Post-traumatic stress disorder refers to the aftermath of highly traumatic events involving death, serious injury, or threat to one's physical integrity in circumstances out of the ordinary, such as war, natural disasters, rape, or torture. Four chapters of this book specifically address post-traumatic stress disorder, as a late-onset or reactivated condition, in World War II veterans and older adults who survived a natural disaster. These contributions, from American and Dutch researchers, bring first-hand information on the prevalence and course of the disorder and they constitute the originality of the book. Two chapters, on the maltreatment of older adults and on the stressful impact of ordinary negative events on older adults, expand the coverage of stress in late adulthood. Starting and finishing with a discussion of general issues in stress and post-traumatic stress research, the book also contains two chapters of a more general nature on the effects of age on physiological responses to stress in both laboratory animals and human beings. Contributions providing a theoretical context for integration and drawing the therapeutic implications of the research findings would have been useful. Still, this book constitutes a unique source of information and a basic reading, given the paucity of research in the area of post-traumatic stress disorder in older adults.

Drug-related illness (DRI) is a common problem in the elderly. Misuse of medications and inappropriate prescribing account for over half of all hospital admissions for DRI and both are potentially preventable. Physicians are the gatekeepers to prescription medication access and, in this role, they have the opportunity to prevent exposure to unnecessary and inappropriate medication and influence the use of medications by their elderly patients. Effective interventions to improve physician prescribing have been identified but they are costly to introduce, they require ongoing maintenance to maintain their effectiveness, they do not address the problems created by multiple prescribers or the challenges of keeping up-to-date on the growing number of new drugs that enter the market each year. Computer-based drug information networks and expert decision-making support systems are proposed as one means of providing (1) an accurate record for the prescribing physicians of drugs currently dispensed to their elderly patients, (2) a review of problems in existing and new prescriptions, and (3) an expert resource to select drug treatment. Canada is in an ideal situation to pioneer the development of these systems, but to do so, policies need to be put in place to address three problems. First, there is inadequate information available about the risks and benefits of drugs in the elderly because older sicker adults are often excluded in clinical trials of drug-effectiveness. Requirements for drug approval need to be amended so that sufficient evaluation of the risks and benefits of new drugs are carried out in the elderly. Second, computerization in the health care sector is central to the development of electronic decision-support systems in health care delivery. Future policy needs to be directed to the development of an effective infrastructure to facilitate the transition to an integrated computerized health sector. Third, the ethical and legal issues related to the access of prescription data through electronic networks need to be identified and clear guidelines for use of this new technology need to be developed.

As Canadian health policy-makers struggle to contain costs while maintaining quality, patient education is promoted as making patients more effective producers of health and consumers of health care. Assessment of existing psychoeducational interventions has concentrated on knowledge enhancement, behaviour modification, and health status while economic outcomes have remained unexplored. Given that such programs are likely to be effective, but costly, economic appraisals are necessary to convince cost-conscious policy-makers. This manuscript describes a cost-effectiveness evaluation of the Arthritis Self-Management Program (ASMP) that I and my collaborators are conducting by randomizing participants to the ASMP as an adjunct to usual medical care versus usual medical care. Direct and indirect costs are evaluated through self-reporting of health services utilization and diminished productivity and effectiveness through a visual analogue scale and the SF-36. To influence health policy, the results must be disseminated to public health authorities, private insurers, and patient and health professional organizations, thereby encouraging funding, increasing awareness, and promoting participation.

The issue of linking research and policy is not unique to health care of the elderly; it has been articulated by numerous stakeholder groups, including those with specific diseases, such as breast cancer. A method of enhancing these links is now being systematically addressed in the Canadian Breast Cancer Initiative with the input of women with breast cancer. The Initiative consists of a number of components and demonstrates a model of consumer participation at multiple levels in setting the agenda for research and policy development, thus enhancing accountability in the transfer of research findings into policy. The concept of consumer participation in linking research and policy is transferable to other diseases and other population groups, such as seniors.

This work is essentially based on a previous study which the author completed for the Quebec Department of Tourism Fish and Game. It identifies the tendencies which influence the supply and demand of recreational services offered to seniors. This work of nine well-structured chapters focusses on Quebec but does not ignore the main Canadian, American, or even European research in this area. The first three chapters take the reader into the heart of the problem: the study of leisure. Chapters 4 to 8 deal respectively with physical, sociocultural educational, social and tourism activities. The last chapter deals with the impact of leisure on the quality of life and the use of social-sanitary services. We learn that recreational activities contribute largely to the well-being of seniors. As part of the general conclusion, the tendencies that most influence the organization of recreation services are synthetically reviewed and summarized.