Common Symptoms of Disease in the Elderly by H.M. Hodkinson. 2nd edition. London, Blackwell Scientific Publications, 1980.
This text covers a wide variety of disease symptoms seen frequently in older adults. The author emphasizes the differences among symptoms seen in the elderly and symptoms seen in younger or middleaged adults.
The first chapter is a summary of ways in which diseases differ in old age. Hodkinson points out that the preponderance of multiple diagnoses in elderly patients calls for a reorientation of thought processes on the part of health care providers. It is insufficient to focus on fitting all of the findings of the history, physical examinations, and laboratory results into one diagnosis. Older people demonstrate the effects of past injuries, illnesses and surgeries. These residuals, combined with a slow decline in functions of most body systems, may modify the presenting symptoms of a new disease. A number of minor problems may interact to produce problems of major consequences. These multiple factors are compounded further by the elderly patient's altered responses to illness. Conditions that cause severe pain in younger patients may be totally painless in old age, and the elderly are less likely to have temperature elevations in response to an infection.
These factors of multiplediseases, multiple minor problems interacting to result in major problems, and altered body response to diseases, make diagnosis in the elderly more of a challenge. Hodkinson points out that these issues are complicated by the fact that many elderly people tend to minimize their symptoms and do not seek medical care promptly.
Following the introduction, Hodkinson discusses the nonspecific presentations of illness and presentations with "mental symptoms. Both of these sections (Chapters 2 & 3) are divided into categories of nonspecific symptoms found frequently in older patients. "Senility" is the first category that is . covered in this section. The author makes the* point that "senility" is not a diagnosis, but is a finding that *»should provide^ a diagnostic challenge to find the cause of mental deterioration in the old person. Hodkinson then discusses several of these possible causes. A number of routine screening tests is discussed, with suggestions on what to consider in the various tests.
The sections "on forgetfulness and depression are Especially well-written, with a summary of what information is needed by the health care provider in order to determine the cause of the symptoms. Hodkinson includes an abbreviated mental test with the admonition to use caution in interpreting a low test score, as the^ulder person may be from a socially or culturally deprived background, or may be depressed. Hodkinson's abbreviated mental test certainly has value and his inclusion of practical considerations in the interpretation of the test are especially important.
In the remaining chapters Hodkinson covers symptoms seen most often in older adults. Symptoms are discussed by the body system involved, possible causes are mentioned, and diagnostic procedures are suggested. The format is easy to use as a reference resource.
The last chapter is on symptoms caused by drugs. The various categories of adverse effects, (i.e., overdosage, side effects, interactions) are given. Then major categories of drugs associated with adverse effects in the elderly are considered. A summary of symptoms due to drugs completes this chapter.
This text, in addition to its value as a reference tool, provides a good overview of symptomatology in the elderly. It contains practical information that covers problems seen commonly in older adults. The section on urinary incontinence is an excellent example of the author's sensible approach of initiating a regular scheduled program of bladder emptying while searching for treatable causes.
This symptom-related approach to working with elderly patients will be most helpful to gerontological nurses. Nurses who have had experience in working with the elderly will be very familiar with the symptoms covered in the text. The recommendations on pursuing the diagnoses will be useful in developing a plan of action for older clients. Nurses who are new to the field of gerontology will gain insight into the vast differences of the elderly in presenting symptomatology. Hodkinson's philosophy of viewing the complex process of diagnosing diseases in the elderly as a challenge is a refreshing change from the often-heard "nothing can be done" attitude. In summary, this is a well-written, insightful text that is useful both as a reference resource and for reading in its entirety.
Beverly Harris, RN, MS
Senior Health Maintenance Program
Health Services Agency
Santa Cruz, California