Vikas Kuriachan, MD, FRCP(C), Fellow, Cardiac Arrhythmia, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB.
Robert Sheldon, MD, PhD, FRCP(C), Professor, Cardiac Sciences, and Associate Dean of
Clinical Research, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB.

The implantable cardioverter defibrillator (ICD) plays an important role in primary and secondary preventions of sudden cardiac death. Several trials conducted in the past few years have shown the superiority of ICDs over drug therapy. Cardiac resynchronization therapy (CRT) is also emerging as an adjunctive treatment for heart failure, with some survival benefits as well. This article reviews the major recent clinical trials of ICD and CRT devices and summarizes their importance in contemporary cardiology.
Key words: cardioverter defibrillator, cardiac resynchronization, older adults, sudden cardiac death, cardiology.

Jagdish Butany, MBBS, MS, FRCPC, Department of Pathology, Toronto General Hospital, University Health Network; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON.
Gursharan S. Soor, BSc, Department of Pathology, Toronto General Hospital, University Health Network, Toronto, ON.
Adriana Luk, BSc, Department of Pathology, Toronto General Hospital, University Health Network, Toronto, ON.
Anna Woo, MD, FRCPC, FACC, Hypertrophic Cardiomyopathy Program, Division of Cardiology, Toronto General Hospital; Department of Medicine, University of Toronto,Toronto, ON.
Anthony Ralph-Edwards, MD, FRCSC, Division of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON.
Heather Ross, MD, FRCPC, Department of Medicine, Division of Cardiology, University of Toronto, Toronto General Hospital, Toronto, ON.

Hypertrophic cardiomyopathy (HCM) is an uncommon disease with significant consequences. Since the 1950s, major strides in understanding its etiology and pathogenesis have led to improved management and patient survival. Hypertrophic cardiomyopathy is associated with various mutations in several cardiac sarcomeric genes. Due to the complications of HCM, such as left ventricular outflow tract obstruction, diastolic dysfunction, arrhythmias, increased risk of stroke, infective endocarditis, and, most importantly, sudden cardiac death, appropriate and timely diagnosis is critical. This review summarizes current knowledge about HCM and the most appropriate investigations for persons suspected of having HCM. Treatment strategies for the disease and its complications are presented briefly.
Key words: hypertrophic cardiomyopathy, cardiomyopathy, sudden cardiac death, older adults.

The burden of heart failure is rapidly rising. Heart failure is associated with substantial mortality, morbidity, and economic cost, which disproportionately affect older adults. Heart failure among older individuals is frequently complicated by geriatric syndromes, including frailty, functional decline, cognitive impairment, and atypical clinical presentations. Understanding the nature of these geriatric syndromes and their impact on the assessment and management of heart failure is a critical component to diagnosing and delivering appropriate care to these patients. In this article we review the geriatric aspects of heart failure.
Key words: geriatric syndrome, heart failure, older adults, diagnosis, frailty.

Fatemeh Akbarian, MD, Dermatologist, Clinical Research Fellow, University of Toronto, Toronto, ON.
Vahid Ghafarian, MD, MPH, BSc.PT, Physiotherapist, Northpark Physiotherapy and Annex Retirement Residence, 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.

Treatment-resistant hypertension (TRHTN) is a common challenge in geriatric practice and a significant cause of mortality and morbidity among older adults. In this overview, we will use a case-based approach to define the magnitude of the problem, identify characteristics of individuals with TRHTN, and explore the causes of uncontrolled hypertension including technical issues, patient-related and physician-related factors, and secondary causes of hypertension. We will then provide a simple approach to the problem, illustrating straightforward diagnostic workup and therapeutic options. In our approach most of the emphasis has been given to detailed history-taking and a targeted physical examination.
Key words: resistant hypertension, hyperaldosteronism, obstructive sleep apnea, older adults.

Lina Medeiros, MSW, Social Worker, University Health Network - Toronto Western Hospital, Toronto, ON.
Debbie Kwan, MSc, Assistant Professor, University of Toronto; Pharmacist, University Health Network - Toronto Western Hospital, Toronto, ON.
Carol Banez, MAN, Clinical Nurse Specialist, University Health Network - Toronto Western Hospital, Toronto, ON.
Beatrise Poroger-Edelstein, MHSc, Manager of Elder Care, North York General Hospital, Toronto, ON.
Kitty Mak, BHthSc, Nurse, University Health Network - Toronto Western Hospital, Toronto, ON.
Keegan K. Barker, MEd, PhD(c), University of Toronto, Toronto, ON.
Rory Agellon, BSc, Dietitian (Retired), University Health Network - Toronto Western Hospital, Toronto, ON.

In light of the aging population trend and the complex needs of the aging population, there is an increasing impetus to develop innovative service delivery models that focus on health promotion and disease prevention and management, are easily accessible for older adults of diverse ethnic backgrounds, are community-oriented, and incorporate an interprofessional team approach.
This article describes the development, implementation, and evaluation of the Seniors Wellness Clinic, an innovative health promotion model of care for older adults focusing on primary and secondary disease prevention and disease management.
Key words: health services for the aged, multidisciplinary care team, program development, health promotion.

