Textbooks in Old Age Psychiatry have become more common over the past decade reflecting the increasing interest and accumulating knowledge of mental health problems in older people. They are usually multi-author works partly to share the enormous undertaking that writing such books involves. The authors Cohen and Eisdorfer are two highly experienced North American clinicians and academics in Old Age Psychiatry and their achievement in writing this textbook is considerable. It is an excellent addition to the existing repertoire of textbooks in Old Age Psychiatry and I would highly recommend it.
The book is divided into three sections: Conceptual Foundations, A Clinical Guide and Special Clinical issues. The opening chapters clearly outline the current challenges facing service providers and provide very sound principles on which clinical practice should be based. It is written in a very clear and lucid style, which easily engages the reader. It is a patient-centred book, the authors quoting Osler's aphorism ‘It is more important to know the patient than the disease’. The regular use of clinical vignettes throughout the book is a very effective technique in illustrating important issues and will resonate easily with readers.
One of the main challenges in writing such a textbook is to be concise and incisive enough to capture the key points without omitting important information. The authors are to a large extent successful in their approach. One of the key strengths of the book is the regular referencing of websites, which facilitates the reader in accessing additional information and evidenced-based guidelines. The authors also very successfully integrate the neurosciences into clinical chapters rather than dealing with them in a separate chapter. This works very well. However, there are areas where the book is short on detail. The chapter on management of BPSD, while appropriately emphasizing the importance of comprehensive assessment, is overly brief on pharmacological approaches. The current challenges in this field are considerable and deserve a more in-depth discussion. The authors do not deal with the difficult issue of driving and dementia. In contrast to this there are several pages devoted to eating disorders in older people, which in the experience of this reviewer are very unusual.
To appeal to a wider international audience this book would have benefited from an explanation of models of service provision in the United States and the extent to which services are hospital based and community orientated. This would be very interesting for clinicians who have not trained in the United States. There could be more focus on the settings in which Old Age psychiatrists practice, the extent of multi-disciplinary teamwork, the interaction between Old Age psychiatrists and primary care services and other hospital specialists such as geriatricians and neurologists. In addition, contributions from other professional grouping involved in managing older people would have added other useful perspectives to the book.
There are many excellent chapters. The authors devote a full chapter to Interviewing and developing a therapeutic alliance with patients. It is thoughtfully written and full of very useful practical advice in assessing patients both with and without cognitive impairment. There is a fascinating chapter titled ‘Disasters and Terrorism’ with reference to the impact on 9/11 on older adults. Chapters on Capacity assessment, Elder Abuse, End-of-Life Care, and Violent Deaths in older people are very well written with the authors’ humanistic approach very evident. The chapter on Family Caregiving integrates research findings in this area with practical clinical interventions for caregivers in helping their dependents. The final chapter provides very useful insights into the health care policies that have shaped the development of services in the United States.
I would highly recommend this book not only to practicing specialists in Old Age Psychiatry and Medicine for Older People but also to general adult psychiatrists and other professional groups dealing with mental health problems in older people.
