Irene Turpie, MB, ChB, MSc, FRCP(C), FRCP (Glas), Professor Emeritus, McMaster University, Hamilton, Ontario.
Leigh Hunsinger, BA, Medical Student, McMaster University, Hamilton, Ontario.

Africa, with its many countries and ethnic groups, has a population of 800 million people and the highest rate of growth of the older adult population in the world. Urbanization and the HIV/AIDS epidemic are changing the traditional role of older adults. The epidemiological transition from acute infections to chronic diseases is occurring more slowly in Africa than in other continents but it is occurring. Many older persons are malnourished and live in poverty. Hypertension, stroke, osteoarthritis, chronic respiratory and mood disorders are expected to increase in incidence and are increasingly being identified in a continent without the resources or infrastructure as yet to mount preventive campaigns and to treat chronic health conditions. What is known about many older Africans is that they have the capacity to age well through daily exercise and healthy diets low in processed sugar and saturated fats. Aging Africans are generally regarded with respect and dignity. There is much that needs to be done to prevent deleterious aging outcomes for older adults in that continent and there is much we can learn about healthy aging and lifestyle prevention.
Key words: aging, Africa, epidemiological transition, developing nations, HIV/AIDS.

Angela K. Troyer, PhD, CPsych, Department of Psychology, Baycrest Centre for Geriatric Care, Toronto, ON.
Kelly J. Murphy, PhD, CPsych, Department of Psychology, Baycrest Centre for Geriatric Care, Toronto, ON.

Functional decline in dementia causes increased dependence on others and negatively impacts quality of life. Emerging evidence indicates that functional debility can be delayed or minimized by promoting an active lifestyle and using memory strategies. Older adults with active lifestyles maintain higher cognitive abilities and have reduced risks of developing dementia. Furthermore, individuals with dementia show improved cognitive and functional abilities following participation in physically and mentally stimulating activities. Memory strategy application can improve situation-specific memory performance in individuals with mild cognitive impairment and dementia, and has been shown to positively impact perceptions of well-being and functional ability in these individuals.
Key words: active lifestyle, dementia, memory intervention, mild cognitive impairment, rehabilitation.

Indranil Dasgupta, MD, MPh, MBA, Clinical Assistant Professor of Medicine, Division of Cardiology, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.
Marc A. Tecce, MD, Clinical Assistant Professor of Medicine, Division of Cardiology, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.
Bernard L. Segal, MD, Professor of Medicine and Director, Division of Cardiology, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.

Disorders of the mitral valve such as mitral valve prolapse (MVP), mitral regurgitation, and, to a lesser degree, mitral stenosis are relatively common forms of heart disease. According to the Women’s Heart Foundation, MVP is the most common condition of the heart valves, and while it is more frequently diagnosed in young women, data from the Framingham study suggest that, overall, MVP affects equal numbers of men and women. These conditions often progress over years, frequently causing symptoms among affected older adults. Understanding the etiology, diagnosis, management, and treatment of mitral valve disease is vital for this population. Medical advances and other factors have allowed the general population to live longer, making mitral valve disease significantly more prevalent. An understanding of the details of the physical exam, ECG changes seen in these disorders, x-ray findings, and echocardiographic and catheterization data are critical to providing the necessary standard of care for older adults.
Key words: mitral regurgitation, mitral stenosis, mitral valve prolapse, older adults, heart failure.

Rita Moretti, MD, Clinica Neurologica, Dipartimento Medicina Clinica e Neurologia, Università degli Studi, Trieste, Italy.
Paola Torre, MD, Clinica Neurologica, Dipartimento Medicina Clinica e Neurologia, Università degli Studi, Trieste, Italy.
Rodolfo M. Antonello, MD, Clinica Neurologica, Dipartimento Medicina Clinica e Neurologia, Università degli Studi, Trieste, Italy.

Cerebrovascular disease is a potential cause of vascular dementia. Vascular dementia is not an univocal entity; it encompasses at least four types of dementia: multi-infarct, subcortical, strategic infarct, and posthemorrhage dementia. Vascular dementia does not contain cognitive problems only. There are also noncognitive behavioural alterations. The major noncognitive behavioural situations are depression, anxiety, agitation, delusions, and insomnia. Disorders such as depression, anxiety, and psychosis not only affect the quality of life of a patient but also that of the caregiver. Behavioural disturbances may also contribute to morbidity and are a major cause of institutionalization since they result in inadequate nutrition and sleep and enhance cognitive disruption. Diagnosing depression in the context of vascular dementia is challenging given the overlap of signs and symptoms between depression and dementia. Both disorders can be characterized by apathy and loss of interest, an impaired ability to think, psychomotor agitation, and psychomotor retardation.
Key words: behaviour, subcortical vascular dementia,, vascular dementia, small-vessel dementia.

