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.

Warren T. Blume, MD, FRCPC, London Health Sciences Centre, University Campus, Epilepsy Unit; Professor, University of Western Ontario, London, ON.
David J. Harris, LRCP(Lond), MRCS(Eng), FRCPC, MRCPsych, London Health Sciences Centre, South Street Campus, Geriatric Mental Health Program; Associate Professor, University of Western Ontario, London, ON.

Management of epilepsy in an elderly person requires accurate classification of seizures, a sufficient neurologic assessment to define etiology, and awareness of the patient's health and social situation. Treatment with an antiepileptic drug requires an understanding of the general health of the patient and the nature of all medications being given to the patient by other physicians. Effective communication with the patient, spouse, any adult children or other caregivers aims to ensure that all understand the goals of treatment, medication side effects and monitoring methods. Concomitant illness such as neurological, psychiatric, metabolic or cardiac disorders will require individualization of treatment plans.
Key words: epilepsy, elderly, differential diagnosis, management.

Anil D. Patel, MD, FRCSC, FACS, Chairman, Department of Ophthalmology, University of Saskatchewan, Saskatoon, SK.

Diplopia is a common visual complaint in the elderly. A wide variety of causes is possible, ranging from benign conditions with spontaneous resolution to serious life-threatening conditions. A proper history that details the characteristics of the diplopia is essential in determining its cause, prognosis and management.
Key words: diplopia, double vision, comitancy, convergence insufficiency, ocular motor palsy.

John P. Preece, PhD, Department of Communicative Disorders, University of Rhode Island, Kingston, RI.
Richard S. Tyler, PhD, Department of Otolaryngology-Head & Neck Surgery, Department of Speech Pathology & Audiology, University of Iowa, Iowa City, IA.
William Noble, PhD, School of Psychology, University of New England, Armidale, NSW, Australia.

Hearing loss in the elderly is a frequently acknowledged problem. Prevalence of hearing loss clearly increases with age, to as high as 50% of persons older than 70 years. Less recognised is an often-related problem, tinnitus. We are concerned here about pathological tinnitus: that which lasts more than five minutes more than once a week. In this article we review the prevalence of tinnitus as a function of age, and its causes and mechanisms. We also describe problems commonly associated with chronic tinnitus and some treatment options. We conclude with some special considerations for the elderly patient.
Key words: tinnitus, prevalence, counseling, sound therapy.