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The third edition of Geriatric Medicine covers basic gerontologic concepts, contexts of care, clinical approaches to the geriatric patient, medical disorders, and ethics and health policy. The values and perspectives of geriatrics are revealed in the consistent effort throughout the chapters to address how the site of care, coexisting conditions, and the health status of the patient influence management. The book offers an approach to serving as a knowledgeable advocate for older adults, ranging from the vigorous 80-year-old in whom prevention and assertive intervention may be appropriate to the elderly person who is dying and needs a provider with extensive skills in comfort care and communication with patients. These themes are exemplified in the chapter on infectious diseases, where host and environmental factors are consistently woven into a pragmatic approach to care. Other perspectives unique to geriatrics are demonstrated in chapters on the determination of decision-making capacity, screening for cancer, nutrition, and pain management. There is a valuable emphasis on ethical issues faced by those who provide care to older adults.
It is never feasible to include all possible topics, given the constraints of cost and space. Nevertheless, there are some surprising omissions from this book. There is little emphasis on the experiences and needs of family care givers or on communication between doctor and patient. Despite the strong focus on chronic disease, there is no consistent approach to "self-management," the modern philosophy of helping the person with a chronic disease become a knowledgeable manager of the disease. There is only minimal attention to the management of behavioral problems in demented persons. Too many chapters tend to be long on text and short on tables and figures, making the format somewhat forbidding at times.
Geriatrics is and will continue to be a predominant part of the daily practice of most generalists. This book is not likely to be useful as a quick reference source, but I recommend it for thoughtful reading about rational and compassionate management of geriatric problems.
Reviewed by Stephanie Studenski, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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