Dr. A. Mark Clarfield is the Chief of Academic Affairs at the Sarah Herzog Hospital in Jerusalem and a staff geriatrician of the Division of Geriatric Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal. We regret that Dr. Clarfield's articles are not available on-line.
Principles of Geriatric Medicine and Gerontology
Editors: Hazzard, WR; Blass, JP; Ettinger, WH; Halter, JB; Ouslander, JG; McGraw-Hill, New York, 1998
Reviewed by: Barry J. Goldlist, MD, FRCPC, FACP
This textbook is a massive multi-authored text that attempts to cover the entire spectrum of clinical geriatrics. For the most part it succeeds admirably. It represents a predominantly United States view of the speciality, with only 6 of the almost 200 contributors coming from other countries (3 from Canada, 2 from the United Kingdom, and 1 from the Netherlands).
The typeface is clear and easy to read, and diagrams and tables are used effectively throughout. Although many of the chapters focus on disease entities that are not exclusive to geriatrics, but rather are common in the elderly, these are not exhaustive chapters, and this book would not function as a replacement for a textbook of internal medicine. Rather, it would serve as an adjunct.
For the practicing physician, the most important section is that on geriatric syndromes. As in all multi-authored textbooks there is some unevenness in the chapters. Not surprising the chapter on urinary incontinence, co-authored by Dr. Ouslander is outstanding, as much because of its innovative presentation as the actual content. In contrast, one wonders whether a chapter on diarrhea in the elderly was even required. Other than an initial section warning us that diarrhea can be more lethal in the elderly and volume status more difficult to assess, it seems like a standard medical text chapter on diarrhea.
The initial chapters on principles of gerontology are well written, and lay a good framework for the clinical portions of the text. The chapter on gender differential in longevity might have been enhanced with some discussion concerning other mammalian species. These chapters, and in fact almost all, are very up to date, with many references from 1997 and some from 1998. This is a remarkable achievement in such a major text.
Who should buy this text? Most specialists in geriatric medicine, in my opinion, would rarely consult a book such as this in their day to day practice, preferring to rely on current literature, although they may purchase a copy for residents to use. A text such as this should be mandatory for every hospital library, and generalist physicians with a large number of elderly patients in their practice would find such a comprehensive text on geriatrics and gerontology a very useful purchase. Whether one should purchase this text or one of its competitors probably depends on style preference and the timing of the purchase. Frequently in a large comprehensive textbook, the one most recently published is the most prudent to buy.
Dr. A. Mark Clarfield is the Chief of Academic Affairs at the Sarah Herzog Hospital in Jerusalem and a staff geriatrician of the Division of Geriatric Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal. We regret that Dr. Clarfield's articles are not available on-line.
Research and Practice in Alzheimer's Disease: 1996
Editors: B. Vellas, J. Fitten, G. Frisoni Serdi Publisher, Paris, 1998.
Reviewed by: Barry J. Goldlist, MD, FRCPC, FACP
This book has been developed in a "yearbook" type format. However, instead of reviewing key articles in the literature, it is composed of invited articles. This of course makes it more like a textbook, with the inevitable problems of keeping it up to date. However, unlike a textbook, there is not a common theme or progression of content.
Nevertheless, this is a worthwhile text. Even if some of the articles in the first section (research in Alzheimer's disease) are not on the cutting edge, there is useful information for the practitioner in the field. The second section (practice in Alzheimer's disease) is particularly successful because of its international flavor. The articles are wide ranging, and include a good review of dementia with Lewy bodies, and interesting articles on how environmental manipulations might affect behavior in dementing disorders.
The editorial that introduces the text suggests that it would be of interest to a wide range of professionals involved with Alzheimer's disease, including primary care physicians. My guess is that its greatest appeal will be for clinicians heavily involved with dementia diagnosis and care, such as geriatricians, geriatric psychiatrists, and neurologists.
Medical Care in the Nursing Home, 2nd Edition
Ouslander, JG, Osterweil, D, Morley, J
McGraw-Hill 1997
Reviewed by: Barry J. Goldlist, MD, FRCPC, FACP
This text was clearly meant to appeal to the American nursing home physician. However, it has much value to offer the Canadian physician involved in long term care. This text is applicable to what we would consider separate fields: residential care, nursing home care, and chronic hospital care (complex continuing care), as most American nursing homes can have several levels of nursing care.
Part one of the text covers general and administrative aspects of medical care in the nursing home, and is based on American legislation and requirements. Nevertheless, the sections on environment, pre-admission assessment, screening and health maintenance, and interdisciplinary teams are fully applicable to the Canadian scene. The description of the minimum data set (MDS) is also useful, as it is making substantial inroads in Canadian long term care. The section on total quality management in the nursing home will be particularly useful to medical directors.
Part two of the book is called clinical conditions, and is extremely strong. There is no attempt to create a comprehensive text of medical problems in the nursing home, rather the issues that differ from other areas of medical practice are stressed. The chapters on falls and urinary incontinence will be particularly helpful to Canadian physicians involved in long term care. The section on depression tends to favor tricyclic antidepressants over SSRI's in the treatment of the depressed nursing home patient. This is probably counter to the usual Canadian practice, but the authors are in fact correct in stating that there is little scientific evidence to favor the much costlier SSRI's.
