Description

New books on elderly medicine are always welcome and usually timely. They reflect the increasing need for clinicians of all specialties to delve into what may be an unfamiliar branch of medicine at a time when for most of us, the acutely ill patients that we see are likely to be elderly. As Dr Keith Harkins mentions in the chapter on social gerontology in this book, the need will inevitably increase and reflects the fact that at the moment 18% of the total population in the United Kingdom are of pensionable age, all with their own individual needs.

While it is true that such a group constitute great heterogeneity, it is the task of the editors of a book like this to pull together certain topics to aid trainees and improve their bedrock of knowledge, and herein lies the problem. For the trainees will have different needs, from the clinician who is relatively unfamiliar with geriatric medicine to an SpR in the specialty, and to a consultant already in post who requires an update on specific topics.

The editors are therefore faced with the almost impossible problem of trying to satisfy everyone. Inevitably this will mean that the individual contributors will have their own agendas and will be targeting different audiences. This has led unfortunately to a certain unevenness in style and on occasions to examples where the subject has been tackled superficially when a more informed, yet simple and direct approach would perhaps have been more welcome.

There is much however that is good in this book and it is very readable.

There are four parts with a final bibliography with the references mostly up to 1999. Individual chapters are written by acknowledged experts in the field, for example, Urologists, Dermatologists and Psychiatrists as well as Clinicians with an interest in Care of the Elderly.

Part One covers general themes such as Ageing, Community Care, Ethics and the Law.

Part Two covers core topics, for example Incontinence, Falls, General and Specific Rehabilitation, Psychiatric Problems.

Part Three is on selected subjects which are systems based; in Neurology there is a chapter on the management of Parkinsons Disease and one on Prostatic Problems in the Elderly. There is even a daunting chapter on Cancer in Old Age which is covered in seventeen pages!

Part Four deals with personal professional skills including a chapter on Preparing for a Consultant Post and one entitled All You Need To Know About Management In One Chapter. This is certainly a new departure for a book of this kind and will prove invaluable for trainees in the United Kingdom where so often expertise is assumed and often found wanting. In many ways this was the most successful part of the book and covers an important area for trainees, which as far as I know has never previously been covered. The editors should be commended warmly for this innovation.

There are minor criticisms. The publishers (Martin Dunitz) have been a little lazy. Many of the figures are of uneven quality and appear to have been lifted from individual contributors. One or two are embarrassingly irrelevant. There are a number of proof errors and some of the quotes at the beginning of chapters I found facile and unnecessary. I am also not sure that the self-assessment questions at the end of the chapters are a complete success. The MRI and CT scans however are well reproduced.

Whilst this book does not quite hit the mark, as I have already pointed out the target is indistinct and always moving. The editors are to be congratulated on an ambitious project which was designed not to be a standard textbook but a lively guide to active learning. In this they have largely succeeded. The chapters are full of up to date information and I would recommend it to any interested clinician to dip into. Readers will still need to consult standard textbooks for a more exhaustive exploration of certain subjects.