Lana S. Rothenburg, BSc(Hons), Neuropsychopharmacology Research Program, Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON.
Nathan Herrmann, MD FRCP(C), Neuropsychopharmacology Research Program; Department of Psychiatry, Sunnybrook Health Sciences Centre; Department of Psychiatry, University of Toronto, Toronto, ON.
Krista L. Lanctôt, PhD, Neuropsychopharmacology Research Program; Department of Psychiatry, Sunnybrook Health Sciences Centre; Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON.

Depression is a common sequela of stroke, occurring in approximately 33% of all patients. Post-stroke depression (PSD) is associated with greater cognitive and functional impairments, excess mortality, and increased health care costs, although symptoms are often mild. Diagnosis of PSD can be made using standard clinical criteria, despite the potential overlap with the somatic and vegetative symptoms of stroke. Post-stroke depression responds to standard antidepressant pharmacotherapies, but use of tricyclic antidepressants may result in increased cardiac adverse events. Given the high prevalence and major negative impact of PSD, active screening of all stroke patients for depression and aggressive treatment is recommended.
Key words: stroke, depression, diagnosis, risk factors, treatment.

Lili Liu, PhD, Associate Professor and Associate Chair, Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB.
Alison Barnfather, MSc, Co-Director, Social Support Research Program, University of Alberta, Edmonton, AB.
Miriam Stewart, PhD, Scientific Director, Institute of Gender and Health, Canadian Institutes of Health Research; Professor, Faculties of Nursing, Medicine and Dentistry, and School of Public Health; Principal Investigator, Social Support Research Program. University of Alberta, Edmonton, AB.

In Canada, older adults are the most likely of all age groups to experience chronic health conditions. Most Canadians living with disabilities or chronic conditions and most older adults are supported by family members or close friends. Caregivers frequently describe the emotional, physical, and financial burdens associated with the caregiver role. Accessible support programs can improve health outcomes for family/friend caregivers of older adults with chronic conditions. Practitioners can use the strategies presented to help caregivers access timely and accessible support resources.
Key words: family caregivers, caregiver support, older adults, home care, chronic conditions.

Susan L. Eldred, RN, BScN, MBA, PhD candidate, University of Ottawa, Ottawa, ON.
Wendy A. Gifford, RN, PhD candidate, University of Ottawa, Ottawa, ON.

HIV/AIDS is rapidly increasing among adults age 50 and older. However, limited research has been conducted to understand the issues associated with HIV/AIDS in advancing age. This paper describes issues related to the transmission and contraction of HIV/AIDS among older adults, their complex clinical picture, and management of antiretroviral therapy, as well as social considerations. Cognizance of polypharmacy and comorbidities common with advanced age as well as the double stigmatization of age and HIV/AIDS is essential. Further research is needed to better understand the interactions between HIV/AIDS and age, and to determine effective, safe treatments and appropriate highly active antiretroviral therapy dosing in older adults.
Key words: HIV, AIDS, sexually transmitted diseases, older adults, highly active antiretroviral therapy.

Elizabeth Hazel, MD, FRCPC, PGY6 Rheumatology, McGill University Health Centre, Montreal, QC.
Michael Starr, MD, FRCPC, Director, Rheumatology Program; Assistant Professor, Department of Medicine, McGill University, Montreal, QC.

Giant cell arteritis (GCA) is the most common form of vasculitis in the older adult population. There are variable clinical presentations of this entity and no perfect diagnostic test, often making the diagnosis challenging. Prompt initiation of corticosteroids may prevent visual loss in affected individuals. Temporal artery biopsy remains the gold standard for diagnosing GCA. Patients require an individualized steroid tapering schedule to minimize side effects. Physicians caring for these patients should be aware of the potential for long-term vascular complications of GCA.
Key words: giant cell arteritis, temporal arteritis, vasculitis, ESR, corticosteroids.

Børge Sivertsen, PhD, Department of Clinical Psychology, University of Bergen, Bergen, Norway.

Chronic primary insomnia is a sleep disorder with no known secondary etiology, and the prevalence increases with advancing age. Insomnia is associated with a range of adverse consequences, both on an individual and societal level. While pharmacotherapy is still the most common form of treatment of late-life insomnia, it is associated with a number of side effects, and recent evidence shows cognitive-behavioural therapy (CBT) to be more effective in managing chronic primary insomnia. This article will discuss the development, consequences, assessment and treatment of chronic primary insomnia among older adults.
Key words: sleep initiation and maintenance disorders, aged, morbidity, treatment, insomnia.

Kerstin Stieber Roger, PhD, Assistant Professor, Department of Family Social Sciences, Faculty of Human Ecology, University of Manitoba, Winnipeg, MB.

This article discusses current research in the social sciences on end-of-life care and people living with dementia. Given the projected increase within the next twenty years of older adults living with dementia, end-of-life care for this demographic will become more relevant than ever before. The main themes emerging in the literature are discussed in this article: personhood, decision-making, counselling and spirituality, pain management, training for professionals, and settings of primary care. Recommendations for further research are offered.
Keywords: care, dementia, end-of-life, family, personhood.