Elizabeth Pham, MD, Resident Physician, Department of Medicine, University of California, Irvine Medical Center, Orange, CA, USA.
Solomon Liao, MD, Associate Clinical Professor, Department of Medicine, University of California, Irvine Medical Center, Orange, CA, USA.

As the population ages, elder mistreatment is a growing concern in North America, and it includes physical and financial abuse and neglect. Careful documentation of the history, physical examination, and diagnostic data help achieve a clinical assessment that may be crucial to the outcome of a legal case and the protection of a patient. Good medical documentation ultimately saves clinicians time and demonstrates competency. This article discusses the items clinicians need to document in suspected cases of elder mistreatment. The emphasis is on issues that are above or beyond those performed in a routine clinical encounter.
Key words: elder mistreatment, elder neglect, elder abuse, financial exploitation, forensic documentation.

Jill Hightower, MA, Hightower and Associates, Halfmoon Bay, BC.

Violence against older women involves physical, emotional, sexual and financial abuse and denial of human rights, often in combination with one another. Abuse is gender- and age-based. The gender-neutral focus of the elder abuse field does not address the key issues of abuse of women in later life. Community-based women’s advocacy and services in the past have failed to recognize and address the needs of older women. By developing an appreciation of issues of gender- and age-based violence, health professionals have increased opportunities to help older women find support and assistance.
Key words: elder abuse, gender violence, women, aging, older women.

The Toronto Regional Geriatric Program (RGP) Elder Abuse Network
Rory Fisher, MB, FRCP(Ed)(C) (Chair), Madeline D'Arpino, RN, Tracey Dion, RT, Sherry Glazier, MSW, RSW, Rola Moghabghab, RN, MN, Elizabeth O, BSc.OT, Anne Stephens, BScN, MEd, GNC(C), Lynn Zimmerman, MSW, RSW.

The problem of elder abuse has been highlighted by the Ontario government's recent strategy. Considerable information is available about elder abuse but there is a lack of connection between this knowledge and the day-to-day activities of healthcare professionals. The Toronto Regional Geriatric Program therefore has developed an elder abuse workshop for frontline staff. In this workshop, elder abuse is defined, types of abuse are discussed, prevalence is addressed, victims and abusers are profiled and case discussions of an interactive nature take place. A post-workshop package is provided. The next step will be to develop a "train the trainer" model.
Key words: elder abuse, workshop, Ontario government, Regional Geriatric Program.

Tracey Tremayne-Lloyd
and Lonny J. Rosen
Tremayne-Lloyd Partners
Toronto, Ontario

Elder abuse is an unfortunate and undiscussed phenomenon in our society, yet it is one that many physicians will encounter in the treatment of their elderly patients. Although there is little agreement on the definition of elder abuse, it can generally be defined as 'any act of commission or omission that results in harm to an elderly person.'¹ The types of harm suffered by elderly patients generally include physical, psychological, and financial abuse as well as neglect. Various studies conducted throughout North America have reported the incidence of elder abuse to be anywhere from 1%-10%. Since elder abuse is such a prevalent problem, it is critical for physicians to be aware of their statutory and professional reporting obligations.

Statutory Reporting Obligation
At present, there is no federal statutory obligation on the part of physicians across Canada to report elder abuse. Such obligations are set by provincial governments, and each of the provinces of Newfoundland, New Brunswick, Nova Scotia and Prince Edward Island have enacted some type of adult protection legislation. These laws impose on all persons the obligation to report a situation where a person is suffering from abuse or is otherwise in need of protection. The legislation in these provinces includes not only abuse of the elderly, but also usually covers all adults over the age of 16 or 18 years, who are in need of protection.

Olya Lechky

A group of volunteers at the Bernard Betel Centre for Creative Living in Toronto have found a unique way to bring elder abuse out into the open.

Like spousal and child abuse, elder abuse is still shrouded in secrecy, denial and shame, says Sheila Zane, co-ordinator of a 15-member drama group that performs plays depicting various aspects of elder abuse. "Basically we do education through drama," says Zane. "Drama is the best vehicle to educate on sensitive and painful issues. Many seniors would not be interested in hearing a lecture on elder abuse, but many are interested in exploring the issue by seeing a play-acted out by seniors. We approach elder abuse by getting in through the back door."

The Bernard Betel Centre provides social activities, recreation, education, meals, counseling and referrals to its members, whose average age is 70. The Awareness Project on Abuse of the Elderly Committee promotes education on elder abuse by means of workshops, information, referrals and play presentations in the community. Originally, the committee focussed on educating the public through the media, lectures and speaking engagements. The idea of going out into the community to educate on elder abuse through drama is a relatively recent addition to the committee's educational efforts.