Nutrition is a key factor in successful aging. Eating well can help older adults maintain their health and independence. A healthy, well-nourished senior is more likely to feel good, stay well and be able to contribute as a vital member of their family and community.

Many seniors are interested in healthy eating and will make significant changes in their food choices in an effort to maintain and improve their health.¹ Dietitians offer the following sound advice to older adults motivated to stay well by eating well:

• Emphasize whole or enriched grain products such as bran cereals, multigrain bread, barley and brown rice;
• Drink plenty of fluids to assist digestion and prevent dehydration;
• Add colourful fruits and vegetables to stimulate appetite and provide essential vitamins and minerals;
• Help strengthen bones by improving intake of calcium and Vitamin D. Choices include milk, yogurt and cheese;
• For high-quality protein, include foods such as beef, poultry, fish, eggs, tofu and legumes;
• Choose lower fat foods more often, add less fat in cooking and at the table;
• Eat and drink enough to maintain a healthy weight.

Most importantly, seniors are encouraged to stay active and make healthy eating a pleasurable part of their daily lives.

For many older adults, physiological, functional and environmental realities of aging interfere with healthy eating.

Ahmed Al-Badr, MBBS, FRCSC, Clinical Fellow
Harold P. Drutz, MD, FRCSC, Professor and Head of Division, Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, ON.

Pelvic organ prolapse (POP) refers to protrusion of the pelvic organs into, or out of, the vaginal canal. It is the result of damage, both direct and indirect, to the vagina and its pelvic support system. Direct injuries include detachments and lacerations of the connective tissue support system or stretching and tearing of the levator ani muscles, most commonly as a result of vaginal delivery. Indirect injury includes hypoestrogenic atrophy and denervation. POP may involve the urethra, bladder, uterus, intestine and rectum.¹ (Figure 1).

Normal Pelvic Support System in Females
It is primarily the pelvic diaphragm, the endopelvic fascia and the vagina that provide support for the pelvic organs (Figures 1 and 2). The pelvic diaphragm is made up of a bilateral paired group of striated, posteriorly fused levator ani muscles and its coverings. The urethra, vagina and the rectum pass through an anterior separation between the levator ani, called the levator hiatus, as they exit the pelvis (Figures 3 and 4).

Cynthia M. Westerhout, MSc^1,2 and Eric Boersma, PhD¹
From the ¹Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands and the ²University of Alberta, Edmonton, AB.

Introduction
The chain of events leading to acute coronary syndromes (ACS), including unstable angina (UA) and non-ST-segment elevation (NSTE) or ST-segment elevation myocardial infarction (STEMI), is triggered by the disruption of an atherosclerotic plaque, which leads to the formation of a platelet-rich thrombus within a coronary artery.^1,2 The inhibition of platelet aggregation is fundamental to the treatment of these patients; however, standard antiplatelet agents such as aspirin do not completely obstruct this activity. Advances in understanding the pathophysiology of ACS have to the recognition of the activation of the glycoprotein IIb/IIIa (Gp IIb/IIIa) receptors on platelets as the final common pathway leading to platelet aggregation. With this target in mind, pharmacological treatment of ACS has been propelled into a new era with agents that completely inhibit platelet aggregation.

Serge Gauthier, MD, FRCPC, Neurologist, McGill Centre for Studies in Aging, McGill University, Montreal, QC.

Introduction
The advent of cholinesterase inhibitors (CI) as regular prescription drugs for the treatment of Alzheimer disease (AD) in mild to moderate stages has created opportunities for a proactive role among primary care practitioners with interest in a geriatric practice. The Canadian Consensus Conference on Dementia original report,¹ and its update,² clearly support the role of primary care physicians in the diagnosis and treatment of AD. A new challenge is the assessment of response to CI in individual patients. This review will examine the evolving expectations of response to treatment since 1986, when tacrine was first described as an effective drug,³ and will conclude with current realistic goals at therapeutic doses of donepezil, rivastigmine and galantamine--improvement in apathy peaking after three months of therapy and one year of stability for cognitive, functional and behavioural symptoms, followed by a decline parallel to natural history.⁴

Responders in Randomized Clinical Studies
The early descriptions of the response to CIs such as tacrine, included 'return to playing golf,'³ which set treatment expectations to a return to previous complex activities. A Canadian double-blind multicentre study did not find such dramatic effects.