Hershl Berman, MD, FRCPC, Assistant Professor, University of Toronto Faculty of Medicine, Department of Medicine, University Health Network, Toronto, ON.
Laura Brooks, RegN, MscN, APN, Advanced Practice Nurse in Palliative Care, Department of Psychosocial Oncology and Palliative Care, University Health Network, Toronto, ON.
Shawna Silver, MD, PEng, Hospital for Sick Children; University of Toronto, Toronto, ON.

Constipation is a common complaint, especially in older adults. It results in millions of physician visits per year, with hundreds of millions of dollars spent on laxatives. Untreated it can lead to serious morbidity and can be a contributing factor in mortality. A rational approach to the patient presenting with constipation includes a detailed history, general and focused physical examination, specific investigations, and appropriate therapy. Treatment should aim to address the underlying cause, as should the choice of laxative. In general, it is best to clear out hard stool in the distal bowel before using an aggressive oral regimen.
Key words: constipation, laxatives, older adults, opioids.

Barry D. Bultz, PhD, Director, Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Cancer Board; Department of Oncology, University of Calgary, Calgary, AB.
Bejoy C. Thomas, PhD, Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Cancer Board, Calgary, AB.
Douglas A. Stewart, MD, FRCPC, Divisions of Medical Oncology and Hematology, Departments of Oncology and Medicine, Tom Baker Cancer Centre and University of Calgary, Calgary, AB.
Linda E. Carlson, PhD, Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Cancer Board; Department of Oncology, University of Calgary, Calgary, Alberta, Canada

Cancer is perceived as an illness that most frequently affects the older adult population, yet there is a dearth of research on the psychosocial aspects of cancer affecting this cohort. The effect of chemotherapy on the psychosocial sequelae in this group is moderately researched. This article discusses emotional distress across the trajectory of cancer care in the older adult population. It also identifies key milestones, times when distress is likely to peak, and the psychological, physiological, and social symptoms of distress. The benefits of psychosocial interventions are also discussed.
Key words: older adult, cancer, chemotherapy, emotional distress, 6th vital sign.

Andrew Liu, BSc Hon, BScPhm, RPh, Clinical Pharmacist, Thrombosis Service, Toronto East General Hospital, Toronto, ON.
Carmine Stumpo, BScPhm, PharmD, RPh, Director, Pharmacy and Emergency Services, Toronto East General Hospital, Toronto, ON.

Warfarin-drug interactions are often encountered in the care of older adults. Interactions may be classified as pharmacokinetic, resulting in changes in serum warfarin concentrations, or pharmacodynamic, resulting in changes in hemostasis or platelet function. Knowledge of these mechanisms of warfarin-drug interactions may help identify warfarin interactions, facilitate prescribing decisions, and assist with appropriate monitoring.
Key words: warfarin, drug interactions, anticoagulants, cytochrome P-450 enzyme system, older adults.

Simone Pomati, MD, PhD, Centre for Research and Treatment on Cognitive Dysfunctions, Institute of Clinical Neurology, Department of Clinical Sciences, Luigi Sacco Hospital, Milan, Italy.
Francesca Clerici, MD, PhD, Centre for Research and Treatment on Cognitive Dysfunctions, Institute of Clinical Neurology, Department of Clinical Sciences, Luigi Sacco Hospital, Milan, Italy.
Stefano Defendi, MD, Centre for Research and Treatment on Cognitive Dysfunctions, Institute of Clinical Neurology, Department of Clinical Sciences, Luigi Sacco Hospital, Milan, Italy.
Silvia Bovo, MD, Centre for Research and Treatment on Cognitive Dysfunctions, Institute of Clinical Neurology, Department of Clinical Sciences, Luigi Sacco Hospital, Milan, Italy.
Claudio Mariani, MD, Chair of Clinical Neurology, University of Milan; Centre for Research and Treatment on Cognitive Dysfunctions, Institute of Clinical Neurology, Department of Clinical Sciences, Luigi Sacco Hospital, Milan, Italy.

Frontotemporal dementia (FTD) is a progressive condition characterized by atrophy of the frontal and/or temporal lobes. Three main clinical syndromes have been described (behavioural variant, progressive nonfluent aphasia, and semantic dementia). The symptoms reflect the anatomical distribution of the pathological changes rather than the precise histological subtype. Frontotemporal dementia is a genetically complex disorder with a strong likelihood of inheritance, mainly transmitted as an autosomal dominant trait. Mutations in microtubule associated tau protein and progranulin have been reported in several families affected by FTD. The treatment is directed to the control of the behavioural disturbances through pharmacological and nonpharmacological approaches.
Key words: frontotemporal dementia, semantic dementia, progressive nonfluent aphasia, neuropsychology, progranulin.

George D. Oreopoulos MD, MSc, FRCS(C), Vascular Surgeon, University Health Network; Assistant Professor, Department of Surgery, University of Toronto, Toronto, ON.

Aortic dissection is the most common vascular emergency involving the aorta. Aortic dissection may present with a variety of clinical features and must be considered in order to avoid delay in diagnosis. Early CT scanning allows for the diagnosis to be confirmed and for the extent of the dissection to be determined. While proximal dissections require early surgery to prevent fatal complications, the initial treatment of distal dissections remains medical therapy with surgery or endovascular therapies being reserved for medical failures or for patients who develop specific complications. Newer endovascular treatments may ultimately alter the initial approach to distal dissections although this remains an area of controversy.
Key words: aortic dissection, clinical presentation, medical therapy, endovascular treatment, malperfusion syndromes.