Mom and Dad are getting older, and guess what? You may be looking after them one day! But don't worry, help is on the way. Baycrest Centre for Geriatric Care and TV Ontario have teamed up on a show that is essentially a crash course in looking after an aging parent.

Taking Care is a 13-part television series that will air Thursdays, starting September 30th at 2:00 p.m. EDT. Hosted by radio personality Mary Ellen Beninger, each half-hour program will address a different challenge along the caregiving road, such as identifying the early signs that a relative may need help, strategies for organizing homecare, coping with dementia, and shopping for a long-term care facility.

Beninger is no stranger to caring for a frail parent. When her mother suffered a series of debilitating strokes, Beninger's father cared for her mother at home. Beninger took time from her busy schedule to help out whenever she could.

"I've seen what elder care can do to families--both the ups and downs," says Beninger, who co-hosts the morning show on Energy Radio in Toronto. "It can be an enriching experience if we can find ways to help people cope better. The key is knowing what support services are out there."

Each of the 13 programs begins by taking viewers into the home of a family who candidly shares their experience caring for an elderly relative. This is followed by a studio discussion with community and health care professionals who provide insight and practical information. At the end of the program, viewers are given community resources and contacts that they can follow up with.

"By educating families with practical information, we're giving them a ray of hope that help is out there--they just have to know where to look for it," says Sorele Urman, Associate Director of Social Work at Baycrest Centre and a consultant on the series. Baycrest gets calls every day from family members who are concerned about their relative's physical or mental state and their ability to continue to live independently.

The premiere show on September 30th is aptly titled The First Signs. Three caregivers talk about the early signs of illness in their parents, how they reacted, what they did about it, family disagreements, and how they made plans for homecare and other supports. Additional topics in the series include transportation and mobility, depression and isolation, and maintaining good health in later year.

Taking Care airs Thursdays, starting September 30th at 2:00 p.m. EDT, repeated Saturdays at 4:00 p.m. and Sundays at 5:30 p.m. Produced by TVO and supported by Baycrest Centre for Geriatric Care.

Sonya Lytwynec, RegN, BScN
Nurse Clinician,
Southwestern Ontario Regional Geriatric Program,
Continence Outreach

Urinary incontinence can be successfully treated in some individuals.¹ There are, however, many individuals who remain unresponsive to behavioural, medical or surgical treatment and continue to experience chronic urinary incontinence. These individuals can benefit from improved continence management, using incontinence products that enable them to maintain social acceptability, skin integrity and comfort.

The focus of this article is to identify the factors that influence product selection and describe the key features of products that may guide the health care professional in meeting the specialized needs of individuals and caregivers.

Incontinence products may be utilized in addition to other treatment modalities to promote comfort and security. For example, supplementing toileting protocols with the use of absorbent disposable diapers and moisture barriers may be effective in reducing the risk for skin breakdown.²

Selecting the most appropriate product can be a complex task.

Anna Liachenko, BSc, MSc

The popularity of theophylline, a bronchodilator used in the treatment of asthma and other bronchospastic diseases for over 60 years, has been declining due to its narrow therapeutic index and the perceived lack of anti-inflammatory effects. Instead, newer therapies, such as inhaled long-acting corticosteroids, have been increasingly recommended. Although valued for their anti-inflammatory properties, these newer therapies can nevertheless produce serious side effects at therapeutic concentrations. Fortunately, the prescribed dosages can be decreased due to the recently discovered anti-inflammatory properties of theophylline, which is now recommended as an add-on therapy to corticosteroids. In this article, the beneficial effects and necessary precautions when using theophylline are examined, with particular emphasis on the elderly.

In Canada, theophylline is currently indicated for the symptomatic treatment of reversible bronchospasm associated with asthma, chronic bronchitis, emphysema, and associated bronchospastic disorders. Historically, asthma was treated mainly with bronchodilators. During the 1980s it became apparent that an unacceptably high rate of asthma-related hospitalizations and asthma deaths were partly attributed to the under-use of anti-inflammatory medications. For this reason, the use of inhaled corticosteroids increased. Unfortunately, there is some systemic absorption of inhaled corticosteroids.

