Irving E. Salit, MD, Director of Immunodeficiency Clinic, Division of Infectious Diseases, Toronto General Hospital; Associate Professor, University of Toronto, Toronto, ON.

Kaposi’s sarcoma (KS) is a malignancy closely associated with human herpesvirus-8 (HHV-8). KS occurs in immunocompromised subjects—those with HIV infection or after immunosuppressive therapy—but it also occurs without obvious immune deficiency (older men of Mediterranean origin or in central Africans). The incidence of KS in Acquired Immunodeficiency Syndrome (AIDS) has markedly decreased in recent years. Treatment depends on the predisposing condition and the extent of disease. Common management options include no therapy, reversal of immunosuppression, local radiation, and systemic chemotherapy.

Key words: Kaposi’s sarcoma, malignancy, HIV, AIDS, transplant.

Robert W. Teasell, MD, FRCPC, Physical Medicine and Rehabilitation, Lawson Health Research Institute, University of Western Ontario, London, ON.
Jeffrey W. Jutai, PhD, Cpsych, Physical Medicine and Rehabilitation, Lawson Health Research Institute, University of Western Ontario, London, ON.

Stroke rehabilitation is best provided by a specialized interdisciplinary team, and the benefits of such a program in improving functional outcomes and reducing disability have been well established in multiple randomized controlled trials (RCTs). There is also evidence that the intensity of therapy is important. The risk of not providing stroke rehabilitation, established in one RCT, is a marked increase in death and dependency for moderate to severe stroke patients. Rehabilitation is best provided early to take advantage of post-stroke brain plasticity. Increasing age has an impact on stroke recovery, and very old patients respond better to a slower, less intensive approach to rehabilitation. Insufficient attention is often given to the importance of assistive devices.

Key words: stroke rehabilitation, interdisciplinary stroke rehabilitation unit, older adult, assistive devices.

Christopher B. Johnson, MD, FRCPC, University of Ottawa Heart Institute, Ottawa, ON.

Older patients have a high prevalence of heart valve disease and prosthetic heart valves, and are therefore at particularly high risk for endocarditis. Streptococcus viridans and Staphylococcus aureus are the most common pathogens in older patients with endocarditis. While antibiotics may cure endocarditis, surgery is required on occasion to treat complications of endocarditis such as heart failure due to valvular regurgitation, systemic and cerebral emboli, and persistent bacteremia. Endocarditis can be accurately diagnosed in aging patients using clinical, microbiological, and echocardiographic criteria. Early diagnosis and prompt institution of antibiotic therapy can result in excellent outcome among older patients with endocarditis.

Key words: endocarditis, older adults, echo, heart valve, bacteria.

David B. Hogan, MD, FACP, FRCPC, Professor and Brenda Strafford Foundation Chair in Geriatric Medicine, University of Calgary, Calgary, AB.

Dementia is a common condition that places its victims at risk for injury. This article provides an overview of home safety for those with dementia. A conceptual approach to this management challenge is the Home Safety / Injury Model described by Hurley and colleagues. I focus on two common safety concerns: wandering and falls. Unfortunately, most recommendations are based on “common sense” (i.e., what seems reasonable). Whether these approaches actually decrease the likelihood of harm is largely unknown. It is anticipated that future research will lead to evidence-based recommendations.

Key words: dementia, home safety, wandering, falls.

Isabelle J. Dionne, PhD, Faculty of Physical Activity and Sports, University of Sherbrooke; Research Centre on Aging, Geriatric Institute of Sherbrooke University, Sherbrooke, QC.
Martin Brochu, PhD, Faculty of Physical Activity and Sports, University of Sherbrooke; Research Centre on Aging, Geriatric Institute of Sherbrooke University, Sherbrooke, QC.

