Kristen Davidge, MD, Plastic Surgery Resident; Candidate, Master of Surgical Science, Department of Surgery, University of Toronto, ON.
Joel Fish, MD, MSc, FRCS(C), Burn Surgeon, Ross Tilley Burn Unit, Sunnybrook Health Sciences Centre; Chief Medical Officer, St. Johns Rehab Hospital; Associate Professor, Department of Surgery, University of Toronto; Director of Research, Division of Plastic Surgery, University of Toronto, Toronto, ON.

Burn injury among older adults will result in significant morbidity and mortality despite the many advances in burn treatment. Many adult burn units in North America admit and treat a significant number of older adults so understanding the issues and problems specific to this age group is important. Older adults experience specific problems with wound care, and if the injury is large, they will require critical care interventions during the course of treatment. Despite the advances in wound care and critical care that have occurred, the mortality rates of older adults with burn injuries remain quite high. This article reviews the literature on specific issues for older adults that need to be considered when treating older adults with burn injury.
Key words: burn injury, burn depth, older adults, geriatric, mortality.

Bridget K. Gorman, PhD, Assistant Professor, Department of Sociology, Rice University, Houston, TX, USA.
Jen’nan Ghazal Read, PhD, Assistant Professor, Department of Sociology and Center for Health Policy Research, University of California, Irvine, CA, USA.

Men have shorter life expectancies than women in most nations around the world. The gender gap in mortality is particularly striking in high-income industrialized nations such as the United States, where women were expected to live 5.3 years longer than men in 2003 (80.1 years compared to 74.8 years). However, in recent decades this gap has been steadily shrinking in many nations. This review examines the mortality gap, primarily in the U.S. context, by providing an overview of the gender pattern in mortality, an explanation of its existence, and an assessment of how and why it has changed over time.
Key words: mortality, life expectancy, gender, smoking, cigarettes.

Adrienne H. Kovacs, PhD, CPsych, Behaviour Cardiology, Division of Cardiology, University Health Network, Toronto, ON.

Approximately 20% of older adults with cardiovascular disease (CVD) experience significant depression. Further, in a pattern consistent with the general adult population, women with CVD have double the rates of depression compared to men. Among older men and women with CVD, depression is associated with poorer cardiac outcomes, although patterns of depressive symptoms appear to differ between men and women. Treatment approaches include traditional modalities, namely psychotherapy and pharmacotherapy. Additional recommendations involve emphasizing adherence to prescribed medical and behavioural health regimens, fostering social support, and increasing referrals to cardiac rehabilitation programs as medically appropriate.
Key words: depression, gender differences, cardiovascular disease, myocardial infarction, mortality.

Karen L. Smith, MSc, Kunin Lunenfeld Applied Research Unit, Baycrest and Department of Nutritional Sciences, University of Toronto, Toronto, ON.
Carol Greenwood, PhD, Kunin Lunenfeld Applied Research Unit, Baycrest and Department of Nutritional Sciences, University of Toronto, Toronto, ON.
Helene Payette, PhD, Research Center on Aging, Health & Social Services Center - University Institute of Geriatrics of Sherbrooke, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC.
Shabbir M.H. Alibhai, MD, MSc, Division of General Internal Medicine & Clinical Epidemiology, University Health Network; Geriatric Program, Toronto Rehabilitation Institute; Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.

Unintentional weight loss is a common problem among community-dwelling older adults. Although a slight decline in body weight is considered a normal part of the aging process, clinically significant weight loss (>5% of usual body weight) has harmful consequences on functional status and quality of life, and is associated with excess mortality over a three- to twelve-month period. A variety of physical and psychological conditions, along with age-related changes, can lead to weight loss. In up to one-quarter of patients, there is no identifiable cause. A rational approach to clinical investigation of these patients can facilitate arriving at a diagnosis and minimize unnecessary diagnostic procedures.
Key words: weight loss, older adults, mortality, epidemiology, diagnosis.

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.htm

Lonn Myronuk, MD, FRCPC, Member of the Canadian Academy of Geriatric Psychiatry, President, GeriPsych
Medical Services, Inc., Parksville, BC.

Depressive symptoms in older adults are common and are associated with subjective distress, increased rates of functional impairment, and death. The natural history of depression in the aged appears to differ from that of the younger population, such that conventional criteria for diagnosis of a major depressive episode may not be met by the older patient. Yet, these subsyndromally depressed patients have equivalent levels of disability and risk of morbidity and mortality. Current thinking advises the inclusion of subsyndromal patients in treatment for depression, in contrast to earlier recommendations.

Key words: aged, depressive disorders, morbidity, mortality.

Lilia Malkin, BSc

Contrary to popular belief, heart disease is not predominantly a "male" illness: according to Health Canada, nearly 20,000 Canadian women, compared to approximately 24,000 men, died of causes related to ischemic heart disease in 1995.

As awareness of women's vulnerability to cardiovascular disease increases, so does the number of clinical studies that address potential differences between men and women in coronary heart disease (CHD) presentation, course, and treatment. Notably, Dr. Beth Abramson, Director of Women's Cardiovascular Health in the Division of Cardiology at St. Michael's Hospital in Toronto emphasized that there are many issues in cardiology where treatment is irrespective of gender. However, recent research shows that several cardiac health issues may be specific to women, such as risk perception, heart disease presentation, use of diagnostic and treatment procedures, as well as some unique risk factors.

Unfortunately, many North American women do not perceive cardiovascular disease as a considerable health risk and focus their attention predominantly on illnesses affecting reproductive organs, as well as breast cancer. However, CHD is the leading cause of death in Canadian women, especially older women. It is estimated that 1 in 3 North American women will die of heart disease, while 1 in 25 will succumb to breast cancer.