Gail Elliot, MA
McMaster University
Office of Gerontological Studies

Canada consists of over 100 ethnocultural groups. The 65+ age group is comprised of a population that largely identifies with an ethnic origin other than Canadian.¹ Research has too often documented that the health care practices in this country are ethnocentric, focusing on westernized, scientific based practices that too often ignore the alternative methods of care and cure.^2,3,4

In a multicultural country such as Canada, cultural sensitivity should be intricately woven throughout all interactions in the health and social service delivery system. Not only should cultural sensitivity be considered for the purpose of providing patient-centred care, it must also be recognized that this country as a whole has adopted statutory and constitutional policy, and regulations that are intended to place "equality for all" at the forefront of individual rights and freedoms. In fact, Canada has spent nearly thirty years developing policies that are designed to encourage "all of us to work together to build a society in which the principles of multiculturalism are fully realized in practice.

Rhonda Witte, BSc

"I'm so out of breath! I must be getting old." Have you ever heard someone use that expression before? Chances are that you have. You may have even used it yourself. Sometimes it is used as an excuse for not having exercised enough. But is there truth to that statement? The answer is yes. With age, the respiratory system changes and may predispose us to shortness of breath in situations where we may not have been before.

Exogenous and endogenous factors play a role in age-associated changes to the respiratory system. Infection, climate, air pollution and mechanical injuries are a few of the exogenous insults the lungs incur over time.¹ System diseases and infectious diseases are endogenous factors that can often affect the lungs in elderly patients.¹ For example, COPD occurs more commonly in the elderly. Esophageal disorders and Parkinson's disease are other endogenous factors which are frequently associated with lung aspiration and pneumonia in elderly individuals.¹

Older and younger patients differ with respect to pulmonary function because of age-related changes of the respiratory system. Consequently, it is important that the physician in care is aware of the changes so that proper care is administered. Although much more work needs to be done to determine the exact consequences of these age-related changes, one should be aware of possible complications that may occur.

Christopher Patterson, MD, FRCPC
Division of Geriatric Medicine
McMaster University
Hamilton, ON

• What do you do when an older man complains that his wife is more forgetful than one year ago?
• Can you distinguish depression from dementia in an older women who is having difficulty looking after herself?
• How do you manage an individual with dementia who resides in a nursing home and becomes aggressive?

Approaches to these and other clinical situations are addressed in the recently published conclusions from the Canadian Consensus Conference on Dementia.¹ This work built upon the earlier recommendations of the Canadian Consensus Conference on the Assessment of Dementia which was published in 1991.² For the recent con- ference, a more comprehensive view of dementing conditions was undertaken. A panel of Canadian experts in the areas of Geriatric Medicine, Geriatric Psychiatry, Neurology, Family Medicine and other disciplines undertook an evidence-based approach to the recognition, assessment and management of dementing disorders. Recommendations are targeted towards primary care physicians in Canada.

Joyce So, BSc

Despite growing concerns about air pollution, environmental tobacco smoke, and actions taken to reduce them, the incidence of asthma in North America has continued to rise since the 1970s.^1,2 It is estimated that about 4 to 5% of the general population suffers from asthma.¹ Asthma is a chronic inflammatory disease of the airways triggered by allergens and other stimuli, which lead to episodes of bronchial hyper-responsiveness and obstruction of airflow. Common signs and symptoms of asthma include recurrent wheezing, coughing, difficulty breathing and chest tightness. These symptoms often occur or worsen at night, during exercise, or in the presence of viral infection and common allergens such as dust, pets, pollen and smoke.

In the elderly, studies have shown that advanced age, male gender, parental history of chronic airway disease or hay fever, history of childhood respiratory illness, and environmental tobacco smoke exposure are all risk factors for developing asthma.1 In addition, various studies have established a clear association between bronchospasmic exacerbation and air pollution, with increased incidence of obstructed airways and hospital emergency department admissions for asthma in polluted, urban regions.

