Addressing Renal Impairment among Aging Adults

I am always pleased when we focus on renal disease among older adults, because for the past few years I have been heavily involved in the administration of a dialysis rehabilitation program for older patients at the Toronto Rehabilitation Institute. The program has been successful primarily because of the brilliant clinical leadership of a nephrologist, Vanita Jassal, who is also well trained in geriatrics and is the co-author with Dr. Gemini Tanna of our new web exclusive feature. Kudos also have to go to Professor Dimitri Oreopoulos, one of the most renowned nephrologists in the world (and a Canadian!), who recognized the impact of the aging of the dialysis population over 20 years ago. To enter a dialysis unit in 2007 is very similar to entering a geriatric day hospital, as so many of the patients are older adults. The unit managed by Dr. Jassal is attuned to the complex medical and rehabilitation needs of older adults, and has a high success rate in getting patients back to their own homes.

Despite the success in rehabilitating older patients on dialysis, the issue of end-stage renal disease is still overwhelming. We obviously need more emphasis on instituting proper measures to slow progression of chronic kidney disease once it starts. To achieve this, doctors need to recognize early evidence of renal impairment and institute appropriate therapies. This requires the use of a classification system that is practical in day-to-day clinical practice. This is the thrust behind our web exclusive article “Chronic Kidney Disease Classification” by Drs. Gemini Tanna and Sarbjit Vanita Jassal. Another focus article is on “Disorders of Potassium Homeostasis” by Dr. Vijay Rao and Dr. Madhav Rao. Our CME article this month is on one of the commonest of renal disorders and is entitled “Metabolic Evaluation and Management of Older Adults with Kidney Stones” by Dr. Richard Norman.

We have our usual group of excellent articles on other geriatric topics. Our CVD column is on “Aortic Dissection in Older Adults” by Dr. George D. Oreopoulos, and our dementia column is entitled “Frontotemporal Dementia” by Drs. Simone Pomati, Francesca Clerici, Stefano Defendi, Silvia Bovo, and Claudio Mariani. Our Drugs & Aging column addresses the difficult topic of “Warfarin Drug Interactions among Older Adults” and is by Andrew Liu and Dr. Carmine Stumpo. Given the seriousness of the problem, I am particularly pleased to see that this month’s Gastrointestinal Disease column offers “A Rational Approach to Constipation” and is by Dr. Shawna Silver, Dr. Hershl Berman, and Laura Brooks. Our Cancer column on “Distress--the Sixth Vital Sign in Cancer Care” is by Drs. Barry D. Bultz, Bejoy C. Thomas, Douglas A. Stewart, and Linda E. Carlson. And last, our Preventative Care article is by a group whom I am fortunate to work with at times: “The Seniors Wellness Clinic: An Interprofessional Health Promotion and Disease Prevention Care Model” by Lina Medeiros, Debbie Kwan, Carol Banez, Beatrise Poroger-Edelstein, Kitty Mak, Keegan K. Barker, and Rory Agellon.

Finally, it’s my pleasure to announce that Geriatrics & Aging is now formally affiliated with the Canadian Society for the Study of the Aging Male (CSSAM). As an association of physicians and health care professionals collaborating on research and public awareness initiatives about the full spectrum of changes that aging men experience, CSSAM and our journal share an educational mission. We are Canada’s leading medical publication dealing with issues specific to an aging population, and we too work to disseminate information on all conditions that affect the health of this growing population segment. We are confident that this alliance will promote greater awareness and understanding of the health of men as they age, and we are excited about the potential of this partnership to contribute to physician education and improvement of care.

Enjoy this month’s journal.

Barry Goldlist