William A. Banks, GRECC, Veterans Affairs Medical Center and Saint Louis University School of Medicine, Division of Geriatrics, Department of Internal Medicine, St. Louis, MO.
Marian R. Banks, Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO.

The term "nursing home" is often a misnomer. The typical nursing home is more institution than home and run more like a hospital than a household. Indeed, the American Heritage dictionary defines "nursing home" as "a hospital for convalescent or aged people" (emphasis ours). Yet many of us will spend a good portion of the last part of our lives in these institutions. How can these last years be made as enjoyable and meaningful as possible? We recently published a study examining the effects of animal-assisted therapy (AAT) on loneliness among nursing home residents. The statistical aspect of that study has been published elsewhere and it showed, among other things, that AAT can reduce loneliness.¹ However, during the course of that study we learned several lessons that couldn't be reduced to statistics. Here, we review some of the things we learned about making long-term care facilities more comfortable and enjoyable for residents.

There are many movements afoot to improve life in long-term care facilities. Pet therapy, music therapy, activities and holiday events are all assumed to be progressive programs. Since these programs are considered to be good, they are assumed to be good for all.

J. David Spence, MD, FRCPC, Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, London, ON.

Effective treatment of hypertension is even more beneficial in the elderly than in younger patients because the elderly have a higher absolute risk of vascular events. Treating hypertension not only prevents stroke, but also reduces risk of dementia. Effective blood pressure control is based on identifying and treating its physiological cause. Renal hypertension, primary hyperaldosteronism and renal tubular abnormalities such as Liddle's syndrome can be identified by measuring the plasma renin and aldosterone. Most elderly patients require diuretic therapy for control, but most will require additional drugs to achieve the lower targets now supported by evidence.
Key words: hypertension, elderly, adrenocortical, renovascular.

Roy C. Ziegelstein, MD, Department of Medicine, Division of Cardiology, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD.

Depressed mood is common after a myocardial infarction and is associated with increased mortality risk. Although mild forms of depression often resolve without specific treatment, moderate to severe depression is typically longer lasting. Depression is particularly unlikely to resolve spontaneously in those who are socially isolated, a common problem in older individuals. Patients may be screened for depression using one of several short and valid instruments. If antidepressant treatment is indicated, a selective serotonin reuptake inhibitor is preferred and should be combined with efforts to improve social support, to address medication adherence issues and to encourage participation in a cardiac rehabilitation program.
Key words: depression, myocardial infarction, screening, social support, antidepressants.

Kunin-Lunenfeld Applied Research Unit 2nd Annual Conference at Baycrest Centre for Geriatric Care, October 18, 2002

Joanna Goldberg, MSc, Associate Editor, Geriatrics & Aging.

Speakers

1. The Role of Anti-inflammatories and the Inflammatory Hypothesis in the Prevention of Alzheimer Disease
   Presented by Patrick McGeer, MD, Vancouver, BC.
2. Decreasing Dementia Risk and Minimizing Cognitive Decline with Participation in Engaging Activities and Memory Rehabilitation
   Presented by Angela Troyer, PhD, CPsych, Baycrest Centre for Geriatric Care, Toronto, ON.
3. Pharmacological Strategies for Prevention of Alzheimer Disease
   Presented by Serge Gauthier, MD, FRCPC, McGill Centre for Studies in Aging, Montreal, QC.

The goal of research at the Baycrest Centre for Geriatric Care is to provide a scientifically based understanding of diseases and disorders of the elderly. Through various educational methods, staff are trained to implement new practices in assessment, management and rehabilitation. The ultimate goal is to find preventative measures to delay or eliminate the onset of disease. Three of the eight lectures at this conference that touched on how future research, clinicians and care providers may help to achieve these goals in patients with dementia are presented in this report.

I.

Karen Beattie, BSc, PhD Candidate and Dr. A. Papaioannou, MSc, MD, FRCP(C), Associate Professor of Medicine; Department of Geriatrics, McMaster University, Hamilton, ON.
Dr. P. Boulos, MD, FRCP(C) and Dr. J.D. Adachi, MD, FRCP(C), Professors of Medicine; Department of Rheumatology, McMaster University, Hamilton, ON.

Osteoporosis is a major health concern in Canada, affecting 25% of women and 12% of men. Vertebral compression fractures, the most common of all osteoporotic fractures, are clinically diagnosed only 30% of the time. Treatment for such fractures is primarily pharmacological. However, newer, non-invasive methods of treatment, namely vertebroplasty and kyphoplasty, stabilize compression fractures, provide pain relief and even improve posture and functional ability. While vertebroplasty involves the injection of a cement product into one or more compressed vertebrae, kyphoplasty adds another step of inserting a balloon into the vertebra to re-establish original vertebral height. Clinical studies of these procedures suggest kyphoplasty provides better symptomatic relief and is associated with fewer complications than vertebroplasty. However, further randomized, controlled evidence comparing these procedures is required.
Key words: kyphoplasty, vertebroplasty, osteoporosis, vertebral fracture, compression fracture.

