Robert E. Coffee, MD, MPH, Clinical Instructor, Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, USA.
Tara A. Young, MD, PhD, Assistant Professor, Jules Stein Eye Institute, David Geffen School
of Medicine, University of California, Los Angeles, USA.

Age-related macular degeneration (AMD) is the leading cause of blindness among older adults in North America. This article reviews the clinical spectrum, risk factors, pathophysiology, and potential therapeutic options for this disease. Despite significant advances in the treatment of certain forms of AMD, there is currently no cure for this degenerative condition. The substantial personal, social, and economic burden of AMD requires that those who provide care to older adults have a general understanding of this cause of blindness. It is important for the ophthalmologist and primary care physician to address modifiable risk factors for the progression of AMD such as poor cardiovascular status and smoking, which may worsen visual loss. In addition, educating patients and their families regarding risk factors and potential treatment options may greatly benefit those affected by AMD.
Key words: blindness, geriatric, age-related macular degeneration, choroidal neovascularization, ranibizumab, bevacizumab.

Jeffrey Schiff, MD, FRCP(C), Instructor, Division of Medicine, University of Toronto; Division of Nephrology and Multi-Organ Transplant Program, Toronto General Hospital, Toronto, ON.

Due to the excellent outcomes of renal transplantation, there is an increasing number of people surviving with, or receiving a transplant, at an older age. While the transplant centre usually manages the immunosuppression and renal problems, these individuals also require primary care. This article will review the common health issues that primary care physicians encounter routinely among these patients. Common problems include managing cardiovascular risk factors, screening for malignancy, vaccinations, treatment of uncomplicated infections, and bone disease. Important drug interactions will be reviewed. Communication between the primary care physician and the transplant centre will also improve care of these patients.
Key words: renal transplantation, primary care, cardiovascular disease, drug interactions, chronic kidney disease.

Zena Moore, RGN, MSc, FFNMRCSI, Health Research Board of Ireland, Clinical Nursing and Midwifery Research Fellow, Royal College of Surgeons in Ireland, Dublin, Ireland.
Seamus Cowman, PhD, MSc, FFNMRCSI, P.G Cert Ed (Adults), Dip N (London), RNT, RGN, RPN, Professor and Head of Department, Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.

Pressure ulcers are common, costly, and adversely affect quality of life. Nutritional status is one risk factor that predisposes individuals to the development of a pressure ulcer. The impact of nutritional supplementation is reflected in the reduced incidence of pressure ulcers; however, the evidence is limited. The precise role of nutritional supplementation in pressure ulcer healing is less clear, yet a trend towards healing has been suggested. Patients should have their nutritional status monitored carefully. If difficulties arise, these should be detected early, and if it is not possible to increase the intake of normal food and fluids, then advice should be sought from the dietitian.
Key words: pressure ulcers, risk, prevention, treatment, nutrition.

Wey Leong, MSc, MD, Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, ON.
Alexandra M. Easson, MSc, MD, Department of Surgical Oncology, Princess Margaret Hospital and Mount Sinai Hospital, University of Toronto, ON.
Michael Reedijk, PhD, MD, Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, ON.

Melanoma must be considered in the differential diagnosis of any skin lesion in older adults. With the incidence of melanoma increasing in general and even more so among older people, more older adults are being diagnosed with melanoma than in the past. Among older adults, melanomas display more aggressive histological features with worse prognosis and treatment outcomes than among younger individuals. Furthermore, older individuals have fewer surgical and medical treatment options because of age-associated comorbidities. This article reviews the epidemiology and management of melanoma with emphasis on the older adult population.
Key words: older adults, melanoma, aged, cancer, skin neoplasm.

Jenny Rogers, MD, Psychiatry Department, Postgraduate Education, University of British Columbia, Vancouver, BC.
Bonnie S. Wiese, MD, Psychiatry Department, Postgraduate Education, University of British Columbia, Vancouver, BC.
Kiran Rabheru, MD, CCFP, FRCP, Clinical Associate professor, Psychiatry Department, University of British Columbia, Vancouver, BC.

