Geriatrics. By G. K. Wilcock, BSc, DM, MRCP, and A.M. Middleton, MB, BS, MRCP. London, Grant Mclntyre Ltd, 1981. $9.95.
This 172-page pocket consultant was written, according to its authors, as a useful aid in the management of elderly patients. This is a concise, practical book that outlines pertinent facts about common geriatric problems, laboratory tests, and prescribing for the elderly. It is not a textbook of geriatrics but, rather, a small supplemental reference with selfcontained sections for quick and easy use. Its intended audience is medical students, junior medical staff, and general medical practioners. Even though Geriatrics follows a medical work-up format, its use as a pocket consultant will benefit nurses who work with the frail elderly.
Perhaps the greatest strength of this book is the clarity with which it sets priorities in working up a specific problem. The work-ups are specific to the elderly and reflect the practical knowledge of experienced geriatric clinicians. The assessment for weight loss, for example, not only includes a review of nutrition and gastrointestinal disorders, but also of endocrine disorders, psychiatric problems, cancers, chronic infections, and drug responses. Specific instructions are provided as to the order in which to proceed for these assessment areas.
Work-ups also review atypical presentations of disorders, and consider specific causes for signs and symptoms. For example, the workup on urinary incontinence includes a section on apparent incontinence including causative factors such as urinary tract infection, potent diuretics, clumsiness with the use of a urinal, and temporary disorientation due to relocation. Geriatrics does a nice job in reviewing and setting priorities in investigating specific problems. Do not look to this book, however, for information on how to do the work-up.
Treatments are very general, limited, and usually specific to medical interventions. The pros and cons of specific interventions are missing as well. It is clear that Geriatrics is not interdisciplinary in its focus nor is it treatment oriented. This limitation is a result of a purposefully narrow focus and audience. Nevertheless, geriatric nurse practitioners and gerontological nurses working with physicians will find much pertinent and helpful information.
The chapter on principles of drug prescribing contains bits and pieces of useful information that one might want from a quick reference source. Overall, however, this chapter generalizes too much and thus is not reliable as a primary source of information. An example of one such oversimplification is the first sentence of the chapter: "In general, treatment of diseases by drug therapy is the same in the elderly as in the young." A more serious limitation is the use of a two-category drug classification system for psychotropic medications. The use of only two categories - hypnotics and tranquilizers - is not as clinically useful as are the subcategories that specify treatment for anxiety, sleep disorder, and psychotic behavior. Finally, the chapter includes a small list of medications that are unavailable in the United States.
The lab values section is not used as easily by nurses for quick reference as is the rest of the book. Its organization presupposes a knowledge of common tests for specific disorders. Another problem is that the values are sometimes given as mmol/1 whereas, in the United States, we measure the same value as mg/ 100 ml. Nevertheless, the chapter is wellwritten and includes very pertinent and interesting information and rationales for lab tests.
The chapter that includes medicolegal information is rather unsophisticated for nurses and often is pertinent only to the British system. It covers material at a level that is most applicable for first-year nursing students.
Perhaps Geriatrics' major limitation is a lack of references. Because the book is designed to be a quick and easy resource it does not offer detail or depth. The breadth of information is large, but the reader is given no guidance as to further sources of information. There is a small reading list at the end of Geriatrics, but this does not meet the reader's need as would references throughout the book. Even though a pocket consultant, by design, must limit its number of pages, Geriatrics has unduly restricted its potential by not including chapter references.
A review of Geriatrics would not be complete without mentioning the very impressive sensitivity the authors show toward the problems of aging. The authors' values and medical ethics are highly supportive of self-care, dignity, and independence in old age. Topics such as pain relief, terminal care, and surgery are addressed with the utmost respect for patient rights. The authors state, for example, that "age alone should never be considered a contraindication for surgery."
The strengths of this pocket consultant clearly are in the areas of streamlining and establishing priorities for work-ups of common geriatric problems as well as providing a geriatric focus to the care of elderly patients. Gerontological nurses, geriatric nurse practitioners, and experienced nurses working with the elderly, will find this short, inexpensive book a valuable resource for various aspects of their practice.