There is a high prevalence of obesity in older adults up to the age of 80. While women generally gain body weight during the menopausal transition, men tend to accumulate an excess of fat mass earlier in life for as yet unknown reasons. Consequently, an increasing proportion of older adults are now obese. Obesity’s association with metabolic diseases such as metabolic syndrome, type II diabetes, and cardiovascular disease is widely recognized. However, recent evidence shows that, in older adults, obesity is also related to functional impairment and decreased quality of life. This review addresses the actual prevalence and definition of obesity in older adults, the energy-balance equation, and the known consequences of obesity. Finally, the heterogeneity of obesity in older adults regarding its association with metabolic diseases and functional capacity will be discussed, as well as how obesity treatment should be conducted in this population.

Key words: obesity, metabolic syndrome, diabetes, weight loss, impaired functional capacity.

George P. Chandy, MD, MSc, Department of Medicine, University of Ottawa, Ottawa, ON.
Shawn D. Aaron, MD, MSc, Department of Medicine and the Ottawa Health ResearchInstitute, University of Ottawa, Ottawa, ON.

Chronic Obstructive Pulmonary Disease (COPD) has been increasing in prevalence over the past several decades. The impact of COPD on the health status of Canadians will continue to be a major issue, despite declining rates of smoking, as physiologic manifestations of COPD may only be evident decades after the initiation of smoking. Given the delay between the initiation of smoking and the development of significant disease, COPD is primarily a disease of the older population. While a cure for COPD is not available, a number of medications have been noted to have a significant impact on symptoms, exercise tolerance, and quality of life.

Key words: COPD, treatment, management, older adults.

David Fitchett, MD FRCP(C), St Michael’s Hospital, University of Toronto, Toronto, ON.

As a response to recent clinical trials of low-density lipoprotein (LDL) lowering, the Adult Treatment Panel III (ATP III) has proposed new thresholds and targets for treatment. In addition, the population that is considered to benefit from LDL lowering has been extended to include the diabetic and the older patient. This article reviews the clinical trial evidence, and the new recommendations, and provides commentary with special reference to management of the older person.

Key words: cardiovascular disease, LDL cholesterol, statin therapy, older patients, diabetes.

Post-Stroke Depression

Ricardo E. Jorge, MD, Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
Robert G. Robinson, MD, Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.

In most western countries, 0.2 % of the population suffer a stroke each year. One-third of them die over the next year, one- third remain permanently disabled, and the other third make a good recovery. Depression is one of the most common emotional disorders associated with cerebrovascular disease. Longitudinal studies of stroke patients have shown that about 20% of these patients will develop major depression and another 20% will develop minor depression during the first year after stroke. Depression has also been demonstrated to significantly effect clinical recovery and mortality and, more important. Post-stroke depression responds to antidepressant treatment.

Key words: stroke, mood disorders, antidepressants, cognitive disorders, disability.

Colin P. Derdeyn, MD, Associate Professor, Mallinckrodt Institute of Radiology and the Departments of Neurology and Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA.

The brain requires the continuous delivery of oxygen and glucose for normal function. Even brief interruption or impairment of this supply can cause permanent injury, most dramatically and catastrophically in the form of stroke. There is emerging data that in addition to stroke, microvascular arterial obstructive disease may be a common cause of dementia. With normal aging, and as an effect of a number of diseases common in older adults such as hypertension, several pathological conditions of the brain vasculature may develop. This brief review will discuss a few common cerebrovascular diseases of older adults and recent data regarding their treatment. These conditions include intracranial aneurysms, atherosclerosis and atherosclerotic stenosis, and vascular dementia.

Key words: intracranial aneurysms, atherosclerosis, stroke, brain vasculature, vascular dementia.

Mitchell Sabloff, MD, Assistant Professor of Medicine, Ottawa Hospital, Ottawa, ON.

Non-Hodgkin’s lymphoma is on the rise in the older population. Traditional therapies have had limited impact upon this illness because they are compromised by toxicity and, in many cases, patients’ performance status is suboptimal at initial presentation. There has been some progress recently in addressing these issues with novel therapeutic options, permitting the delivery of more effective therapy while still limiting the toxicity.

Key words: non-Hodgkin’s lymphoma, immunotherapy, treatment, aging.