Clinical Geriatrics

Geriatric medicine is an emerging field in the U.S., Canada, and Europe with Asia following not too far behind. And as the aging population increases worldwide, the field will continue to grow in importance. Keeping pace with this rapidly expanding field, Clinical Geriatrics provides the basic principles of geriatric medicine, including important aspects of patient evaluation and management in the hospital, nursing home, home, and other community settings.

Unique in its simplicity of style, the book is based on material derived from standard international journals and the experience of the contributors. It presents information in an easy-to-find and easy-to-understand format, yet does not oversimplify the subject. The editors also cover topics not commonly found in texts on geriatrics including vitamin B12 deficiency, HIV disease in the elderly, and cutaneous skin infections. The combination of authoritative information and convenient format make Clinical Geriatrics the definitive text for teaching geriatric medicine and the ideal reference for primary health care providers.

Demographic changes in industrialized countries grow more compelling with each census. In many of these countries, 15 percent of the population or more is older than 65 years of age. In the United States, people in this age group make up 13 percent of the population, and these figures are projected to double in the next 30 years -- from 35 million to more than 70 million. The leading edge of the Baby Boom generation will reach 65 years of age in less than 10 years, and clinicians in all medical specialties except for obstetrics and pediatrics are already seeing increased numbers of elderly people. The fastest-growing segment of the population is people older than 85 years of age, a group that uses a substantial portion of health care services. Clinicians caring for elderly people have a wide variety of educational resources to help them stay up to date in the diagnosis and management of geriatric conditions. Clinical Geriatrics is a new textbook designed to meet the educational needs of primary care physicians, nurse practitioners, and physician assistants. The book has five sections. The first focuses on basic principles, including those involved in aging and public health, physiology, care delivery in various settings, preventive health, exercise, nutrition, end-of-life care, and ethical and legal issues. The second section addresses common geriatric problems such as falls, urinary incontinence, and osteoporosis. Geriatric neuropsychiatry is covered in the third section, and section four is organized according to organ system. The final section contains discussions of miscellaneous conditions, such as vitamin B(sub 12) deficiency, hormone-replacement therapy, and aging and infection with the human immunodeficiency virus. Clinical Geriatrics is clear and consistent in writing style and tone, which is commendable for a book with multiple authors; nearly half the chapters are coauthored by the editors. The chapter called "Ethical and Legal Issues in Nursing Home Care" seems to be an aberration. Although the information presented in the chapter is helpful, it is written in the first person, with numerous editorial comments. For seasoned clinicians, Clinical Geriatrics contains insufficient detail, but an encyclopedic scope does not appear to be the goal. For example, lumbar spinal stenosis, a relatively common geriatric condition, does not appear in the index, and the brief discussion in the section on back pain does little to assist the practitioner. Nor is Clinical Geriatrics a clinical handbook with quick answers to thorny questions that should be kept in a busy clinic for ready reference. Rather, Clinical Geriatrics reads like a board-review syllabus that provides a basic grounding in core topics. The chapters are more useful as introductory overviews of fundamental concepts than as clinical guides. The chapters contain a reasonable number of references and a high proportion of citations of other textbooks and professional syllabi. The book contains very few figures or photographs, and the overall quality of the figures that are presented is highly variable. In summary, Clinical Geriatrics is practical, easy to read, and comprehensible. It provides useful overviews of geriatric principles and conditions affecting elderly people. Students and fellows who are seeking to build a basic foundation of geriatric knowledge should consider this book an excellent resource. Mark E. Williams, M.D.
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