Book Review
Geriatric Psychiatry
Geriatric Consultation Liaison Psychiatry. Pamela Melding, Brian Draper, editors. Oxford (UK): Oxford University Press; 2001. 396 p. CAN$79.50.
Reviewer
rating*: Good
Review by Ron Keren, MD, FRCPC
Toronto, Ontario
With the aging of baby boomers, the elderly are the fastest-growing population
in Canada. As a result of this and the fact that older people have considerably
more medical problems than do their younger cohorts, geriatric referrals
to general hospital psychiatric consultation services are abundant and
rising. This text is therefore a must-read, not only for geriatric psychiatrists
but also for consultation liaison (CL) psychiatrists and for residents
training in psychiatry, geriatrics, and internal medicine. As the editors
point out, there are plenty of excellent texts that cover both geriatric
psychiatry and CL psychiatry but none, until now, that combine these very
important aspects of psychiatry. The editors have succeeded in bringing
together several leading experts in the field of geriatric psychiatry to
produce a comprehensive guide to the psychiatric care of the medically
frail elderly. Despite having only a single Canadian contributor, the book—including
the section on ethical and legal issues—is relevant to the Canadian health
care system.
This text is well written, easy to read, and concise—perhaps even a little
too concise. The use of clinical vignettes throughout the book engaged
my interest, although I would have liked some more challenging cases with
less simple solutions. Of the book’s many tables, some are quite practical,
while others can be too “busy” and at times redundant. As well, the tables
are presented in black fonts on a gray background, which is difficult for
my nongeriatric eyes to read. Unfortunately, as is the case with many textbooks,
more recent research had come out by the time the book was published, making
some information dated. Nevertheless, it fulfills its purpose by providing
a comprehensive review of the diagnosis and management of psychiatric problems
in the medically ill elderly.
The book is divided into 5 sections (“The Context,” “Assessment,” “The
Major Disorders,” “Treatment,” and “Ethical and Legal Issues”) that I found
to be uneven: the sections on “Assessment” and “Treatment” bring out the
unique aspects of psychiatric care of the medically ill elderly, but the
section entitled “The Major Disorders” sometimes seemed to read more like
a basic text on geriatric psychiatry than a text on geriatric CL psychiatry.
The chapters entitled “The Assessment” and “Specific Patients and Problems”
stood out as particularly practical and could be expanded on in future
editions. Evans and Mottram’s review of affective disorders in the general
hospital setting is excellent, as are Flint’s chapter on psychopharmacological
management of medically ill older patients and Perkins’ chapter on ethical
issues in geriatric psychiatry liaison. The chapter on electroconvulsive
therapy (ECT) in older patients with physical illness by Tew, Muslant,
and Towers offers the reader an excellent review of this effective, yet
often underused, treatment.
In addition to learning from this reasonably priced book, I enjoyed reading
it and highly recommend it to my colleagues and anyone in any discipline
engaged in the care of the medically ill elderly.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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