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Editors: G S Rai, G P Mulley
430 pp Price £45 ISBN 9-05823-234-4 (h/b)
London: Martin Dunitz, 2002.
With its population getting older, the UK is increasingly in need of well-trained and enthusiastic elderly-care physicians. Fifty years ago geriatrics dealt mainly with continuing care and rehabilitation but it has evolved into a specialty encompassing acute general medicine with a holistic multidisciplinary approach. In future years the national service framework for older people may well generate opportunities for subspecialty work in areas such as stroke, falls and intermediate care.
Rai and Mulley's Guide does not set out to be exhaustive. It offers practical advice on common problems, incorporating clinical trial evidence where possible and common sense where not. The text is easy to read and the layout allows one to skip between chapters and diagnoses with ease. Some sections deal with frequent dilemmas in the elderly such as falls and instability, pressure care and practical management of stroke. Others address diseases that affect all age groups, such as cancer and respiratory disease, but with a bias towards management and diagnosis in the elderly. On certain matters, such as Parkinson's disease, the detail struck me as insufficient; and coronary heart disease is not covered at all. But these can be pursued elsewhere. Clinical issues apart, aspiring consultants in old age medicine will appreciate the guide's helpful words on negotiating with managers, service development and interview practice.
Overall I was very impressed by the book, which draws on the experience of a wide range of individuals. I recommend it to trainees in geriatric medicine, and it will be useful to other doctors in training whose day-to-day practice includes older people.