Maida J. Sewitch, PhD, Assistant Professor, Department of Medicine, McGill University, and the Divisions of Gastroenterology and Clinical Epidemiology, The Research Institute of the McGill University Health Centre, Montreal, QC.
Caroline Fournier MSc, Research Associate, Division of Clinical Epidemiology, The Research Institute of the McGill University Health Centre, Montreal, QC.

Colorectal cancer (CRC) is a commonly diagnosed cancer and a leading cause of cancer deaths in Canada and the industrialized world. According to cancer registries, incidence varies by age, geographical location, site, and time. CRC screening reduces both CRC incidence through removal of premalignant polyps and CRC deaths through early detection and treatment. Health Canada considers CRC an ideal target for mass screening of individuals 50 years of age and older. This article reviews the epidemiology of CRC and the reasoning behind the development of screening guidelines for persons 50 years of age and older. Various Canadian and U.S. guidelines are detailed. Routine screening of average-risk individuals is advocated. Finally, the review highlights trends in patient utilization of CRC screening as well as the role of screening in an aging population.
Keywords: aging, colorectal cancer, epidemiology, screening, adenomatous polyps.

Lodovico Balducci, MD, Professor of Oncology and Medicine, University of South Florida College of Medicine and H. Lee Moffitt Cancer Center and Research Institute; Director, Division of Geriatric Oncology, Department of Interdisciplinary Oncology; Tampa, FL, USA.

The need for physicians to manage cancer in older patients is increasingly common. Cytotoxic chemotherapy for lymphoma, cancers of the breast, of the colorectum, and of the lung may be as effective in older individuals as in younger adults provided that patient selection is individualized on the basis of life expectancy and functional reserve rather than chronologic ages; the doses of chemotherapy are adjusted to the Glomerular Filtration Rate (GFR); prophylactic filgrastim or pegfilgrastim are utilized to prevent neutropenic infections; and hemoglobin is maintained at 120gm/l.
Keywords: Cancer, aging, older adult, chemotherapy, toxicity.

Yosuke Wakutani, MD, Centre for Research in Neurodegenerative Diseases, Departments of Medicine, University of Toronto, and Toronto Western Hospital Research Institute, Toronto, ON.
Peter St. George-Hyslop, MD, Centre for Research in Neurodegenerative Diseases, Departments of Medicine, University of Toronto, and Toronto Western Hospital Research Institute, Toronto, ON.
Ekaterina Rogaeva, PhD, Centre for Research in Neurodegenerative Diseases, Departments of Medicine, University of Toronto, and Toronto Western Hospital Research Institute, Toronto, ON.

There are ~200 human diagnostic categories presenting as or accompanying dementia (interested readers may investigate the database Online Mendelian Inheritance in Man, a catalog of human genes and genetic disorders, at www.ncbi.nlm.nih.gov/ genome/guide/human/). Many forms of dementia are associated with deposition of different aberrant proteins in the brain. Familial aggregation in Alzheimer’s disease (AD), frontotemporal dementia (FTD), and other forms of dementia implies the presence of inherited susceptibility factors. Many forms of dementia remain genetically unexplained; however, linkage analyses suggest that most of them are complex disorders with several underlying genetic factors. Here we provide an update on known genes responsible for dementia with the strongest focus on AD and FTD, which are the most common forms of dementia.
Key words: dementia, Alzheimer’s disease, gene, APP, APOE, frontotemporal dementia.

Silja Majahalme, MD, PhD, FESC, Cardiologist and Clinical Hypertension Specialist, Appleton Heart Institute/Appleton Cardiology Associates, Appleton, WI, USA.

Heart failure (HF) is an increasing problem in the older adult population, specifically among women. The majority of health care expenses are generated in the last few years of life, and hospitalization for HF is one of the major medical conditions influencing the expenditure. The nature of women’s HF differs from men: coronary artery disease is the most common etiologic factor for HF in men while women more often suffer from hypertensive heart disease, which results in stiffness of the left ventricle with relaxation problems, and diastolic HF. Most commonly there is a long history of poorly controlled hypertension. In acute situations these patients often present with florid edema and congestion along with significantly elevated blood pressure levels, which are both challenging to treat. This short review covers issues related to gender differences in etiology and epidemiology of HF, and evaluates current evidence for drug therapies.
Key words: epidemiology, heart failure, gender, myocardial infarction, hypertension.

Tara Snelgrove BSc, MSc, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL.
Proton Rahman MD, MSc, FRCPC, Associate Professor of Medicine, Department of Medicine, Division of Rheumatology, Memorial University of Newfoundland, St. John’s, NL.

Rheumatoid arthritis is the most common etiology for inflammatory arthritis in the older population, with an estimated prevalence of 2%. An older individual with inflammatory polyarthritis usually falls into one of two categories. The first consists of patients with well-established long-standing disease, whose course is often confounded by end organ damage and toxicity related to antirheumatic drugs. The other category comprises patients with late-onset inflammatory polyarthritis, whose presentation is often nonspecific and, thus, more elusive to diagnose. Systemic lupus erythematous can also occur in the older adult; it is less prevalent than rheumatoid arthritis and is associated with multiple organ involvement, including musculoskeletal symptoms.
Key words: rheumatoid arthritis, systemic lupus erythematosus, inflammatory polyarthritis, late-onset disease.

