A field guide to aging

I woke up

and I was old—

It’s hard to judge

if this new country

was worth

its costs

Eileen R. Tabios,

Mom Betty Addresses the Nature of Proportion

Aging and its attendant risks and losses—some visible, others not—is a theme of the February 2025 issue of Canadian Family Physician. Since 2018 the journal has published the Geriatric Gems series, curated and contributed to by Dr Chris Frank from Queen’s University in Kingston, Ont, and Dr Frank Molnar from the University of Ottawa in Ontario. The latest article, “Traumatic brain injury in older adults. Short- and long-term implications” (page 115),¹ is another gem. It provides a timely reminder to thoroughly evaluate and not overlook a common injury in older adults that can have substantial short- and long-term consequences. The authors remind us over half of people aged 65 years and older will experience a fall-related injury annually, about two-thirds of which will result in a traumatic brain injury (TBI).

Why is this so important? First, patients may not report hitting their heads due to amnesia caused by the event, so a high degree of suspicion is warranted when assessing them. Second, TBI symptoms vary among patients depending on which part of the brain is injured, so it is important to recognize common post-TBI symptoms described in the article. Finally, it is important for family physicians to recognize a TBI is not just an acute injury; a single moderate-to-severe TBI can lead to earlier onset of Alzheimer dementia, increase the risk of Parkinson disease, and cause earlier onset of frontotemporal dementia.¹

This month’s issue of Canadian Family Physician also features yet another excellent evidence-based Tools for Practice article, “Vitamin D and fracture prevention,” by Drs Jennifer Young and Émélie Braschi (page 121).² The bottom line: Vitamin D supplementation alone does not prevent fractures regardless of dose, starting vitamin D level, or history of previous fractures.² But there is more to the article than simply the bottom line and I recommend readers see for themselves.

This issue of the journal features the final article of the Oncology Briefs series. We are grateful to Dr Anna N. Wilkinson from the University of Ottawa and her colleagues who have contributed to this series since its inception in 2021. In “Having hard conversations. Advance care planning, serious illness conversations, and goals of care discussions with oncology patients” (page 117)³ Drs Wilkinson and Leah O’Shea map out the trajectory of these difficult conversations on a continuum from general discussions about advance care planning, to more specific serious illness conversations, to the very particular goals of care conversations as patients near the end of their lives. In addition, the article provides family physicians with a serious illness conversation guide using patient-tested language along with practical tips for effective communication skills and discussing prognoses.³

That these skills are necessary not only in caring for patients with end-stage cancers, but also in caring for older patients with other life-ending conditions, is revealed in a research study by Dr Helen Tam-Tham and her colleagues at the University of Toronto in Ontario (page 122).⁴ These researchers assessed access to palliative care in older adults with advanced chronic kidney disease. The study reveals how challenging having these difficult conversations can be for family physicians and the need for not only enhanced training for family physicians, but greater access to specialist palliative care when needed.⁴

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