Chris MacKnight, MD, MSc, FRCPC, Division of Geriatric Medicine, Dalhousie University, Halifax, NS.

Introduction
Vascular dementia is common, and currently there is no accepted therapy aimed at the cognitive symptoms. Prevention of further strokes is, of course, well established.¹ Evidence is accumulating that the cholinesterase inhibitors, proven therapy in Alzheimer disease (AD), may also be of use in vascular dementia (VaD). This paper will summarize that evidence.

Epidemiology of Vascular Dementia
Vascular dementia can be diagnosed when there is a high degree of suspicion that cognitive impairment and stroke are related. Various criteria exist, which unfortunately do not overlap to any great extent, but all share several features.² These include: the presence of stroke, either clinical or found on neuroimaging; the presence of focal neurologic signs, such as asymmetric power or a positive Babinski response; and a characteristic course, with a sudden onset or stepwise progression. For the highest degree of confidence in the diagnosis, a temporal relationship between the stroke and the dementia is required.

In most surveys of older adults, vascular dementia is the second most common cause of dementia in the community, after AD. In Canada, the prevalence of VaD is 1.5% in people 65 and over, and 5.1% for AD.³ Other surveys have found similar values.

June M. Chan, ScD, Assistant Adjunct Professor, Departments of Epidemiology & Biostatistics and Urology, University of California, San Francisco, CA, USA.

Prostate cancer is the most commonly diagnosed cancer and is second only to lung as the most fatal cancer among men in the United States. It is the ninth most common cancer in the world, with higher rates predominating in North America, Europe and Australia, and lower rates reported in Hong Kong, Japan, India and China. The main non-modifiable risk factors include age, race and family history.

The incidence of prostate cancer increases exponentially with age, with men age 75-79 experiencing an incidence rate more than 100-times greater than that of men age 45-49 (age-specific prostate cancer incidence rate for men age 75-79 = 1400/100,000 person-years; for men age 45-49 = 11/100,000 person-years).¹

African Americans have the highest recorded age-standardized rates in the world, estimated at 137 cases per 100,000 persons in 1997 according to Surveillance, Epidemiology, and End Results (SEER) data.² In contrast, the rate among Caucasians in the U.S. was 101/100,000. Europeans tended to have rates in the range of 20-50 cases/100,000.

It has been an exciting year at Geriatrics & Aging, with the formation of new alliances and major changes to the publication, including the move to a journal size format and the new indexing on the AgeLine database.

Last year, we conducted our first ever readership survey to determine how you felt about the quality and content of the publication. Thanks to last year's respondents, we were able to make big improvements to the publication for the current year.

This year, we asked how you felt about the changes that have been made. I am happy to report that the feedback was very positive, with many people particularly pleased with the change to a more 'user-friendly' journal size format. We were also excited to see that the majority of respondents regularly use our publication for making clinical decisions and consider the quality of the content as Very Good or Excellent. Feedback like this makes our jobs that much easier!

However, we were disappointed to find out that many of you were not aware that all of our clinical content is available on our website at www.geriatricsandaging.ca. Articles are indexed by topic, author and keyword, and content goes back to our first year of publication. We have also recently added a new Message Boards section, where visitors can ask questions, or participate in discussions. Drop by the site and take a look!

As promised, all respondents to the survey were entered into a draw for prizes and the winners have been selected. Insert drum-roll here please! The lucky Grand-prize winner of $1000 for the 2002 Geriatrics & Aging Reader's Survey is Dr. Roger Bunn, of Brampton, Ontario. Dr. Bunn's administrative professional Irene Theodoropolous will also walk away with $100. In close second is Dr. Jeff Tschirhart of Simcoe, Ontario, who wins $500, with $100 in prize money going to Vicki McKnight. Last, but certainly not least, is Dr. Christena Côté of Halifax, Nova Scotia and her administrative professional Marilyn Healey, who win $200 and $100, respectively. Congratulations to all of our winners!