Alcohol, recreational drugs, over-the-counter, and prescription medications may cause a range of cognitive impairments from confusion to delirium, and may even mimic dementia. Moderate to high alcohol consumption is one of the often overlooked risk factors for development of dementia and cognitive impairment among older adults. Substances such as opioids, benzodiazepines, and anticholinergics pose a particular risk of cognitive impaiment and the risk increases when these are combined with multiple medications, as polypharmacy is common in patients over 65. A substance-induced dementia may have a better prognosis compared to other types of dementia, as once the instigating factor is gone, the cognition often improves.
Key words: Alcohol related dementia, geriatric substance abuse and dependence, polypharmacy, anticholinergic adverse effects, cognitive impairment.

Robert J. Hinchliffe, MD, MRCS, Clinical Lecturer in Vascular Surgery, St George’s Regional Vascular Institute, St George’s Hospital and St George’s University of London, London, UK.
William Jeffcoate, FRCP, Professor, Foot Ulcer Trials Unit, Department of Diabetes and Endocrinology, Nottingham University Hospitals, City Hospital Campus, Nottingham, UK.

Individuals with ulceration of the foot should be identified and referred urgently to a specialist. Unfortunately there is little formal health care education in diabetic foot ulceration and often no specialist referral pathway. We discuss the common modes of presentation of patients with diabetes and foot ulcer. The clinical implications of a range of symptoms and signs will be explained, including the most common diagnostic pitfalls in everyday primary care practice.
Key words: diabetes, peripheral vascular disease, ulcer, vascular surgery, peripheral arterial disease, diabetic foot.

Jeffrey A. Fialkov, MD, MSc, FRCSC, Assistant Professor, Division of Plastic Surgery, Department of Surgery, University of Toronto; Staff Plastic Surgeon, Sunnybrook Health Sciences Centre, Toronto, ON.

This article reviews surgical and nonsurgical rejuvenation techniques as they relate to the anatomic changes that occur with facial aging. An understanding of the changes that occur to the facial soft tissues and their support structures over time and with exposure to the elements facilitates individualized treatment optimization for older adults seeking facial rejuvenation. In addition, treatment optimization must take into account the patient’s underlying medical status and personal psychosocial concerns.
Key words: facial rejuvenation, cosmetic surgery, facial aging, noninvasive rejuvenation, photoaging.

Kristen Davidge, MD, Plastic Surgery Resident; Candidate, Master of Surgical Science, Department of Surgery, University of Toronto, ON.
Joel Fish, MD, MSc, FRCS(C), Burn Surgeon, Ross Tilley Burn Unit, Sunnybrook Health Sciences Centre; Chief Medical Officer, St. Johns Rehab Hospital; Associate Professor, Department of Surgery, University of Toronto; Director of Research, Division of Plastic Surgery, University of Toronto, Toronto, ON.

Burn injury among older adults will result in significant morbidity and mortality despite the many advances in burn treatment. Many adult burn units in North America admit and treat a significant number of older adults so understanding the issues and problems specific to this age group is important. Older adults experience specific problems with wound care, and if the injury is large, they will require critical care interventions during the course of treatment. Despite the advances in wound care and critical care that have occurred, the mortality rates of older adults with burn injuries remain quite high. This article reviews the literature on specific issues for older adults that need to be considered when treating older adults with burn injury.
Key words: burn injury, burn depth, older adults, geriatric, mortality.

Foy White-Chu, MD, Geriatric Fellow, Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Madhuri Reddy, MD, MSc, Department of Medicine, Director of the Chronic Wound Healing Program, Hebrew Rehabilitation Center; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA; Director, Wound Healing Clinic, Lahey Clinic, Burlington, MA, USA.

The skin of older adults undergoes intrinsic aging and is susceptible to multiple ailments. Both comorbidities and environmental issues increase the risk for particular skin diseases among older adults who live in long-term care facilities. This article looks at four common skin conditions frequently found among older adults living in long-term care facilities, and reviews methods of treatment and prevention.
Key words: skin, wound, skin tear, scabies, incontinence dermatitis.

Shen-Yang Lim, MBBS, FRACP, Movement Disorder Centre, University of Toronto, Toronto Western Hospital, Toronto, ON.
Susan H. Fox, MRCP (UK), PhD, Movement Disorder Centre, University of Toronto, Toronto Western Hospital, Toronto, ON.

Parkinson’s disease (PD) is characterized by the presence of bradykinesia, rigidity, and rest tremor. Nonmotor symptoms are also very common in PD and may result in significant disability. Many approaches are available to reduce symptoms. In this article we provide an update on the management of PD. We also discuss the limitations of current treatments.
Key words: Parkinson’s disease, treatment, motor response complications, nonmotor, nondopaminergic.