Dr. Neil Baum, MD, Urologist and Clinical Associate Professor of Urology, Tulane Medical School, New Orleans, LA, USA.
Dorothea Torti, Stanford University, CA, USA.

Prostate cancer is the most common cancer in men in North America. One of the treatment options is medical castration using LHRH agonists to reduce the production of testosterone by the Leydig cells in the testes. One of the side effects of this class of agents is hot flashes, which can be very disabling and can affect a man's quality of life. This article will discuss the pathophysiology of hot flashes and the treatment of this common side effect with natural and synthetic female hormones, as well as non-hormonal therapies.
Key words: prostate cancer, hot flashes, LHRH agonists, hormone therapy.

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

For the diabetic patient, hypertension more than doubles the risk of myocardial infarction, stroke and cardiovascular death, and is central in the development of diabetic nephropathy. Control of hypertension is an important vascular protective measure. However, the thresholds and goals of antihypertensive treatment have fallen as trials have shown improved outcomes with blood pressures reduced to 120/80mmHg or less. Although reducing blood pressure to the lower target levels must be the primary goal of treatment, the use of diuretics and angiotensin-converting enzyme inhibitors should be considered as first-line therapy in the diabetic patient. Both agents have been demonstrated to improve a wide range of cardiovascular outcomes compared to other antihypertensive medications.
Key words: diabetes, hypertension, nephropathy, blood pressure control.

Xiumei Feng, MD, MSc and Norm R.C. Campbell, MD, Division of General Internal Medicine, University of Calgary, Calgary, AB.

Normal blood pressure is less common than "hypertension" in the elderly, and most hypertension is primary, or essential. Nevertheless, secondary hypertension in the elderly should be considered in patients with suggestive features, as the prevalence of secondary hypertension increases with age. The most common causes of secondary hypertension in the elderly are renal parenchyma diseases, primary aldosteronism, renal vascular stenosis and drug induced. Timely recognition and treatment of secondary hypertension will reduce the morbidity and mortality associated with uncontrolled hypertension.
Key words: hypertension, high blood pressure, elderly, secondary causes.

Sheldon Tobe, MD, FRCP(C), Assistant Professor of Medicine, Nephrology, University of Toronto; Division Director Nephrology, Sunnybrook & Women's College Health Sciences Centre, Toronto, ON.
Sudha Cherukuri, MD, DNB(Nephrology), Clinical Fellow, University of Toronto, Toronto, ON.

Isolated systolic hypertension (ISH) is a common disorder in the elderly. Several studies have shown a constant positive and graded association between the level of systolic blood pressure and subsequent mortality from cardiovascular disease and stroke. ISH is defined as an elevated systolic pressure above 160mmHg and a diastolic pressure below 90mmHg. Arterial stiffening is the main cause of increasing systolic pressure in the elderly. The finding of high systolic blood pressure with diastolic below 90mmHg is a marker of higher cardiovascular risk and an indication to follow this patient more closely. The placebo-controlled SHEP and Syst-Eur trials have demonstrated that the treatment of ISH with diuretics or long-acting calcium channel blockers results in a marked reduction in cardiovascular events and stroke.
Key words: hypertension, isolated systolic hypertension, clinical trials, drug therapy, elderly.

Robert J. Petrella, MD, PhD, President, Canadian Coalition for High Blood Pressure Prevention and Control; Associate Professor and Medical Director, Canadian Centre for Activity and Aging, University of Western Ontario, London, ON.

Hypertension is the leading reason for office visits to primary care physicians and is also the leading chronic disease of aging. Given the aging demographic in Canada, its burden on the health care system will grow, making prevention and treatment of hypertension a priority. Solid evidence regarding effective pharmacological therapies in hypertension is available, yet diagnosis and treatment rates remain poor. Likewise, solid evidence regarding the effect of non-pharmacological or lifestyle interventions also is available for clinicians. Furthermore, lifestyle interventions may potentiate the effects of pharmacological therapies due to their inherent modification of positive chronic disease behaviour, resulting in improved maintenance of treatment interventions. With pressure to see many patients in the busy primary care practice, clinicians should resist the "quick-fix" approach to treating hypertension solely by pharmacological means. Consideration of lifestyle modification is worth the time in terms of obtaining sustained control of a growing population at risk.
Key words: hypertension, lifestyle interventions, behaviour change.