Brocklehurst’s Textbook of Geriatric Medicine and Gerontology, 6th Edition

Editors: Raymond C. Tallis and Howard M. Fillit.
Churchill Livingstone, 2003.

Reviewed by: Chris MacKnight, MD, MSc, FRCPC,
Dalhousie University, Halifax, NS.

The world of the geriatric medicine textbook is a crowded one. Why, then, should one choose this text, which claims to be the leader? For the reasons discussed here, I believe that it would be a good choice.

Brocklehurst's is an attractive work, full of figures and pictures, and there is a nice mix of European and North American authors. An innovation since the 5th edition--one that aids readability--is the addition of summary boxes to each chapter, listing the key points of that chapter. This textbook follows the usual order of most texts in the field, with an introductory section on various features of aging, system-specific sections and then chapters on geriatrics and geriatric services worldwide (there are even a few pages on Canada!). One of my criticisms that applies to most of these works is that they are more texts of the internal medicine of old age than of geriatrics, which I see as the care of the frail older adult. This textbook, however, does concentrate on frailty, with almost every chapter at least nodding towards frailty and the older adult, who suffer with multiple comorbidities and disabilities.

Most texts should accomplish two functions: they should provide an introduction to and comprehensive overview of a field for the novice, and provide a resource for the expert. I recently used this text as a resource for the first few patients I saw on March 3, 2003. My first was a home visit to a patient who had had an episode of syncope. Although there was little information provided on home visits (less than in the 5th edition), there was a detailed and up-to-date chapter on syncope by a recognised world leader in the field. The next consultation was on a woman with Diogenes Syndrome, with the inpatient team wondering about her competency to return home. The section on Diogenes Syndrome was much improved from the 5th edition, and very useful. Unfortunately, I could find nothing related to assessing competency, either in the index or after a hand search of the chapters I thought might be relevant. There also is no chapter on legal issues, although this would likely be difficult in an international text.

I then saw a patient with a postoperative delirium and pre-existing vascular dementia. The chapter on vascular dementia is a great improvement over the section in the 5th edition, where it was lumped in with the other dementias. The section on postoperative delirium also was very helpful and lucid, though there was some repetition between the discussion in the chapter on Delirium and that in the chapter on Surgery.

As with all texts, currency is a problem. There are some references to the 21st century, but not many. New issues, such as West Nile Virus, are nowhere to be found. The editors do recognise this limitation, and realise that for up-to-date information they cannot compete with electronic resources. Where they can compete, however, is in offering a comprehensive overview and foundation, and I believe they have succeeded admirably. This text is useful for trainees, libraries and those healthcare professionals who need either an introduction or a refresher to geriatric medicine.