Medical Care of the Elderly by M.R.P. Hall, W.J. MacLennonand W.D.W. Lye. New York, Springer Publishing Co., 1978. 164 pp. $8.95.
This book might well have been titled, A Holistic Guide to the Health Care of the Elderly: A Handbook. The text is geared to professionals from a number of disciplines, including social work, physical, occupational and rehabilitation therapies, nutrition, nursing and medicine. In addressing the myriad members of the health care team the text serves to enhance an interdisciplinary approach to assessing health needs of our elderly as well as to planning and impleof meriting appropriate interventions. The style is concise; it is written in a straightforward manner that avoids the inclusion of professional jargon.
The respectful focus of this work is to provide care for elderly people-elderly men and women who transcend such labels as patient, client, senior citizen, or golden ager. Clearly, the goal of the authors is to enable older persons to achieve and maintain an optimal sense of mental, physical and spiritual wellbeing compatible with the limitations imposed by the aging process and any attendant incidence of disease.
The authors of this book, which was first published in England in 1978, are British. It has been generally recognized that Great Britain has been a leader in the practice of medical and nursing care of geriatric patients in hospitals, nursing homes, hospices, and the community. Most issues discussed are pertinent to an American readership; however, the use of primarily British medical references for further readings at the end of each chapter and the use of specifically British population statistics and health care costs detract from the usefulness of this book.
The text does aid in the identification of the elderly at risk and at high risk. Universal objectives of care include four basic areas of need: physical, emotional, social, and spiritual. The authors emphasize consideration of home and community-based care and recommend a vigorous interdisciplinary team approach to that care.
The 15 chapters are prefaced by the presentation of seven case studies illustrating the diversity of problems that may be faced by some elderly. The presentations are problem oriented in the medical manner, and emphasize secondary and tertiary intervention. However, primary intervention, through diet, exercise, and health enhancing life habits, is discussed in Chapter One. Conceptual models in the form of 44 tables lead to clarity of understanding and visual comprehension.
Whereas chapters one through four provide theoretical bases for assessment, chapter five begins a shift to the planning and implementation phases of care. Humanistic and holistic approaches to care of the elderly continue as the authors address the roles of relatives, friends, neighbors, and the patient in planning for the care of incapacitated persons in various community facilities.
Of particular usefulness is a section on drug therapy, including basic principles of drug prescription and administration for the elderly. Idiosyncratic effects of drugs and combinations of drugs peculiar to this population are presented.
Chapter Six clearly reflects the position of the authors in their statement that symptoms and disabilities afflicting old age result from disease-not old age alone. Health care providers are challenged to look for and treat the underlying pathophysiology of alterations in hearing, vision, mobility, mental function, nutrition, energy, and integument.
Chapters Seven through Thirteen present succinct, if somewhat superficial, discussions of disease conditions that contribute to alterations in comfort, awareness, safety, and material exchange of some elderly persons.
In Chapter Fourteen the authors discuss a social, personal, medical, and nursing concern: incontinence. The emphasis is on remediation. The final chapter is concerned with the ethical and practical considerations of cáring for the terminally ill.
As the strength of the manuscript emanates from a humanistic philosophy, its holistic and interdisciplinary approach to health care, and the scope of its intended readership, its main weakness lies in the lack of in-depth discussion of the pathophysiology underlying disease conditions. Interventions deemed appropriate for the nurse on the health care team are limited, as is the scope of the role of the nurse. Sex roles, thus professional roles, are traditionally and stereo^ typically designated.
I recommend this book as a small convenient handbook that gives an overview to care of the elderly. This basic primer in geriatric care may be supplemented with standard indepth specialty texts, as indicated in the preface by the authors.