Ian K. Tsang, MB, FRCPC, Clinical Professor, Division of Rheumatology, Faculty of Medicine, University of British Columbia, Vancouver, BC.

Gout is more prevalent in older adults than middle-age adults, and it affects women almost as commonly as men. An important clinical consideration regarding gout is that while hyperuricemia is commonly associated with gouty arthritis, a diagnosis of asymptomatic hyperuricemia does not generally require treatment. In addition, the clinical presentation and course of gout in older patients differ from the typical cases of middle-aged patients. Moreover, older gout patients present a challenge for physicians who manage them because of the high incidence of comorbid conditions and the likely occurrence of reduced renal function among this age group. This article reviews the diagnosis and management of asymptomatic hyperuricemia and gout in the older adult.
Key words: gout, hyperuricemia, NSAID, allopurinol, arthritis.

Dale A. Lund, PhD, Professor of Gerontology & Sociology, University of Utah, Salt Lake City, UT, USA.
Michael S. Caserta, PhD, Associate Professor of Gerontology & Health Promotion & Education, University of Utah, Salt Lake City, UT, USA.

Although men are less likely than women to outlive their spouses, 27% of men age 65 and over in Canada are widowed and in the U.S., 43% of men over age 85 are widowed. Rather than relying on cultural stereotypes about how men cope with widowhood and bereavement, research findings can be used to provide a more accurate description of their process of adjustment, identify their most common difficulties, and offer valuable suggestions for effective ways to maintain and restore a high quality of daily life.
Key words: widowhood, widowers, grief, bereavement, coping.

Wojciech P.Olszynski, MD, PhD, FRCPC, Clinical Professor of Medicine,University of Saskatchewan, Director, Saskatoon Osteoporosis Centre, Saskatoon, SK.

Though osteoporosis occurs less frequently in men than in women, it is nonetheless a significant medical problem. Osteoporotic vertebral fractures in particular are as common for men as for women, and about one-third of all hip fractures occur in men. As a consequence of fragility fractures, the associated morbidity and mortality are higher in men than women, particularly after fracture of the hip. Idiopathic osteoporosis is common; however, secondary causes are found in about 50% of cases. Bone density measurements should be advised for every man over 65 years of age and for younger men in the presence of osteoporosis risk factors. For practical purposes, the use of T-score <= 2.5 for men over age 65 should be used for the diagnosis of osteoporosis.

Key words: osteoporosis, men, fracture, diagnosis, treatment

Epidemiology
Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture.

D’Arcy Little, MD, CCFP, lecturer and Academic Fellow, Department of Family and Community Medicine, University of Toronto; Director of Medical Education, York Community Services; 2002 Royal Canadian Legion Scholar in Care of the Elderly, Toronto, ON.

Part II of this series briefly reviews the literature on the success of family therapy in families with dementia. A case from the author’s practice (with significant details modified to conserve privacy) is then presented with a view toward applying family therapy. Finally, as the author has an interest in medical education, a proposal on how to integrate family therapy for families with dementia into an educational program is briefly described. The author welcomes comments and suggestions at darcy.little@geriatricsandaging.ca.
Key words: dementia, Alzheimer’s disease, family therapy, family, Systems Theory.

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

The incidence of coronary heart disease increases with advancing age. Although older patients may develop classical symptoms of ischemic heart disease, other symptoms such as dyspnea, syncope, and fatigue are often the dominant presenting features of angina and myocardial infarction. The present discussion aims to heighten awareness of the atypical nature of myocardial ischemic symptoms in the older adult and to suggest a structured approach to facilitate achieving a more accurate diagnosis.
Key words: chest pain, myocardial ischemia, dyspnea, coronary artery disease, infarction.

Muammer Kendirci, MD, Tulane University, School of Medicine, Department of Urology, Section of Andrology and Male Infertility, New Orleans, LA, USA.
Wayne J. G. Hellstrom, MD, FACS, Tulane University, School of Medicine, Department of Urology, Section of Andrology and Male Infertility, New Orleans, LA, USA.

