Julie McGarry, DHSci, MMedSci, PGDip (Medical Ethics), BA (Hons), RGN, RMN, PGCHE, Associate Professor, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Derby, UK.
Christine Simpson, MA, BSc (Hons), RGN, HV (Cert), Lecturer, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Derby, UK.

Abstract
The consequences of domestic violence significantly impact the long-term health and emotional well-being of those affected. While the literature offers an insight into the scope and nature of domestic violence among younger populations, there is currently little available data regarding older women and domestic violence. This is increasingly being recognized as a significant deficit in awareness and understanding within society as a whole and, more particularly, for those responsible for support and care provision.
While research in this area may be scarce, the work that has been undertaken to date suggests that domestic violence is both a significant and an underrecognized phenomenon that has a wide-ranging impact on the lives and health of older women. It also suggests that older women's experiences of domestic violence are markedly different from those of younger women and that these differences have not been adequately acknowledged or accounted for.
Keywords: domestic violence, older women, service provision, health community, health.

Emily Saks, MD, Fellow, Division of Urogynecology and Female Reproductive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA.
Lily Arya, MD, Assistant Professor and Program Director, Division of Urogynecology and
Female Reproductive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA.

Pelvic organ prolapse is a common condition among women, and its prevalence increases with age. Pelvic organ prolapse is multifactorial in etiology but ultimately results from a disruption in the pelvic floor muscles and their attachments. Patients may be asymptomatic or may report a variety of pelvic floor symptoms. Prolapse can be easily diagnosed through clinical examination. Treatment involves simple observation, pessary, or surgery.
Key words: pelvic organ prolapse, older women, pessary, vaginal surgery.

Margaret Fitch, RN, PhD, Head, Oncology Nursing and Supportive Care; Director, Psychosocial and Behavioural Research Unit,Toronto Sunnybrook Regional Cancer Centre, Toronto, ON.

Ovarian cancer has more than a physical impact.There are also emotional, psychosocial, spiritual, and practical consequences for those women diagnosed with the disease. These women face many challenges— lives are changed irrevocably with the diagnosis, and life becomes a series of transitions. In caring for women with ovarian cancer, health care providers must be sensitive to myriad concerns these patients may have and try to understand the issues from the perspective of those experiencing them.
Structures and processes need to be established within care facilities that allow patients to have regular comprehensive assessment, good symptom management, effective communication, and individually tailored support.The availability of timely and relevant referral to other experts when needed is of key importance at moments of care transition.
Keywords: supportive care, ovarian cancer, older women, psychosocial concerns, emotion.

Sue O’Hara, RN, MScN, ACNP, GNC(C), Nurse Practitioner/Clinical Nurse Specialist, Specialized Geriatric Services, St. Josephs Health Care London, Parkwood Hospital, London, ON.; Michael J. Borrie, BSc, MB, ChB, FRCPC, Professor, Department of Medicine, Division of Geriatric Medicine, The University of Western Ontario, London, ON.

Urinary incontinence is a significant problem in older women. Prevalence rates vary from 4.5–44% in healthy older women and increase to 22–90% in patients in long-term care facilities. Canadian Continence Guidelines have recently been developed to assist patients and health care professionals in assessment, treatment and follow-up of urinary incontinence. Urinary incontinence can be treated successfully, improved or better managed in most patients. Treatment falls into four major categories: behavioural, pharmacologic, surgical and supportive measures. Education, the key to effectively addressing the needs of women with incontinence, is aimed at the patient and/or their caregiver, as well as health care professionals.
Key words: urinary incontinence, older women, assessment, treatment, Canadian Continence Guidelines.

Anne-Chantal Braud, Institut Paoli Calmettes, Marseille, France,
Martine Extermann, MD, H. Lee Moffitt Cancer Center and Research Institute and the University of South Florida, Tampa, FL,USA.

Half of breast cancers occur in patients older than 65 and 25% in patients aged 75 or older. Prevention and early diagnosis are a societal but also an individual issue in this population. Good guidelines for screening and prevention are available for patients up to 70, but few data are available for older patients. The present article reviews these data in an effort to provide some guidance to geriatricians and primary physicians about screening and prevention of breast cancer in their older patients. Age alone should not be used to determine when to screen; rather, life expectancy estimates can help decision-making. Patients with a life expectancy of 10 years or more are likely to benefit from mammography screening. Very few data are available for tamoxifen prevention in women older than 70. There is a need for further randomized controlled trials to clarify a host of outstanding issues in improving the prevention and the care of breast cancer in older people.
Key words: older women, breast cancer, mammography, prevention.

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.