David Heath, MB, ChB, FRCPC
Geriatric Psychiatrist
Program for Older Adults
Homewood Health Centre
Guelph, ON

You receive a call from Mrs. Roberts' daughter and she tells you, "They want to give mum shock treatment for her depression. I didn't think they still did that. What do you think doctor? Mum says she doesn't want to sign the consent form without first talking to you." Some physicians might feel put on the spot after such a conversation and are unsure how to respond. They may not have learned much about electroconvulsive therapy (ECT) in medical school and much of what they hear about it in the media is negative and often sensationalised. So, what are the facts about this widely misunderstood treatment?

ECT's voodoo image is not helped by the fact that its mechanism of action is still unknown. The induction of a seizure is universally accepted as necessary for its effectiveness, however, and its origins are quite scientifically respectable. Convulsion, induced by camphor, has been known to "cure insanity" since 1764. Von Meduna started treating schizophrenic patients this way using camphor and then Metrazol in the 1930's. In 1938, Cerletti used electrical stimulation as a less unpleasant convulsant.

Neil Fam, BSc, MSc

Pneumonia is a common and serious condition that claims over 6,000 lives in Canada annually. The elderly are particularly at risk, with individuals over 65 accounting for 50% of all pneumonia cases and 90% of deaths due to lower respiratory tract infection.¹ Indeed, elderly patients with pneumonia have a mortality rate 3-5 times that of young adults. A combination of factors contribute to the increased incidence of pneumonia in the elderly, including the presence of comorbid illness and the effects of aging on the lungs and immune system (see Age-related Changes to the Respiratory System Will Not Affect Healthy Elderly). Recent advances in our understanding of pneumonia have led to a re-evaluation of traditional approaches to the disease. This review outlines disease presentation, common pathogens and current diagnostic, treatment and preventive options in the care of elderly patients with pneumonia.

Donepezil (Aricept), is now being reimbursed to eligible Ontario patients by the Ontario Drug Benefit Program. Donepezil received Health Protection Branch (HPB) approval in August 1997. Until now, however, donepezil has not been reimbursed by any provincial health plan, including Ontario's public drug program which covers senior citizens and those on social assistance. People wanting donepezil have had to pay for it themselves or have it reimbursed by private insurance.

Effective June 1, 1999, eligible ODBP beneficiaries will have the cost of donepezil reimbursed. There are two categories of coverage. Those who have already been on donepezil treatment for more than 60 days, have a confirmed diagnosis of mild to moderate AD and meet the ODBP program criteria will be eligible for reimbursement of donepezil by the ODBP.

Others with a confirmed diagnosis and who meet the ODBP and program criteria but who have never taken donepezil (or have taken it for less than 60 days) will be enrolled in a 12-week trial prescription program, with the medication provided free of charge by Pfizer. The trial prescription program is administered by an independent pharmacy and healthcare company, Caremark Ltd., based in Mississauga, Ontario.

The patient and caregiver also will receive a Pfizer-sponsored program of educational material about AD, including a video, called TriAD and a patient diary. The physician will continue to be supplied with diagnostic and other support tools to help him or her evaluate and track the patient's progress.

At the end of the 12-week trial prescription program, those patients who have benefited from the treatment will be eligible for continuing treatment reimbursed by the Ontario government. All patients receiving reimbursement will be reviewed annually to ensure they are still benefiting from the treatment and thus remain eligible for reimbursement.

The major instrument used to measure eligibility and effectiveness will be the Mini Mental Status Exam (MMSE). A score of 30 represents full cognitive ability; persons with impairment caused by AD score lower and their scores diminish over time as the disease takes its toll on cognitive function.

To be eligible for coverage, persons with mild to moderate AD will have to have and maintain an MMSE score between 10 and 26. A score that drops below 10 is indicative of advanced cognitive impairment of the later stages of AD, for which treatment with donepezil would not be appropriate.

Patients, caregivers or healthcare professionals seeking more information about reimbursement for donepezil can call toll-free to 1-800-510-6141.