Simon H.K. Huang, MD, FRCPC, Clinical Associate Professor, Division of Rheumatology, Faculty of Medicine, University of British Columbia, Vancouver, BC.
Ian K. Tsang, MB, FRCPC, Clinical Professor Emeritus, Division of Rheumatology, Faculty of Medicine, University of British Columbia, Vancouver, BC.

The two most common forms of crystal-induced arthritis among older adults are gout and calcium pyrophosphate dihydrate (CPPD) deposition disease. Gout in older adults has unique clinical features. The new case incidence is the same in males and females over age 60. Upper limb and polyarticular involvement are not unusual. CPPD deposition disease may present as asymptomatic chondrocalcinosis on radiographs and symptomatically as pseudogout, pseudo–rheumatoid arthritis, or pseudo-osteoarthritis. Other crystals may cause periarthritis or arthritis. Management of crystal-induced arthritis among older adults requires special considerations due to comorbid conditions and concomitant medications. Nonsteroidal anti-inflammatory drugs may be contraindicated. Steroids taken either orally or intra-articularly are often an alternative.
Key words: gout, chondrocalcinosis, pseudogout, pseudo–rheumatoid arthritis, pseudo-osteoarthritis.

Arthur Bookman, MD, FRCPC, Division of Rheumatology, Toronto Western Hospital/University Health Network, Toronto, ON.

Rheumatoid arthritis (RA) in older adults has a lower female-to-male ratio, and presents as either a rheumatoid factor positive typical case of RA, or an acute seronegative syndrome consisting of myalgia, fever, weight loss, and fatigue. Differentiating among systemic lupus erythematosus, polymyalgia rheumatica, and rheumatoid arthritis may initially be very difficult in older patients. Rheumatoid arthritis beginning in younger people can lead to earlier death, accelerated atherosclerosis, complicated polypharmaceutical management, debilitating deformity, osteoporosis, and more frequent infection as these patients enter their geriatric years.
Key words: rheumatoid arthritis, geriatrics, polypharmacy, chronic disease, inflammatory arthritis.

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.
Kayi Li, BHSc, medical student, University of Toronto, Toronto, ON.

Osteoporosis is a systemic disease resulting in bone fragility and increased risk of fractures. For optimal prevention, the literature increasingly supports the combined use of education on nutrition, lifestyle, and exercise. Currently, multidisciplinary, multimodal initiatives are rarely implemented in the community. The POWER (Promoting Osteoporosis Wellness through Education, Exercise and Resources) program in Toronto, Ontario, strives to empower individuals with osteoporosis with diverse cultural backgrounds to sustain healthy behaviours for self-management of their condition. This article provides a description of the POWER program philosophy, as well as a preliminary evaluation to assess its benefits and potential for further expansion and adaptation.
Key words: osteoporosis, management program, cultural differences, education, health beliefs.

M. Bachir Tazkarji, MD, CCFP, CAQ Geriatric Medicine, Lecturer, Family Medicine Department, University of Toronto; Toronto Rehabilitation Institute, Toronto, ON.

As the population is aging, physicians from all specialties are expected to see more older adults at their outpatient practices and in the acute settings. Abdominal pain remains one of the most common and potentially serious complaints that emergency physicians encounter. Vascular pathology should be considered early in the diagnostic course of all older adults who have abdominal pain because the time for intervention is critical.
Key words: abdominal pain, older adults, management of acute abdominal pain.

Ellen Grober, PhD, Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA.

We have developed and validated a cost-effective case finding tool for early dementia in primary care that consists of two stages: a rapid dementia screening test administered to all patients over the age of 65 and a second stage to identify memory impairment administered to patients who fail the first stage. The Alzheimer’s Disease Screen for Primary Care (ADS-PC) had high sensitivity and specificity for early dementia and higher sensitivity for AD, and distinguished AD from non-AD dementias. The ADS-PC outperformed the MMSE and worked equally well in African-American and Caucasian primary care patients and in patients that differed in educational level.
Key words: Alzheimer’s disease, early dementia, mass screening, primary health care, neuropsychological tests.

Bailus Walker Jr., PhD, MPH, Department of Community and Family Medicine, College of Medicine, Howard University, Washington, DC, USA.
Charles Mouton, MD, MS, Department of Community and Family Medicine, College of Medicine, Howard University, Washington, DC, USA.

