Judith Glaser, DO, Resident, Physical Medicine and Rehabilitation, New York University School of Medicine, Rusk Institute of Rehabilitation Medicine, New York, NY, USA.
Lydia Rolita, MD, Instructor, Section of Geriatrics, Department of Medicine, New York University School of Medicine, Bellevue Hospital Geriatric Clinic, New York, NY, USA.

The number of over-the-counter (OTC) medications is increasing as more prescription medications are being switched to OTC status. Many older adults rely on self-management of medications to treat common medical conditions such as the common cold, pain, diarrhea, and constipation. Although OTC medications are regulated by the U.S. Food and Drug Administration and Health Canada, many people are unaware of proper dosing, side effects, adverse drug reactions, and possible medication interactions that may not be clearly labelled. This article reviews the major side effects of common OTC medications and how to recognize these adverse effects, and provides health care professionals with information to offer to older adults and their caregivers about safe OTC medication use.
Key words: over-the-counter, self-medication, older adults, side effects, patient education.

Julie Lemieux, MD, MSc, FRCPC, Adjunct Professor, Department of Medicine, Université Laval, Centre des maladies du sein Deschênes-Fabia, Centre d’hématologie et d’immunologie clinique, Unité de recherche en santé des populations, Hôpital St-Sacrement du Centre Hospitalier affilié de l’Université Laval, Québec, QC.
Louise Provencher, MD, MA, FRCSC, Associate professor, Department of Surgery, Université Laval, Centre des maladies du sein Deschênes-Fabia, Unité de recherche en santé des populations, Hôpital St-Sacrement du Centre Hospitalier affilié de l’Université Laval, Québec, QC.

A large proportion of breast cancers in older women have positive hormone receptors. Therefore, these women are eligible to receive adjuvant endocrine therapy to decrease their chance of cancer recurrence. Over the last few years, a new class of endocrine therapy, aromatase inhibitors (AIs), has challenged the place of tamoxifen as the gold standard adjuvant endocrine agent. We will discuss randomized clinical trials comparing tamoxifen to AIs in terms of efficacy and side effects.
Key words: breast cancer, tamoxifen, aromatase inhibitors, side effects, quality of life.

Noleen Smith, 4th-year Medical Studentt, Guy's King's and St Thomas' Medical School, London, UK.
Mark Harding, MD, MBBCH(Wits), FRACGP, Dip Occ Health, BSc (QS) Hons, General Practitioner, Inverell, New South Wales, Australia.

Polymyalgia rheumatica (PMR) has a female predominance and typically occurs in people over 50 years of age. PMR usually presents as pain and stiffness in the neck, shoulder, and pelvic areas. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are used to determine disease activity. PMR is thought to be a systemic component of giant cell arteritis with aborted vasculitis. Other studies have looked at infectious agents as a causative factor. PMR is treated using a corticosteroid regime that, in turn, causes many unwanted side effects. Various methods to decrease these unwanted effects have been studied, including the addition of methotrexate as a steroid-sparing agent and intramuscular injection of methylprednisolone rather than oral prednisolone.
Key words: erythrocyte sedimentation rate, C-reactive protein, vasculitis, corticosteroids, side effects.

Robert D. Helme, PhD, FRACP, FFPMANZCA, Barbara Walker Centre for Pain Management, St. Vincent’s Hospital, Melbourne, Australia.

Narcotics are commonly required for the treatment of severe pain due to malignancy at all ages. In recent years, it has been recognized that they may also benefit older people with nociceptor pain that is unresponsive to other management strategies. In this circumstance, narcotic treatment should be undertaken in the full knowledge of relevant laws and potential for side effects in patients who are fully informed and involved in their treatment program. The choice of narcotic depends on the preference and experience of the clinician. It must be recognized that both benefits and side effects of narcotics occur at lower doses in older people than in younger cohorts.
Key words: aging, pain, narcotics, comorbidity, side effects.

Joel B. Epstein, DMD, MSD, FRCD(C), University of Illinois, College of Dentistry, Department of Oral Medicine and Diagnostic Sciences and Chicago Cancer Center, and Advocate Illinois Masonic Medical Center, Chicago, Il.

Harvey Wigdor, DDS, MS, University of Illinois, College of Dentistry, Department of Oral
Medicine and Diagnostic Sciences and Chicago Cancer Center, and Advocate Illinois
Masonic Medical Center, Chicago, Il.

Oropharyngeal cancer is a disease of adults and has a higher risk of occurrence with increasing age. In addition, oral complications of cancer therapy are more frequent and may be more severe in older patients. The prevention and treatment of oral complications of cancer therapy, with an emphasis on older adults, are reviewed in this report.

Key words: oropharyngeal, cancer, palliation, radiation, side effects.