This book achieves its stated main aim – to provide an evidence-based and practical text for newcomers to the specialty of geriatric medicine (or geriatrics as it is sometimes called). The specialty came into being because hospital general medicine served the needs of older people poorly. In a similar way, standard medical textbooks have too often failed to take account of the special needs of older people and the different approaches to diagnosis and treatment that are required. Rather than approach the subject from a systems basis, which usually means starting at the mouth and working through the rest of the body, Woodford has concentrated on the ‘geriatric giants’ of falls, immobility, incontinence and confusion. These are symptom areas for which there is growing evidence that therapeutic interventions can make a real difference to older people's health and quality of life.
The practice of geriatric medicine has developed differently in different countries and the contents of this book reflect the ‘British’ model. In other countries, for example, stroke and Parkinson's disease are the domain of the neurologist rather than the geriatrician. In this book, there is a bias towards secondary rather than primary care. Again this reflects UK practice where community geriatrics has only recently re-emerged after a period of decline. The role of general practitioners and their teams in health promotion and chronic disease management are not specifically covered. Also omitted is discussion of the new ways in which non-hospital treatment is being provided, for example, in intermediate-care settings.
The book is enhanced by several diagrams and flow charts for investigation and therapy and there are plenty of references to original research, reviews and clinical-guideline websites which will help those who wish to enquire further. All doctors who work with older people, and that is almost all doctors, will benefit from reading this book as will other members of the multidisciplinary team. They should also pay heed to James George's comment in the Foreword, ‘Older patients are often wiser than their doctors and when given the alternative options … will make the right decision for themselves’.
