Preventing and Treating Influenza in Older Adults

Roger E.Thomas,MD, Ph.D., CCFP, MRCGP, Professor, Department of Family Medicine, University of Calgary, and Cochrane Coordinator, University of Calgary, Calgary, AB.

Recent evidence has shown that vaccination against influenza is effective in reducing the complications of influenza (pneumonia, hospitalization for influenza or pneumonia, and deaths due to influenza or pneumonia) for those 60 years and over living in long-term care facilities (LTCs) during periods of high viral circulation if the vaccine has a good match to the circulating strain. Vaccination was found to be similarly effective for those 60 and over living in the community. There is further evidence that health care workers should be vaccinated for their own benefit, as vaccination is demonstrably effective for healthy adults under 60, and most health professionals are under 60.There is some evidence that vaccination of these workers may provide additional protection for residents of LTCs from the complications of influenza. Influenza can be detected by rapid office-based tests and should be used when the pretest probability of influenza is less than 30%. The evidence suggests that oseltamivir and zanamivir are effective in reducing the symptoms of cases and reducing infections in households and contacts of cases.
Keywords: influenza, older adults, vaccination, prevention of influenza, antivirals.

Cancer Chemotherapy in the Older Cancer Patient

Lodovico Balducci, MD, Professor of Oncology and Medicine, University of South Florida College of Medicine and H. Lee Moffitt Cancer Center and Research Institute; Director, Division of Geriatric Oncology, Department of Interdisciplinary Oncology; Tampa, FL, USA.

The need for physicians to manage cancer in older patients is increasingly common. Cytotoxic chemotherapy for lymphoma, cancers of the breast, of the colorectum, and of the lung may be as effective in older individuals as in younger adults provided that patient selection is individualized on the basis of life expectancy and functional reserve rather than chronologic ages; the doses of chemotherapy are adjusted to the Glomerular Filtration Rate (GFR); prophylactic filgrastim or pegfilgrastim are utilized to prevent neutropenic infections; and hemoglobin is maintained at 120gm/l.
Keywords: Cancer, aging, older adult, chemotherapy, toxicity.

Safe Foreign Travel for the Older Adult

Patrice Bourée, MD, Head of the Department of Tropical Medicine, Bicetre Hospital (AP-HP); Paris-XI University, Paris, France.

The older population continues to increase; these individuals generally have substantial leisure time and are in good mental and physical health. As a result, they take the opportunity to travel. To avoid unnecessary risks, trips should be carefully planned with regard to updating immunizations according to the destination. Some older individuals suffer from chronic diseases which, though not a contraindication to travel, should be considered. Their medication should be reviewed with regard to the climate; there may be a need for specific travel medication such as chemoprophylaxis of malaria. It may be necessary to seek the advice of different specialists related to the patient’s medical problem. With careful planning, older adults shall remember only the pleasant moments of the trip.
Key words: immunization, travel, older adults, infectious disease, advice.

Headaches in the Older Adult

Marek Gawel, MB BCh FRCPC, Department of Medicine (Neurology), Sunnybrook and Women’s Health Sciences Centre, Toronto, ON.

Headache has been classified in an exhaustive classification by the International Headache Society Classification Committee. As people age the presentation of headaches may change, making them more difficult to classify and diagnose. In addition, secondary causes of headache become more common and need to be rigorously sought out. This article describes some of the types of headaches found in older adults.
Key words: headache, older adult, tumour, arteritis, primary headache, secondary headache.

Ophthalmic Interventions to Help Prevent Falls

John G. Buckley, PhD, Senior Research Fellow, Vision & Mobility Laboratory, Department of Optometry, University of Bradford, Bradford, UK.
David B. Elliott, PhD, MCOptom, FAAO, Professor of Clinical Vision Science, Department of Optometry, University of Bradford, Bradford, UK.

There is mounting evidence that visual impairment is significantly associated with the increased incidence of falling in the older adult. Surprisingly, the leading causes of visual impairment in the aging adult population are correctable and due to undercorrected refractive errors and/or cataract. This highlights that, to reduce fall risk, older people should be encouraged to have regular eye examinations to detect and subsequently correct such problems as early as possible.
Key words: falls prevention, visual impairment, ophthalmic intervention, older adult.

Treatment of Pain in the Older Adult

Hershl Berman, MD, FRCPC, Department of Internal Medicine, Department of Psychosocial Oncology and Palliative Care, University Health Network, Toronto, ON.
Shawna Silver, BASc, PEng, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON.

Pain in the older adult can present unique challenges. Cognitive impairment and polypharmacy can make assessment and treatment difficult. An interdisciplinary team that includes family caregivers is essential. A rational approach to the ambulatory older patient with nociceptive pain would be to begin with regularly dosed acetaminophen, then add an NSAID if appropriate. The next step would be to add a low-dose opioid. If the patient uses a sufficient quantity of the opiate, dosing should be spread out throughout the day. Once a stable dose is reached, one can use a sustained-release formulation. Nonopioids should be continued throughout the titration process.
Key words: pain, analgesia, opioids, older adult, pain assessment.

Primary Care Prevention of Suicide among Older Adults

Marnin J. Heisel, PhD, C.Psych, Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Paul S. Links, MD, FRCP(C), Arthur Sommer Rotenberg Chair in Suicide Studies, Suicide Studies Unit, Department of Psychiatry, University of Toronto/St. Michael’s Hospital, Toronto, ON.

Older adults have high rates of suicide worldwide. Suicide rates increase with advancing age, and older adults typically use highly lethal means of self-destruction. In addition, suicidal older adults tend to pursue treatment in primary care rather than mental health settings, but current limitations in the primary care system potentially restrict suicide prevention in older patients. We briefly review the epidemiology of late-life suicide and suggest modifications in primary care to better address the psychosocial needs of at-risk older adults, supported by research on suicide risk and resiliency, clinical assessment and treatment options, and collaborative models of primary medicine and mental healthcare.
Key words: suicide, suicide ideation, suicidal behaviour, older adults, primary care.

Nonpharmacological Treatments for Older Adults with Depression

Pharmacotherapy of Depression in Older Adults

The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme

Beyond Sad Mood: Alternate Presentations of Major Depression in Late Life