Nadine Gagnon, MD, FRCP(C), Research Fellow, Department of Psychiatry, University of Toronto and University Health Network, and Toronto Rehabilitation Institute, Toronto, ON.
Alastair J. Flint, MB, ChB, FRCP(C), FRANZCP, Professor of Psychiatry, University of Toronto, and Head, Geriatric Psychiatry Program, University Health Network, Toronto, ON.

To date, researchers have addressed many aspects of falling. During the past two decades, there has been increasing interest in the phenomenon of fear of falling. This paper summarizes data pertaining to the epidemiology, assessment and management of fear of falling, as well as the relationship of fear of falling to other factors.
Key words: fear of falling, elderly, epidemiology, self-efficacy, activities of daily living.

Gabriele Meyer, Research Fellow, Andrea Warnke, Research Fellow and
Ingrid Mühlhauser, Professor; Unit of Health Sciences and Education,
University of Hamburg, Hamburg, Germany.

Prevention of falls in the elderly is a high priority in many countries. Single component and multifaceted interventions have been extensively studied. However, only two interventions have been shown to reduce injuries or fractures. Hip protectors effectively reduce hip fractures. Home-based exercise programs administered by qualified professionals may reduce falls and fall-related injuries. Most interventions are intensive and require substantial resources. Before considering implementation of a fall prevention program, its practicability, acceptance and cost-effectiveness should be explored.
Key words: accidental falls, prevention, hip fractures, hip protector, protective devices.

Elizabeth Steggles, Occupational Therapist Reg. (ON); Manager, Independence Technologies, Hamilton, ON.

Every-day technologies, such as telephones and remote controls, are an important part of life but are not always user friendly. Too often, devices are designed for people who have good fine motor skills, mobility, hearing, cognition and vision. This article will suggest some simple technologies that may help maintain independence as people age.

Telephones
Ameriphone¹ provides a range of telephones with good access features. Most of the telephones incorporate the following features: large buttons with large numbers and good contrast, amplification of the incoming voice, a ring flasher and a loud ringer.

Some specific models are worth mentioning. The Dialogue XL-50 telephone has the features described above, as well as the ability to increase the sound up to 48 decibels, which is 200 times louder than normal. The Dialogue JV-35 has jumbo buttons with Braille characters, and an electronic voice announces each number as it is dialed. In addition to the general features, the Photo Phone P300 has nine memory locations that may be identified by a photograph of the person whose number is stored. This is very helpful for people who have difficulty remembering or reading numbers. Dialogue CL-40 is a cordless telephone with large back-lit buttons, 100 times amplification and an extra loud ringer.

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.

Tara Morrison, MD and James R. Perry, MD, Crolla Family Brain Tumour Research Unit, Division of Neurology, Sunnybrook and Women's College Health Sciences Centre; University of Toronto, Toronto, ON.

Primary brain tumours are most commonly diagnosed in elderly individuals and the incidence of these uniformly fatal malignancies is on the rise. Recent studies have shown that the most common of these tumours, the glioblastoma multiforme, is genetically different in elderly compared to younger patients. Current research studies exploiting the genetic differences of these tumours as anti-cancer targets hold promise for the immediate future. At present the focus of brain tumour treatment is excellent supportive care. Radiation treatment and chemotherapy are being actively revisited to maximize quality of life. In addition, complications such as venous thromboembolism, seizures and therapy-induced adverse effects have received much attention and are reviewed in this article.
Key words: brain neoplasms, glioblastoma multiforme, palliative care, chemotherapy.

Claudio S. Cinà, MSc, FRCSC, Associate Clinical Professor, Department of Surgery, Division of Vascular Surgery, McMaster University, Hamilton, ON.
Catherine M. Clase, MSc, FRCPC, Associate Professor, Department of Medicine, Division of Nephrology, McMaster University, Hamilton, ON.

Carotid endarterectomy is effective in preventing strokes in patients with symptomatic carotid stenosis greater than 50%. The magnitude of the benefit is greater with increasing degree of stenosis, male sex, greater number of risk factors for strokes, strokes or hemispheric transient ischemic attacks rather than amaurosis fugax, recurrent events, plaque ulceration, contralateral carotid occlusion and tandem (intracranial and extracranial) stenosis. The effectiveness of carotid endarterectomy, however, is very sensitive to the rate of perioperative events, and centres providing care for these patients need to prospectively monitor their complication rates.
Key words: carotid stenosis, carotid endarterectomy, stroke, transient ischemic attacks.

D'Arcy Little, MD, CCFP, Director of Medical Education, York Community Services; Lecturer and Academic Fellow, Department of Family and Community Medicine, University of Toronto; 2002-3 Royal Canadian Legion Fellow in Care of the Elderly, Toronto, ON.

Neuropathic pain is a relatively common and challenging entity in the elderly, with a wide differential diagnosis and numerous treatments available. In general, damage to peripheral nerves via an injury or as a result of abnormal functioning is thought to trigger a cascade of events in sensory neurons that is responsible for the generation of pain. Potential treatments include tricyclic antidepressants, serotonin re-uptake inhibitors, venlafaxine, ion channel blockers, opioids, capsaicin and the Lidocaine patch. This article reviews the relative efficacy of these treatments, with specific reference to considerations in the elderly.
Key words: neuropathic pain, peripheral neuropathy, treatment, anticonvulsant, antidepressant.

Helen Gia Levin, BA(Psychology), BSW, MSW, RSW, Member of Ontario Association of Professional Social Workers, Regional Geriatric Program Central Service, Toronto, ON.
Zoë Anne Levitt, BSW, MSW, RSW, Social Worker, Regional Geriatric Program Central Service, Toronto, ON.

Performing the assessment for capacity to make admission decisions to long-term care can either be simple or fraught with problems. A discussion of two clinical case examples will illustrate how this process, which appears to be straightforward, can become quite complex. The authors assume that the readers have a working knowledge of the process for assessing elders' capacity to make admission decisions to long-term care.
Key words: admission decisions, long-term care, capacity assessment, Consent and Capacity Board.

Maha Theresa Haroun, MD, FRCP(C), Staff Dermatologist, Sunnybrook and Women's College Health Sciences Centre; Division of Dermatology, University of Toronto, Toronto, ON.

Xerosis, or dry skin, is a common problem and its incidence and severity increase with age. It is the most common cause of generalised pruritus in the elderly. The cause of dry skin is not completely understood. It has a genetic component and is influenced by environmental factors, such as cold or dry climates, and the use of soaps and harsh cleansers. Age-related changes in the skin also can explain the dryness that tends to develop with age. The management of xerosis should be directed towards altering environmental factors and treating the signs and symptoms of the patient. Attention to the care of dry skin becomes more important as our population ages.
Key words: dry skin, xerosis, aging skin, stratum corneum, moisturisers.

R. Allan Purdy MD, FRCPC, Professor of Medicine (Neurology), Dalhousie University, Halifax, NS.

Of all the neurological disorders, migraine is one of the most common and fascinating. In importance, the modern neurobiology of migraine places it among other major neurological conditions of a paroxysmal nature. Migraine occurs at all ages and is not uncommon in middle- and late-life. It can present with aura and no or little headache, and with or without a prior history of migraine in earlier life. Physicians seeing older patients with transient neurological symptoms and headache need to understand the role of migraine in the diagnosis and ensure no other sinister etiology exists or coexists.
Key words: migraine, aura, migraine accompaniment, acephalgic migraine, headache.