younger individuals, older adults now represent one of the highest risk groups for the acquisition of and adverse outcomes related to IE. Prior to focusing on the updated recommendations for IE prophylaxis and the rationale behind them, we briefly review the clinical aspects of IE in the general population, as well as special considerations for older adults.
Key words: endocarditis, prophylaxis, older adults, cardiovascular disease, antibiotics.

Susan B. Jaglal, PhD, Toronto Rehabilitation Institute Chair, Associate Professor, Faculty of Medicine, Department of Physical Therapy, University of Toronto, Toronto, ON.

A wrist fracture is associated with an increased risk of another fracture and should prompt investigation for osteoporosis in both men and women. If the fracture was caused by low trauma (a fall from a standing height or less), a bone density test should be ordered. If the T score is <–1.5, pharmacological treatment with a bisphosphonate and calcium (1,500 mg/d) and vitamin D3 (≥800 IU/d) is recommended. Management should also include balance, posture, and muscle-strengthening exercises and walking, as well as a review of fall-prevention strategies.
Key words: wrist fracture, osteoporosis, diagnosis, treatment, exercise, falls.

Alison Mudge, MBBS, FRACP, Physician, Department of Internal Medicine and Aged Care, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia.
Robert Mullins, MAppSci (Clin Ex Sci), Clinical Exercise Physiologist, Heart Failure Service, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia.
Julie Adsett, BPhty (Hons), Physiotherapist, Heart Failure Service, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia.

Exercise offers significant health benefits to older people, but may also carry risks of injury and cardiovascular events. These can be minimized with appropriate screening, prescription, and monitoring of an exercise program. Tailored exercise prescription is developed in consultation with the participant, taking into account identified risks, functional limitations, and individual goals. Exercise professionals can provide valuable assistance with screening, prescription, and supervision of an exercise program, but limited access to experienced staff and supervised programs remains a significant barrier to exercise participation. Innovative models of care are required to investigate optimal participant targeting, long-term exercise adherence, and cost-effectiveness.
Key words: exercise therapy, physical fitness health services for older adults, risk assessment, patient compliance.

Simona Abid, MD, FRCP(C), Geriatric Medicine Fellow, McMaster University, Hamilton, ON.
Alexandra Papaioannou, MD, FRCP(C) MSc, Professor, Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON.

Vertebral compression fractures (VCF) are the hallmark of osteoporosis, yet two-thirds of all VCF remain undiagnosed and untreated. Both symptomatic and occult VCF are associated with considerable increases in morbidity and mortality, hospitalization rates, admissions to long-term care, and health care-related costs. These fractures increase the risk of future osteoporotic fractures, both vertebral and nonvertebral, independent of bone mineral density. Older adults have lower rates of diagnosis and treatment compared with younger patients, although clinical studies have shown the efficacy and safety of currently available therapies for osteoporosis in older adults are comparable with those in younger individuals.
Key words: vertebral compression fractures, osteoporosis, bone mineral density, antiresorptive therapy, anabolic agents.

Irwin W. Kuzmarov, MD, FRCSC, Assistant Professor, Department of Surgery (Urology), McGill University; Director of Professional and Hospital Services, Santa Cabrini Hospital, Montreal, QC; Past President, Canadian Society for the Study of the Aging Male.
Jerald Bain, BScPhm, MD, MSc, FRCPC, CertEndo, BA, Professor Emeritus, Department of Medicine, Department of Endocrinology and Metabolism, Mount Sinai Hospital; University of Toronto, Toronto, ON; Past President, Canadian Society for the Study of the Aging Male.

Sexuality and sexual activity do not end when a person reaches a certain age. Sexual desire and activity continue well into later life, and age is not a deterrent to a happy and healthy sex life. However, clinicians should be aware that the normal sexual response of men and women may change with aging. When sexual dysfunction occurs, studies show that men and women tend to view sexual dysfunction differently. Part I of this article addresses sexuality and sexual dysfunction in aging women; Part II ( will address the male side of the picture. It is crucial that family doctors be aware of sexuality in the aging couple, and be able to evaluate and manage problems that may arise.
Key Words: aging, sexual activity, sexual dysfunction, women, testosterone therapy.

Ekaterina Rogaeva, PhD, Associate Professor, Centre for Research in Neurodegenerative Diseases, University of Toronto, Department of Medicine, Toronto, ON.

There are at least four well-confirmed genes responsible for Alzheimer’s disease (AD), the most common form of dementia. In addition, many reports indicate an association between the disease and genetic variations in different gene candidates. The complexity and interpretation of these studies are discussed using, as an example, the recent discovery of the association between AD and the SORL1 gene. The knowledge obtained from AD genetics is applicable to many other forms of dementia, which are also genetically complex disorders and are almost all associated with the deposition of different aberrant proteins in the brain.
Key words: Alzheimer’s disease, gene, APP, APOE, SORL1.

Anita S. Bagri, MD, Geriatric Research, Education, and Clinical Center (GRECC), VA Healthcare System, Miami, FL, USA.
Bernard A. Roos, MD, GRECC, VA Healthcare System, Miami; Stein Gerontological Institute, Miami, FL, USA.
Jorge G. Ruiz, MD, GRECC, VA Healthcare System, Miami; University of Miami Miller School of Medicine, Miami; Stein Gerontological Institute, Miami, FL, USA.

Geriatrics education is severely limited by the paucity of trained educators and models of care for implementing the standardized and competency-building learning experiences that have been recognized during the past decade. Simulation can increase the reach, effectiveness, adoption, implementation, and maintenance of geriatrics education. Through simulation, educators can repeatedly present, with reduced faculty presence, standardized clinical scenarios to multiple learners with no threats to patient autonomy and safety. The knowledge-skill-attitudes elements addressed through simulation can include not only the historically well-tested technical and action skills but also individual cognitive and critical thought processes, team performance, and communication.
Key words: training, competency-based education, older adults, computer simulation, professional competence.