Sexual dysfunction in the older man is common and has a significant impact on quality of life. In the aging man, erectile dysfunction (ED) has been encountered frequently due not only to associated comorbidities such as heart disease, hypertension, medications, diabetes, smoking, and depression, but also as a result of the aging process itself. Aging may impair molecular and structural components of erectile function. The introduction of effective oral erectogenic drugs has led to increased awareness of sexual issues and advancement in the methods used by clinicians to diagnose ED. Over the last twenty years, the approach for identification and evaluation of ED has transformed from invasive techniques to patient self-reporting and minimally invasive office procedures.

Key words: erectile dysfunction, aging, diagnosis, evaluation.

Colin A. Barry, MD, FRCPC and Marino Labinaz, MD, FRCPC, University of Ottawa Heart Institute, Ottawa, ON.

Cardiovascular disease remains the number one cause of mortality in Canada. Persons over 65 represent the most rapidly growing demographic group in Canada. These factors will result in a significant increase in the total number of cardiovascular cases in the next several decades. Coronary revascularization procedures such as coronary artery bypass grafting and percutaneous coronary interventions have steadily increased over the past decade and will continue to do so as the population ages. Several studies have demonstrated that older patients derive significant benefit in terms of reduced morbidity and mortality, but these procedures are often underutilized in this patient group.

Key words: coronary artery bypass grafting, percutaneous coronary intervention, cardiovascular disease

Introduction
Cardiovascular disease remains the number one cause of mortality in Canada, representing 36% of all deaths in Canada (1999) with death from coronary artery disease accounting for 19.

Gordon E. Searles, OD, MD, MSc, FRCPC, FACP, Internal Medicine and Dermatology, Western Canada Dermatology Institute, Edmonton, AB.

Practitioners are commonly asked about issues of skin and skin disorders. While many skin lesions are benign, it is becoming increasingly important for clinicians to be able to distinguish benign lesions from premalignant or malignant lesions. The goal of this article is to describe the most common forms of benign lesions in older patients and suggest various treatment strategies.

Key words: melanoma, pigmentary, macules, keratosis, ephelides.

Mohammed Al-Omran, MD, MSc, and Yaron Sternbach, MD, Division of Vascular Surgery, Toronto General Hospital and the University of Toronto.

Arterial occlusive disease of the lower extremities is an important cause of disability in older adults and those with risk factors for atherosclerosis. The process may be asymptomatic or manifest as a progression from claudication to ulceration. Identification of patients at risk is vital to careful surveillance and early intervention. Revascularization remains the mainstay of therapy for critically ischemic limbs. Catheter-based techniques such as angioplasty are useful for focal disease. Conventional bypass surgery remains the mainstay of therapy for more extensive disease with ulceration and may be supplemented by adjunctive plastic surgery procedures for soft tissue coverage and limb salvage. Amputation is performed when reconstruction is not feasible or in the setting of severe progressive infection. The current article provides a more detailed review of lower extremity ischemia.

Key words: Peripheral arterial occlusive disease (PAOD), atherosclerosis risk factors, bypass, angioplasty, patency rates.

D’Arcy Little, MD, CCFP, Lecturer and Academic Fellow, Department of Family and Community Medicine, University of Toronto, Toronto, ON.

Dermatophytes are fungi that require keratin for growth and thus are restricted to the hair, nails and superficial skin.1 Dermatophytoses are referred to as “tinea” infections and are also named for the site of the body affected. Such infections can be spread by direct person-to-person contact (anthropophilic organisms), by contact with animals (zoophilic organisms) or with the soil (geophilic organisms). Onychomycosis, fungal infections of the nails, accounts for one-third of fungal skin and nail infections.2 The purpose of this article is to briefly review the diagnosis and management of common fungal infections of the skin and nails.

Key words: Dermatophytes, Tinea corporis, Tinea pedis, Tinea cruris, Tinea unguium.