Peter G. Passias, MD, 4th year resident, Tufts Affiliated Hospitals Orthopedic Surgery Residency Program, Medford, MA, USA.
James V. Bono, MD, Clinical Professor of Orthopedics, Tufts University School of Medicine; Director of Education, New England Baptist Hospital, Medford, MA, USA.

Total hip arthroplasty (THA) is one of the most commonly performed and successful operations in orthopedic surgery in terms of clinical outcome, implant survivorship, and cost-effectiveness. The average age for a patient undergoing a THA is 66 years. As life expectancy continues to increase in developed nations and the percentage of the population that is older than 65 years rises, THA surgery will be more frequently performed. This change in demographics is clinically relevant as the indications, risks involved, and outcomes are not identical to those of younger THA candidates. Osteoarthritis is by far the most common diagnosis among patients undergoing primary elective THA. Other common diagnoses include rheumatoid arthritis, other types of inflammatory arthritis, post-traumatic arthritis, and osteonecrosis of the femoral head. Patients that are candidates for THA have radiographic evidence of hip joint degeneration together with the clinical symptoms of disabling pain and functional limitation despite adequate nonsurgical management. The following article attempts to summarize some of the key issues regarding THA in an older population.
Key words: total hip arthroplasty, osteoarthritis, avascular necrosis, hip fracture, older population.

The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme.htm

Kevin D. Gross PT, PhD, Boston University Clinical Epidemiology Research and Training Unit, and the Department of Medicine at Boston Medical Center, Boston, MA, U.S.A.
David J. Hunter MBBS, PhD, Boston University Clinical Epidemiology Research and Training Unit, and the Department of Medicine at Boston Medical Center, Boston, MA, U.S.A.

Despite the increasing prevalence of symptomatic knee osteoarthritis, many uncertainties exist pertaining to its management. Many putative risk factors are characterized by excessive loading of vulnerable joint structures. Clinical examination includes assessment of knee function and the influence of modifiable risks such as malalignment, muscle strength, and obesity. Knee braces, footwear, exercises, and dieting are prescribed for the purpose of improving the distribution of loads on the knee, and reducing the likelihood that osteoarthritis (OA) and its symptoms will worsen. In this conservative approach, pharmaceuticals of low toxicity are preferred and given only when other methods fail to achieve functional improvement.
Key words: knee osteoarthritis, mechanical risk factors, nonpharmacologic management, physiotherapy, joint replacement.

Timothy Daniels, MD, FRCSC, Associate Professor, University of Toronto, Toronto, ON.
Eran Tamir, MD, Department of Orthopaedic Rehabilitation, Sheba Medical Center, Tel-Hashomer, Israel.

Neuropathic foot complications are increasing in frequency, and surgery is becoming recognized as an important adjunct to their treatment and prevention.
The development of a diabetic foot ulcer is a multifactorial process; however, the presences of obvious and/or subtle foot deformities are being recognized as a significant contributing factor.
Off-loading of the affected area is the standard of care and commonly results in healing the noninfected neuropathic ulcer. Methods of off-loading can be broadly categorized as external (nonweightbearing, casting, braces, orthotics, and shoes) or internal (surgical intervention to correct the deformity).
Reconstructive surgery can prevent foot complications when conservative methods fail. By correcting the musculoskeletal deformity, the areas at risk are off-loaded so that the prevention of ulcer becomes less dependent on protective footwear and patient compliance.
Key words: Diabetic foot, ulceration, off-loading, surgery, reconstruction.

Joseph F. Coffey, BSc, MD, PGY4 Dermatology, University of Alberta, Edmonton, AB.
Gordon E. Searles, OD, MD, MSc, FRCPC, Assistant Clinical Professor; Program Director, University of Alberta, Edmonton, AB.

As the population ages, the corresponding rise in incidence of skin cancer and photodamaged skin necessitate skin assessments of older patients in the dermatology clinic. Sallowness, wrinkles, solar lentigos, and other benign conditions reflect extensive ultraviolet damage to the skin, and provide a background of mutagenesis for skin cancer formation. Some treatments available for photodamaged skin are cosmetic and only available in a dermatology or plastic surgery office setting. However, there are many treatments that improve sun-damaged skin as well as prevent progression to skin cancer formation; these tools are available in the primary care physician’s office. This article addresses ablative and nonablative treatment options for sun-damaged skin and encourages the promotion of sun-safe behaviours, including use of protective clothing and sunscreen.
Key words: photoaging, therapy, prevention, cosmetic, nonablative, ablative.

Patricia K. Long, FNP-C, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.
David W. Ollila, MD, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.

Proper management of patients with biopsy-proven melanoma is vitally important. Patients with melanoma in situ, invasive melanoma <1 mm thick, and invasive melanoma >1 mm thick should have surgical resection margins of 5 mm, 1 cm, and 2 cm, respectively. All patients with melanomas >1 mm should be offered a sentinel node procedure, the most important prognostic variable in this group of patients. All patients with metastatic melanoma in the sentinel node should undergo a complete therapeutic lymphadenectomy.
Key words: melanoma, margin of resection, sentinel node biopsy.