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Introduction: Demographic changes in the developed world have resulted in population aging. Although Israel has a relatively young population, the older population is aging at a rapid rate. This has placed significant strains on health services in the community, in acute care, rehabilitation and long-term care. Geriatric medicine stands at the forefront of providing high quality care to the older population. The recognition of the importance of the "Geriatric Giants", which include immobility, instability (falls), incontinence, intellectual impairment (dementia and delirium), and iatrogenesis (including polypharmacy), has resulted in the development of improved diagnosis, prevention and treatment of these syndromes. The knowledge and understanding of aging and age-related diseases, and the development of a multidisciplinary function-based approach to assessment and treatment, have resulted in geriatricians playing a central role in the health care of older people. The current issue of Harefuah presents an overview of topics and studies of interest to Israeli researchers.

Background: The most common cause of dementia is Alzheimer's disease. The major manifestation of the disease is the cognitive impairment which appears at the onset of the disease. In addition to the cognitive impairment there are behavioral dysfunctions such as apathy, anxiety, depression and sleep disturbances. The treatment for the manifestations of Alzheimer is currently pharmacological and behavioral. One of the newest behavioral treatments for Alzheimer is the multi-sensory treatment using the Snoezelen room., Methods: The study group included 16 hospitalized Alzheimer patients. A device called the ActiGraph, which reads movement level, was placed on the subjects' non-dominant wrist. The measurements took place continually for five nights: two nights before snoezelen treatment, the day of treatment and two nights after the treatment. This protocol was repeated after a week of rest., Results: The results showed that snoezelen treatment has a positive effect on the quality of sleep during the first week but not on the second week., Conclusions: Snoezelen treatment should be considered as part of the treatment regimen of Alzheimer patients, in addition to the pharmacological treatments in order to improve their quality of sleep and quality of life. Larger sample size and longer periods of time are needed to confirm the effectiveness of the treatment.

Background: The health care of the growing number of older people in the population is predominantly provided by the family physician, who is usually faced with time limitations. A community-based Comprehensive Geriatric Assessment (CGA) unit has the potential to provide the family physician with the necessary support required in managing older patients., Objectives: To describe and review the structure and clinical experience of a community-based CGA unit over a period of five years., Methods: The CGA unit comprises a multidisciplinary team that utilizes a comprehensive array of assessment instruments. Specific emphasis is placed on comorbidity, polypharmacy, cognitive and affective status, social support and daily function., Results: Over a period of five years, 456 older patients were evaluated. The mean age was 76.7 +/- 6.1 years and 36.2% were women. A total of 6.57 +/- 2.72 new diagnoses were made, the most common being dementia (60.1%), recurrent falls (43.9%) and social problems (32.5%). There were an average of 7 recommendations provided to the family physician, the majority relating to preventive medicine, fall prevention, improving mobility and social interventions. Based on a sample of files evaluated some six months later, we found that these recommendations had been carried out by family physicians to varying degrees. Prescriptions for new medications were provided for 55.6% of those recommended, 45.5% drugs were discontinued as suggested, and 44.4% investigations were performed. Preventive medicine recommendations were carried out in only 11.4% of patients.