I read this book with interest, having had personal experience of working in a medical day hospital where I was confronted by an elderly patient who seemed to be “a little down.” After a careful assessment I concluded that this was mild depression and that watchful waiting would be appropriate management. However, as a novice junior doctor I then had several sleepless nights worrying that something terrible might happen. Had I read this book my fears might have been allayed.
Integrated Management of Depression in the Elderly deftly covers the etiology, assessment and management of depression in older adults in a slim and portable volume. The reader is confronted with a long list of contributors at the start of the work, but the editors have skillfully condensed these contributions to produce a book that is readable and without pronounced changes of style.
The first two chapters give an overview of depression in the elderly. They cover epidemiology, etiology, presentation, issues in different ethnic groups, clinical assessment and management in a mere 31 pages. This provides a good review for those new to the subject, but I suspect would leave questions unanswered for those with greater experience.
The largest portion of the book is devoted to case studies, starting with cases of mild depression and working through to severe illness. This section develops the concepts outlined at the start. Each case is discussed by two of the contributors – usually a general practitioner and a second health or social work professional – in order to give an integrated view. I found this approach useful as it provides a more active form of learning and helps one apply the principles in real life practice. My one issue with this approach is that for a book that intends to be integrated, having each case discussed by two individuals separately hinders integration. This meant that at times there was a repetition of points with certain concepts labored a little too much.
The chapter I found most useful was a resource section which reproduced rating scales and websites that provide patient information and guidelines. This would be a handy reference tool in providing high standards of patient care and information. Personally I found the final two chapters covering an international case interesting if a little incongruent with the rest of the book. In this section international experts gave the view from their nation's experience of one case history. This was illuminating in demonstrating that elderly depressed patients are similar the world over, as are the problems with lack of resources and money. It did provide some insight into innovative practices around the globe and subtle cultural differences.
In conclusion I would recommend this book to those setting out in the practice of medicine or psychiatry, both in primary and secondary care. The editors express their message clearly and concisely that the multidisciplinary holistic approach is the most appropriate for the management of older adults with depression.