In the late 1990s, it became increasingly clear that air pollution, even at the lower ambient concentrations prevalent in many urban areas, is associated with increased mortality and other serious health effects. More recently, considerable research has focused on particulate air pollution as studies have linked a growing number of health effects to fine particles. Hundreds of studies now indicate that breathing fine particles discharged by vehicles, factories, and power plants can trigger a cardiac event and exacerbate respiratory disease in vulnerable populations. Older adults are one subgroup considered more susceptible to the effects of airborne particles. This sensitivity can be attributed to a number of factors including loss of pulmonary functional reserve and compensation due to age or disease. Although a number of mechanisms have been proposed to explain the adverse impact of particles on cardiovascular health, many questions remain. Their answers will require further transdisciplinary research.
Key words: heart disease, air pollution, smog, particulates, older adults.

Victoria J. Scott, PhD, RN, Clinical Assistant Professor, School of Population and Public Health; Senior Advisor, Falls & Injury Prevention, BC Injury Research & Prevention Unit and Ministry of Healthy Living and Sport, Victoria, BC.
S. Johnson, PhD, Professor, Faculty of Kinesiology and Health Studies, University of Regina, SK.
J.F. Kozak, PhD, Assistant Professor, School of Population and Public Health, University of British Columbia; Director of Research Centre for Healthy Aging, Providence Health, Vancouver, BC.
Elaine M. Gallagher, PhD, RN, Professor, School of Nursing; Director, Centre on Aging,
University of Victoria, Victoria, BC.

Approximately one in two older adults living in long-term care (LTC) settings sustains a fall every year, resulting in significant human suffering and treatment costs. The complex set of factors that contribute to fall risk among this population demands a multidisciplinary approach to this problem, with physicians playing a pivotal role in risk assessment, prevention, and management. We describe a study where facility personnel from five LTC sites were trained in the use of a standardized surveillance tool to track falls, fall injuries, and contributing factors over 16-months. Using a pre-/post-test design, interventions included a multidisciplinary, evidence-based approach to fall risk assessment and monitoring, environmental modifications, exercise, and education strategies. Interventions by a multidisciplinary team, including physicians, were successful in reducing fall-related injuries and relatively successful in reducing the rate of falls among LTC residents. Further study is needed over a longer period of time, using a randomized control trial, to determine the effectiveness of specific interventions and to generalize findings to the larger population of LTC residents.
Key words: fall prevention, long-term care, multidisciplinary approach, older adults.

Christopher Patterson, MD, FRCPC, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON.
John W. Feightner, MD, MSc, FCFP, Chair, Canadian Task Force on Preventive Health Care; Department of Family Medicine, Faculty of Medicine, University of Western Ontario, London, ON.

The ultimate aim of critical appraisal is to decide whether the conclusions of an article are helpful in the prevention or management of illness in your patients. This requires the article to be relevant to your practice and to contain sufficient information to determine if the conclusions are supported by the evidence within it. We offer approaches to the appraisal of different types of publications addressing primary and secondary prevention.
Key words: prevention (primary, secondary), clinical research, critical appraisal, clinical practice guidelines.

Mazen S. Bader, MD, FRCPC, MPH, Department of Medicine, Division of Infectious Diseases, Memorial University of Newfoundland and Labrador, St. John’s, NL.
Daniel Hinthorn, MD, FACP, Department of Medicine, Division of Infectious Diseases, University of Kansas Medical Center, Kansas City, KS, USA.

Preventive health interventions are key to maintaining the health and good function of older adults. Despite being safe and a highly effective method of preventing certain infectious diseases, vaccination rates among older adults continue to lag behind national goals. Vaccines for older adults can be divided into three categories: those that are required for all older adults, those that may be required for special circumstances, and those that are required for travel. Physicians should be familiar with the indications, contraindications, and adverse effects of commonly used vaccines among older adults. This article will focus only on the vaccines required for all older adults.
Key words: vaccines, older adults, influenza, pneumococcal vaccine, herpes zoster, tetanus.

Catherine Agbokou, MD, MSc, Service de Psychiatrie Adulte, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France.
Emmanuel Cognat, MD, Service de Psychiatrie et de Psychologie Médicale, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris, France.
Florian Ferreri, MD, MSc, Service de Psychiatrie et de Psychologie Médicale, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris, France.

Differentiating between Parkinson’s disease dementia (PDD) and dementia with Lewy bodies (DLB) is a difficult issue for many clinicians. To date, these diseases share most of their clinical, neuropathological, and management features. Therefore, PDD and DLB are considered by some authors to be the two extremities of a single spectrum disease named Lewy body diseases. Nevertheless, specific diagnostic criteria now exist for each disease and specific diagnosis remains of interest in clinical practice. In this article, we summarize features and diagnostic criteria of both PDD and DLB, compare them, and examine their treatment options.
Key words: Parkinson’s disease dementia, dementia with Lewy bodies, Lewy body disease, movement disorders, dementia, treatment.