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New approaches and thinking are required in order to meet the demands for quality care
It's hard to minimize the importance of CME in geriatrics these days hence the theme of this issue is geriatrics and I will do the 'de rigueur' exercise of stating my conflicts of interest. The first is that I am a geriatrician, and I think that care of the elderly is an issue that is the most important one facing our health care system. It's also clear that there are simply not enough trained geriatricians in Canada and the burden of providing care for elderly and aging patients has shifted to family doctors. Second, I have long been involved in continuing medical education, and I believe the experienced staff at the Journal of Current Clinical Care and HealthPlexus have the knowledge, and creativity to make a substantial contribution to the continuing education of physicians in Canada. I certainly hope they continue covering geriatric issues and topics on a regular basis.
Our Dementia article this month "Nutrition and Dementia: An Update" by Drs. Guylaine Ferland, Carol E. Greenwood, and Bryna Shatenstein, comes appropriately enough after the recent publication of important research in this area. Our Caregiving column this month is also on the theme of dementia: "End-stage Dementia and Death: Breaking the Conspiracy of Silence" by Dr. Michael Gordon and Natalie Baker.
As usual, we have several articles of interest in other areas. Our Women's Health column addresses an often overlooked topic in geriatric medicine, namely "Domestic Violence and Older Women: A Review of the Evidence" by Dr. Julie McGarry and Christine Simpson. We have an informative article on "Restorative Home Care Services" by Dr. Gill Lewin. Finally, very practical article, "Hyperhidrosis: A Common Problem" has been contributed by Drs. Christian A. Murray and Nowell Solish.
Enjoy this issue,
Barry Goldlist
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Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.
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Guylaine Ferland, PhD,Département de Nutrition, Université de Montréal; Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal, QC.
Carol E. Greenwood, PhD,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, and Kunin-Lunenfeld Applied Research Unit, Baycrest, Toronto, ON.
Bryna Shatenstein, PhD, PDt, Département de Nutrition, Université de Montréal; Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal, QC.
Abstract
While prospective epidemiologic studies have provided strong evidence linking higher intakes of many nutrients with slower rates of cognitive decline and reduced dementia risk, randomized controlled trials on supplementation with individual nutrients have largely been disappointing. In contrast, recent research points to substantial benefits for brain aging and cognition from consumption of a varied diet centred on plant-source foods, whole grains and fish, and avoidance of foods rich in saturated and trans fats. An unhealthy dietary pattern, in conjunction with obesity, low physical activity, and smoking, could contribute to a pro-inflammatory state and oxidative stress which could exacerbate risk for development of cognitive decline the metabolic syndrome, diabetes, and cardiovascular disease.
Keywords: nutrition, dementia, Alzheimer's disease, nutrients, dietary patterns.
Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.
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Gill Lewin, BSc Hons Psych, MSc Clin Psych, MPH, PhD, FAAG, Professor, Centre for Research on Ageing, Curtin Health Innovation Research Institute, Curtin University of Technology; Research Director, Silver Chain, Perth, Western Australia.
Abstract
Restorative home care services are being developed around the world. While having somewhat different origins and structures, these services share a capacity building paradigm and are designed to assist older people to maximize their functioning and reduce their need for ongoing assistance to complete everyday tasks. The evidence for the effectiveness of these services is positive though limited. In comparison to usual home care, they have been shown to increase individuals' functional abilities, their self-rated health, and their confidence and well-being, and to decrease individuals' need for ongoing care. More research is needed to address a range of unanswered questions about these services.
Keywords: home care, restorative, older adults, functional improvement, service use.
Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.
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Julie McGarry, DHSci, MMedSci, PGDip (Medical Ethics), BA (Hons), RGN, RMN, PGCHE, Associate Professor, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Derby, UK.
Christine Simpson, MA, BSc (Hons), RGN, HV (Cert), Lecturer, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Derby, UK.
Abstract
The consequences of domestic violence significantly impact the long-term health and emotional well-being of those affected. While the literature offers an insight into the scope and nature of domestic violence among younger populations, there is currently little available data regarding older women and domestic violence. This is increasingly being recognized as a significant deficit in awareness and understanding within society as a whole and, more particularly, for those responsible for support and care provision.
While research in this area may be scarce, the work that has been undertaken to date suggests that domestic violence is both a significant and an underrecognized phenomenon that has a wide-ranging impact on the lives and health of older women. It also suggests that older women's experiences of domestic violence are markedly different from those of younger women and that these differences have not been adequately acknowledged or accounted for.
Keywords: domestic violence, older women, service provision, health community, health.
Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.
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Michael Gordon, MD, MSc, FRCPC, FRCP Edin, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System; Professor of Medicine, University of Toronto, Toronto, ON.
Natalie Baker, MSc, Project Coordinator, Baycrest Geriatric Health Care System, Toronto, On.
Abstract
Physicians and other health care providers have learned to approach end-of-life care issues in individuals suffering from malignant disease quite effectively. Palliative approaches are widely accepted for this population. In contrast, individuals suffering from end-stage dementia may also benefit from suitably tailored palliative care which is much less often considered or provided. It is incumbent on health care professionals responsible for treating those with end-stage dementia to offer palliative care. This must be preceded by proper discussions between afflicted individuals, their families and their health care providers to assure that they understand the progress and prognosis of end-stage dementia.
Keywords: dementia, palliative care, end-of-life care.
Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.
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Christian A. Murray MD, FRCPC, Assistant Professor, Division of Dermatology, University of Toronto, Women's College Hospital, Toronto, ON,
Nowell Solish MD, FRCPC, Assistant Professor, Division of Dermatology, University of Toronto, Women's College Hospital, Toronto, ON
Abstract
Focal hyperhidrosis is a disorder of idiopathic excessive sweating that typically affects the axillae, soles, palms, and face. This common problem may be associated with considerable physical, psychosocial, and occupational impairments. Current therapeutic strategies include topical aluminum salts, tap-water iontophoresis, oral anticholinergic agents, local surgical approaches, and sympathectomies. Although non-surgical treatment complications are typically transient, surgical adverse events may be permanent and significant. Considerable evidence suggests that botulinum toxin type A (BTX-A) injections into hyperhidrotic areas can considerably reduce focal sweating in multiple areas without major side effects. BTX-A has therefore shown promise as a potential replacement for more invasive treatments if topical options have failed.
Keywords: hyperhidrosis, botulinum toxin, axilla.
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