Nina M. Silverstein, PhD, Associate Professor, Gerontology, University of Massachusetts Boston, College of Public & Community Service, Boston, MA.
Gerald Flaherty, Director of Special Projects & Safe Return Alzheimer's Association, Massachusetts Chapter, Boston, MA.

Nearly half of all residents in long-term care settings suffer from some type of dementing illness, with Alzheimer disease by far the most common type. People with dementia should be presumed at high risk for wandering due to their cognitive deficits and unpredictable behaviour. Recommendations are shared to minimize attempts to wander and actual wandering episodes by promoting a more therapeutic environment both through the physical structure and through staff training. In addition, effective strategies to follow in situations when a resident is, in fact, missing are presented.
Key words: dementia, wandering, long-term care, environment.

Alexandra Nevin, BSc

Type II diabetes is a complicated, multifactorial disease process characterized by a relative insulin insensitivity leading to prolonged hyperglycemia. In comparison with type I diabetes, which is primarily due to the auto-immune-mediated destruction of the insulin producing beta cells of the pancreas, type II diabetes is the more predominant, generally adult- onset form, which predisposes individuals to pathological complications, and is more amenable to lifestyle modifications.

Senior citizens are the population most susceptible to type II diabetes. The Canadian Heart Health Survey reported that 13.2% of men and 12.0% of women between the ages of 65 and 74 have diabetes. In light of the aging population in Canada, researchers continue to investigate the intertwined role of genetics and the environment in the pathogenesis of type II diabetes in an effort to better understand and, ideally, to devise true preventative therapy measures to combat the disease.

Pathogenesis
Two fundamental defects underlie the pathogenesis of type II diabetes. The primary problem is the development of insulin resistance. In an attempt to compensate for the increased blood glucose load, a period of relative maladaptive hyperinsulinemia occurs.