Edited by Thomas T. Yoshkawa & Dean C. Norman
Marcel Dekker, New York 2000
ISBN 0-8247-0345-6
Reviewed by Barry Goldlist
This book is an effort by multiple authors. Of the 43 contributors, all are from the United States, and 29 are from California. As a result, the approach is distinctly American. Despite this fact, it is an excellent work. The editors have imposed a structured approach on each chapter, making for an easier read, and there is less repetition than is found in most multi-authored texts. Even more impressively, authors of individual chapters have actually focused their comments on truly geriatric issues, rather than merely repeating the contents of more general texts. The result is that the book is not comprehensive; nor is it meant to be. It should be considered an accompaniment to more comprehensive textbooks on emergency and critical care.
The text is divided into four sections: principles of geriatric critical care, surgical emergencies, medical emergencies, and special issues of aging. The principles section is quite solid, and has a superb chapter on acute and critical nursing care, which may be particularly useful for non-geriatricians. It is easy to argue that specialized geriatric nursing is in fact more important than specialized geriatric medical care. I suspect that the chapter on surgical emergencies would be most useful for non-surgeons involved in the care of these patients. I found the discussion of hip fracture particularly clear and helpful. The chapter on emergency anaesthesia is well written but there are a few minor quibbles. For example, the author discusses the unreliable blood levels of meperidine when the drug is given intramuscularly, but does not even mention that meperidine is a poor choice of narcotic for the elderly, and should rarely, if ever, be prescribed in that group.
The medical section is quite strong. The chapter on cardiac emergencies has a superb segment on the atypical presentation of acute myocardial infarction in the elderly. The neurology chapter is also very useful, but should have provided some hints on the non-pharmacological management of the symptoms of delirium, as well as a more detailed description of the pharmacological management of this syndrome. This is poorly managed by many physicians, and is worthy of more detail.
The final section on special issues of aging covers vision, hyper- and hypothermia, and diagnoses of abuse and neglect. The highlight of this section is Robert Palmer's chapter entitled 'Acute Hospital Care: Future Directions'. For those of us who have repeatedly been a witness to the unnecessary functional decline that occurs in hospitalized elderly patients, the description and the rationale for ACE (acute care of the elderly) units are very encouraging.
In summary this is an excellent book. It will appeal most to physicians who work in the emergency department or care for sick elderly patients on hospital wards.
