Practical Geriatrie Therapeutics, Sloan RW. Oradell, NJ, Medicai Economics Co Books Division, 1986, 335 pages, softcover, $24.95.
The number of new books on geriatrics/gerontology which appear is increasing rapidly. Many are of interest, but may not necessarily find their way to the practicing physician. Dr Sloan, in his book Practical Geriatric Therapeutics, addresses the problems that the general practitioner faces every day. It is the intent of this book to present a "core content of clinically relevant information to facilitate safe and effective use of drugs in the elderly. " Since drugs probably are the most cost-effective modality of chronic disease management, and since drugs can (and at times do) affect many patient characteristics adversely, it is a welcome book.
The book is organized into 25 chapters. It is somewhat regrettable that five chapters have been published previously, some as far back as 1981. The first section deals with general topics and principles and the second, larger section (19 chapters) addresses individual drug classes. It is most interesting and helpful that each chapter on drugs contains sections on "patient-at-risk" profile, representative drugs, titrating the dosage, key adverse effects, and, most importantly, alternative drugs. As the Liverpool study on drug interactions clearly showed, most of these interactions and adverse effects can be avoided by selecting alternate drugs. Each chapter lists a small number of key references which, given the stated goal of the book, is quite sufficient.
One might argue with a fact here and there. It is now known that, at least in healthy elderly, cardiac output does not decrease with age. The section on pharmacodynamics does not reflect the enormous activity in that field, and that is important. A study of pharmacokinetics tells the practitioner, in general, to reduce dosages, while based on pharmacodynamics, a dose often must be increased to achieve the desired therapeutic effect, heightening the risk to adverse drug reactions.
The section on drug interactions surely should be enhanced, to discuss the very important area of drug diseases interactions, and certainly drug-nutrition interactions. While metoclopramide and cimetidine are addressed very well, one might wish that there was a little bit more discussion about the meaning of digoxin blood levels (can they be relied on to determine toxicJty?) and the atypical presentation of digoxin loxicity in the elderly. Again, a warning is issued against prophylactic use of anti-cholinergic anti -Parkinson drugs, and this should be expanded to tell the practitioner how to take elderly off these drugs.
But why quibble? It is a good book - a "practical" book for the practitioner, as the title impiies. The author meets and exceeds his stated objectives. The book is recommended for all practitioners - physicians, nurses and pharmacists.