The aim of the paper is to provide a brief overview of diabetes, its associated complications and related morbidity and mortality to highlight the importance of proactively discussing and planning for palliative and end of life care with older people. It suggests palliative and end of life care are essential components of quality diabetes management. Palliative care is no longer only associated with terminal cancer care in hospices: it is also recommended for other life limiting illnesses, including diabetes. Palliative and end of life care are defined, and the relationship among diabetes, the four health trajectories and end of life care is outlined. Strategies that can be used to help people maintain quality of life, dignity and autonomy are suggested for each trajectory. These strategies include health professionals having timely, meaningful conversations about palliative and end of life care with older people with diabetes and their families.

Orofacial pain is a term that includes several painful conditions that affect the area of the face and the mouth. Pain can refer to adjacent parts of the body, as the head and the neck, as well as the symptom can be a referred pain from these structures. For the differential diagnosis, it is necessary to consider dental causes, temporomandibular disorders, neuropathic diseases such as trigeminal neuralgia, burning mouth syndrome, persistent idiopathic facial pain, atypical odontalgia, primary headaches, sinusitis, cervicalgia etc [4]. There are inflammatory and neuropathic neurobiological mechanisms that underlie those conditions or can be secondary to the chronification of pain.

Transcatheter Aortic Valve Implantation (TAVI) is an alternative to Surgical Aortic Valve Replacement (SAVR) in high risk patients with symptomatic aortic valve stenosis. Severe symptomatic aortic stenosis occurs in 3.4% of patients aged > 75 years [1]. TAVI is superior to medical treatment, while survival rates are similar or higher compared to SAVR [2]. Nevertheless, in high risk patients, morbidity and mortality after TAVI is substantial with one-year mortality 14.2- 19% and two-year mortality 33.9-43.3% [2]. Frail patients have increased mortality risk after TAVI [3]. Frailty is defined as a syndrome of impaired physiological reserve and decreased resistance to stressors. Delirium frequently occurs after TAVI; incidence is highly variable, 12-53% [4]. Frailty is associated with postoperative delirium and postoperative functional decline [5,6]. Nowadays geriatric assessment is advised for risk stratification and treatment selection in patients referred for TAVI [6]. The aim of this study was to compare functional and cognitive status in patients before and after TAVI.

The prevalence of thyroid dysfunction is higher in the older adults as compared to the younger population. An excess or deficiency of chemical element contents in thyroid plays an important role in goitro- and carcinogenesis of gland. The variation with age of the mass fraction of twenty chemical elements in intact thyroid of 72 males (mean age 37.8 years, range 2-80 years) was investigated. Measurements were performed using neutron activation analysis and inductively coupled plasma atomic emission spectrometry. Tissue samples were divided into two portions. One was used for morphological study while the other was intended for chemical element analysis. This work revealed that there is a statistically significant increase in Ca and I mass fraction, as well as a decrease in Al, B, Ba, K, Li, Mn, and P mass fraction in the normal thyroid of male during a lifespan. Results of the study showed that for older males there is a goitrogenic and carcinogenic association with inadequate levels of the thyroid parenchymal chemical elements as Al, B, Ba, Ca, I, K, Li, Mn, and P, some of which can increase intra-thyroidal oxidative stress.

