Psychiatry in the Elderly, 3rd Edition

Editors: Jacoby R, Oppenheimer C
Reviewed by: Dr. Barry Goldlist, Editor in Chief, Geriatrics & Aging.

This text is the third edition of what has become a standard reference text in geriatric psychiatry. Chapters have been updated, often with new authors, and some sections have been deleted (e.g., chapters on nursing and occupational therapy, specialties that now have texts of their own). The book is divided into four sections: basic science, clinical practice, psychiatric services and specific disorders.

The chapters in the section on basic sciences, although necessarily brief, are all excellent. There is evidence of firm editorial control in the way that each chapter is written, particularly in the uniformly excellent concluding remarks. The editors include typical basic science chapters (biology of aging, cognitive changes with aging, neuropathology, neurochemistry, molecular genetics and biology), but also include chapters on sociology, epidemiology and economics. I believe they are excellent additions to the "basic science" of old age psychiatry. I was particularly impressed by the clear and practical discussion on cognitive changes in old age by Milwain and Iversen.

The section on clinical practice describes the clinical skills required to care for mentally ill elderly patients. There are chapters on psychological assessment, neuroimaging, psychopharmacology, social work with older persons, psychometric assessment, dynamic psychotherapy, family therapy, primary care and liaison psychiatry. The two chapters that interested me the most were the first two in this section: psychiatric and clinical cognitive assessment and physical assessment. The first chapter on psychiatric and clinical cognitive assessment was both comprehensive and practical, even discussing issues such as in which room to interview the patient and those about gaining access. The majority of initial psychiatric consultations for the elderly in the United Kingdom are done in the patient's home, and most urgent cases are seen within 48 hours and non-urgent cases within one week. This strikes me as convincing evidence that the U.K.'s system of care for the elderly is more responsive than the Canadian system. The chapter on physical examination is brief, but does cover all the important geriatric issues and highlights the high yield systems to examine. I admit, I was astounded to read that a physical examination was part of the geriatric psychiatry exam in the U.K.

The third and shortest section, covering psychiatric services for the elderly, includes chapters on principles of service provision, caregivers' lives and designing homes and facilities for the elderly with dementia. The last chapter is replete with excellent diagrams and details on what makes a facility appropriate for an elderly person with dementia.

The final half of the book is "hard core" psychiatry, i.e., discussions on specific disorders (e.g., dementia, manic syndromes) and ethical and medico-legal issues in geriatric psychiatry. The chapters on dementia are detailed and written by renowned experts while the other topics, though covered more briefly, are also well done. The chapter on manic disorders in old age is written by two renowned Canadian geriatric psychiatrists, Ken Shulman and Nathan Herrmann.

In summary, this is an excellent textbook of geriatric psychiatry. Despite being a U.K. publication, there are contributors from Canada, the U.S., Australia, Germany, Sweden and Ireland, and the text is clearly applicable to the care of the elderly with mental disorders in North America. This book would be a worthwhile purchase for any physician who deals with such patients.