Section three, General Management issues is extremely relevant to the Canadian long term care sector. Issues such as drug use, rehabilitation, ethics, and education are well presented from the viewpoint of the nursing home. The section on pain management and palliative (hospice) care is particularly useful, as this is frequently a neglected area in long term care.
The final section is a real bonus. There are numerous examples of policies and procedures, and various forms that are useful in the nursing home setting. In fact, throughout the text, whenever an assessment tool is recommended, it is included in its entirety in the book so that adoption of the tool in the nursing home requires little extra effort.
In summary, this is a book that is intended for the American nursing home physician. Nevertheless, most of the book is also applicable to the Canadian physician involved in long term care, and I would recommend it highly to them.
The Canadian Society of Geriatric Medicine (CSGM) now has a homepage, which can be viewed at www.canger.org. The homepage has links to several hundred other internet sites specific to geriatric clinical care and research. Educational materials and cases, geared to physicians in geriatric practice are provided, as is a listing of recent job postings for geriatricians in Canada. A bibliography of all recent peer-reviewed publications by CSGM members is posted, as is the GAIN (Geriatric Assessment and Intervention Network) database.
GAIN is a clinical trials network for members of the CSGM. It is meant to facilitate and coordinate multisite clinical geriatric research in Canada by geriatrics trained physicians, residents and fellows in geriatric medicine, recognizing that most geriatric centres have at least some assessment and research infrastructure in place. Apart from individual projects, such as the Canadian Study of Health and Aging, collaborative geriatric research in Canada has been limited to date.
GAIN is NOT meant to focus geriatric research in particular areas, but instead to facilitate geriatric research that may currently be limited by lack of funding, insufficient sample size, lack of local interest, etc.
How GAIN Works
The CSGM website allows access to GAIN. The CSGM website will promote the exchange of information, scientific skills and research ideas across the country. Research ideas and research protocols can be securely posted at the website. Research ideas can be considered 'fishing expeditions', to attract additional help with developing a research protocol, or to determine general interest in a particular project by other CSGM members. For example, CSGM members interested in a particular project would communicate by e-mail to further develop protocols and compile results.
Access to posted GAIN research ideas and protocols is limited to CSGM members, as is access to the csgm membership and the e-mail addressbook.
Membership costs $50/year and is open to Phds and physicians whose primary focus is research and/or care of the elderly.
Contact Dr. Gary Naglie, at gary.naglie@utoronto.ca, CSGM secretary treasurer to join.
Teaching cases or educational materials, monthly columns, evidence based reviews of geriatric literature and other relevant material can be posted directly on the home page, or by contacting Dr. John Puxty at puxtyj@pccc.kari.net, Dr. Mike Newnham at miken@biostats.uwo.ca, or Gaetane Blom glblom@brktel.on.ca.
Please visit the CSGM home page at www.canger.org for more details.
The United Nations General Assembly decided to observe the International Year of Older Persons "in recognition of humanity's demographic coming of age" and the promise that holds for "maturing attitudes and capabilities in social, economic, cultural and spiritual undertakings" (General Assembly resolution 47/5, 1992).
For more information, visit the United Nations website at:
www.un.org/dpcsd/dspd/iyop.htm
The following are some quotes taken from the website:
Situation of older persons
"...the transition to a positive, active and developmentally oriented view of ageing may well result from action by elderly people themselves, through the sheer force of their growing numbers and influence. The collective consciousness of being elderly, as a socially unifying concept, can in that way become a positive factor" (International Plan of Action on Ageing, 1/para. 32).
Life-long individual development
"Ageing is a life-long process and should be recognized as such. Preparation of the entire population for the later stages of life should be an integral part of social policies and encompass physical, psychological, cultural, religious, spiritual, economic, health and other factors" (International Plan of Action on Ageing, para. 25 (i)).
Multi-generational relationships
"The respect and care for the elderly, which has been one of the few constants in human culture everywhere, reflects a basic interplay between self-preserving and society-preserving impulses which has conditioned the survival and progress of the human race" (International Plan of Action on Ageing, para. 27).
Development and the ageing of populations
"Countries should recognize and take into account their demographic trends and changes in the structure of their populations in order to optimize their development" (International Plan of Action on Ageing, para.13).
Geriatric Drug Therapy Interventions
James W. Cooper, Editor
1997, Pharmaceutical Products Press (The Haworth Press)
Binghamton, N.Y.
Reviewed by: Barry J. Goldlist, MD, FRCPC, FACP
This textbook was co-published simultaneously as the 'Journal of Geriatric Drug Therapy' Volume 11, November 4, 1997. This textbook is clearly intended for pharmacists, not for physicians. As a result it can be irritating to the physician reader. Specifically, it treats all adverse drug reactions as though they were avoidable (and presumably a result of physician error!). Even more annoying for the physician, the book implies that history, physical examination, and individual patient characteristics are not important factors in drug prescribing.
Nevertheless, this is still a valuable text. It clearly delineates the enormous cost of adverse drug reactions in human and financial terms, and provides some useful information on the proven benefits of pharmacist participation in the care of elderly patients. Particular emphasis (I believe correctly so) is placed on the elderly having a consistent pharmacist provider to decrease the likelihood of adverse drug interactions.
I would not recommend that physicians involved in care of the elderly purchase this particular text, but it would be worth reviewing if available in the local medical pharmacy. It is not, and does not intend to be, a guide to preventing adverse drug interactions.