The science of balance rehabilitation and fall prevention continue to evolve. At this time, it is well established that balance requires a dynamic and real-time interplay of person to environment to determine the best motor program and monitor where change will most likely be needed [1,2]. It is additionally recognized that the options of balance reactions available in any given task are largely procedural in nature, being automatized and operating primarily on a subconscious analysis of the environment (hand holds, information about surface friction and stability, obstacles, accuracy demands, etc) [3-6]. The science of improving automatized responses, known as procedural memories, is growing and continues to advance in the fields of sports science and, slowly, into rehabilitation. Recently, the evidence for procedural memory training has advanced in sophistication to suggest and ultimately prove that automaticity of a primary motor task can be developed through exposure to massive repetitions (practice) and the forced subconscious processing using dual task interference [7-11]. Sport science is already employing this approach regularly, with training programs that involve basketball players enduring distractions of all kinds to reinforce the accurate retrieval of the skilled movement, regardless of the game-environment context (second basketball to dribble and attend-to, crowd support or opposition, weather, situational pressure). Evidence suggests this application to regain automaticity in primary motor tasks, can be applied to re-learning tasks in rehabilitation as well [10,12]. In all of these applications, coaches, scientists and clinicians employ strategies that involve the introduction of secondary tasks that draw or allocate attentional reserves, leading the nervous system to process a primary task in procedural memory centers. In this article, dual task training infused with balance rehabilitation will be considered for healthcare professionals’ efforts to improve balance reactions in older individuals.

Background: Mobility disability due to spinal stenosis is common in the senior population. We assessed the recovery timeline and compared outcomes among seniors undergoing spinal stenosis surgery by type of surgery.

Methods: We investigated 451 patients (77.4 ± 10.9 years, 58% women) of a consecutive cohort prior to spinal stenosis surgery and at 3 or 6-month and at 12-month follow-up. At each visit, pain, neurological dysfunction, and disability were assessed using the North American Spine Society questionnaire. Repeatedmeasures analysis compared outcomes by type of surgery adjusting for baseline symptoms, gender, age, comorbidities, center, and year of surgery.

Results: Most improvement occurred within the first 3 to 6 months with little or no improvement up to 12 months. Over 12 months and in adjusted models, patients receiving one-segment versus multi-segment decompression experienced greater reduction of pain (-46.0% vs. -41.0%; p = 0.05), neurological dysfunction (-36.4% vs. -26.1%; p < 0.001), and disability (-30.5% vs.-26.7%; p = 0.06). Moreover, reduction in pain and neurological function did not differ with or without additional stabilization and extend of decompression. However, patients who received one-segment (-26.7%) or multi-segment (-27.5%) stabilization experienced significantly less reduction in disability after surgery compared with those who were not stabilized (-31.6%; p < 0.05).

Conclusions: Among seniors undergoing spinal stenosis surgery, recovery was largely complete by 3 to 6 months after surgery, and differed little by type of surgery independent of symptoms prior to surgery and other covariates. However, particularly neurological dysfunction and disability may improve more with less invasive surgery.

Background: This study is a secondary analysis of the process of telephone follow-up of communitydwelling older people with chronic heart disease after index hospitalization. Objective: The objectives of the study were to understand the common problems encountered and the interventions provided by telephone, using the Omaha System as a framework.

Methods: The intervention nurse conducted assessments and interventions based on the system. Patient problems were categorized according to the system. Thirty-four sets of audio recordings, with a total of 896 minutes of verbatim from 17 participants, were transcribed and analyzed.

Results: The results identified the 5 most frequent problems and described the interventions most frequently prescribed by the intervention nurse. Circulation was the only physiological problem among the top problems identified. Nutrition, medication regime, physical activity and healthcare supervision were the common healthrelated behavioral problems cited at the initial and final call. Surveillance was the most frequent category of intervention, followed by teaching, guidance and counseling as the second most frequent category of intervention provided to the participants in the study.

Conclusions: A better understanding is needed of the process of care provided by the intervention nurse via telephone to older people with chronic heart disease in the community. The body of knowledge can extend the continuum of care provided to people living with chronic heart disease in the community. Further study on the integration of low and high technology would enhance the health surveillance and counseling of older people with chronic heart disease

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is a rare immune mediated disorder of the peripheral nervous system which can occur at any age but is more common in older males. Clinical features can include weakness, sensory loss, and gait impairment which may lead to significant functional loss and difficulty managing ADLs and IADLs independently in the elderly population. This case report will highlight why primary care providers need to be aware of CIDP.