We would also like to take this opportunity to thank everyone who participated in the readership survey. We also encourage you to contact us on a regular basis with any comments or suggestions you may have. To those of you who responded but didn't win …don't despair, you'll have another shot at the big money next year!

Nabeel AlAteeqi MD, FRCPC and Johane Allard MD, FRCPC
University of Toronto, Toronto, ON.

Introduction
Zinc is one of the essential micronutrients, and plays an important role in human nutrition and health. In 1961, Prasad first recognized zinc deficiency as the cause of dwarfism and hypogonadism among iron-deficient adolescent Iranian village boys.^1,2

Zinc deficiency occurs in individuals and populations with diets low in sources of readily bioavailable zinc, such as red meat, and high in unrefined cereals that are rich in phytate. The elderly population is potentially vulnerable to zinc deficiency because of decreased intake of food energy, protein, vitamins and minerals, and increased intake of carbohydrates.^3,4

In this review, we discuss the importance of zinc to humans, as well as the causes, clinical features and management of zinc deficiency in the elderly population.

Importance of Zinc
Zinc is an essential mineral, present in most systems of the human body, and plays a role in stabilization of cell membranes, tissue regeneration and protein synthesis. It also serves as a structural component of at least 70 metalloenzymes. Examples of zinc metalloenzymes are carbonic anhydrase, alkaline phosphatase, alcohol dehydrogenase and zinc-copper superoxide dismutase.

In addition, zinc is needed for growth, normal development, DNA synthesis, RNA conformation, immunity, neurosensory function and other important cellular processes.

Jenny F.S. Basran, BSc, MD, and David B. Hogan MD, FACP, FRCPC
Division of Geriatric Medicine, University of Calgary, Calgary, AB.

Introduction
Recently, there has been growing interest in the use of vitamins for the treatment of various health conditions. One study has estimated that 35-54% of older Canadians take some form of vitamin or mineral supplement.¹ Oxidative stress has been theorized to be an important contributor to select conditions, particularly those involving the cardiovascular and central nervous systems. Vitamin E is the only fat-soluble, chain-breaking antioxidant found in biological membranes⁴ and, therefore, has been investigated for its use in the treatment of ischemic cardiovascular disease in recent landmark studies such as the Heart Outcome Evaluation Study (HOPE)² and Heart Protection Study (HPS).³

How Does Vitamin E Work?
Vitamin E is a generic term for chemical derivatives of tocopherol and tocotrienol.⁵ There are eight naturally occurring forms, but only a-tocopherol is found in human plasma, has the highest bioactivity and is the form used for medicinal purposes. a-tocopherol is found naturally in vegetable oils, almonds, sunflower seeds, walnuts, sweet potato, liver, wheat germ and egg yolk.⁶ Synthetic forms are available as vitamin capsules and in fortified foods.

Rory Fisher, MB, FRCP(Ed)(C), Director, Regional Geriatric Program of Toronto and Interdepartmental Division of Geriatrics, Faculty of Medicine, University of Toronto, Toronto, ON.

In Canada, the sustainability of the health care system is a major issue. Two commissions have been established to address the future of health care.^1,2 Improvements in technology and changes in the delivery of health care have led to major restructuring of the system. Acute hospital beds and the length of hospital stays have decreased with the concomitant expansion of ambulatory services. The aging population, which is increasing dramatically in Canada, particularly with regard to the oldest old, is a major priority policy issue in these discussions.³ However, the current management of the elderly in acute hospitals is of concern. In the United Kingdom, an enquiry into the care of older people in acute wards in general hospitals entitled "Not because they are old" found that problems existed with older patient and relatives' dissatisfaction with the care, numerous deficiencies in physical environments, clear evidence of staff shortages and concerns about nutrition.⁴ Problems were also identified with preserving dignity, interactions with staff, insufficient training, discharge planning and the accessibility of services in the community. In addition, a recent study by Health Canada on unmet needs for health care reported, an estimated 7% of Canadians, or about 1.