Age-Associated Issues in Mens Health

Our Senior Editor, Shabbir Alibhai, focuses his main research interests on cancer in the aging, in particular prostate cancer in the older man. I initially had my doubts about a geriatrician treading on a urologist’s territory. Are not most men with prostate cancer seniors? Certainly the urologists were factoring this into their management plans. Perhaps unsurprisingly, Dr. Alibhai has discovered that throughout Ontario many men are being denied optimal management of prostate cancer simply on the basis of age. We should take nothing for granted when it comes to health care for the aging. As well, there is evidence that at any age men are more reluctant to consult physicians than are women. Persistent ageism in our medical culture and traditional male reluctance to consult doctors make the topic of Men’s Health a natural question for Geriatrics & Aging to tackle.

Those of us who enjoy watching sporting events have noted that medications for erectile dysfunction (ED) might replace the beer industry as the most frequent sponsors. Beer companies present a universe in which sexual activity seems inevitable if you select the right brew, but the pharmaceutical advertisements remind us that this is not necessarily true as we age. This consumer-oriented advertising leaves out the crucial first step to follow in a man with ED, namely, making an accurate diagnosis. Drs. Muammer Kendirci and Wayne Hellstrom address this in “The Diagnosis and Investigation of Erectile Dysfunction in the Older Man.” Dr. Peter Pommerville discusses the specific medications available for ED in “Drug Treatments for Erectile Dysfunction: An Update.” Just as common a problem in older males is that of benign prostatic hyperplasia (BPH). Surgery is not always required for BPH, and side effects of surgery are not rare (and they include ED!). Therefore much effort has been put into advancing the medical care for men with this condition. Drs. David Mobley and Neil Baum bring us up to date in “Medical Management of Benign Prostatic Hyperplasia in Older Men.” When I was involved in a randomized trial of management of fractured hips a decade ago, it became apparent early on that a substantial number of the fractures occurred in men (approximately 25% in our series). The topic of osteoporosis in men has become “hot” recently, and Dr. Wojciech Olszynski discusses this in “Osteoporosis in Men: Myth or Fact?” Our final focus article addresses the issue of men who are widowers. Although more women than men face widowhood (women live longer, and often marry older men), men often are bereft of many skills required for independent living . Drs. Dale Lund and Michael Caserta discuss these issues in “Older Men Coping with Widowhood.”

Our articles on other aging-related themes include Dr. David Fitchett’s discussion of “An Approach to the Diagnosis of New Onset Chest Pain in Older Adults”; recall that cardiovascular disease is still the number one cause of death in the aging. Our Senior Editor and frequent contributor, Dr. D’Arcy Little, continues his discussion on management of dementia-associated family strife in “Family Therapy in the Context of Families with Older Members and Members with Dementia: Part II,” and our final article from Dr. Ian Tsang “Diagnosis and Management of Asymptomatic Hyperuricemia and Gout in Older Adults”.

Enjoy this issue,
Barry Goldlist