Old age psychiatry is a rapidly developing branch of psychiatry, not only because of demographic changes but also as a result of recent advances in neurosciences, neuron-imaging and related clinical techniques. For this reason there is a need for an updated and comprehensive textbook. The Oxford Textbook of Old Age Psychiatry, now in its fourth edition, is welcome as a publication that helps the reader make sense of the vigorous development of the field. The book has five sections. First, a broad basic science section, neglected in many textbooks, provides some theoretical background and recent research regarding the process of ageing. The section encompasses important neuro-physiological and genetic as well as social, epidemiological, and psychological aspects of the process. The authors have not omitted the themes of the changing social structure and changing social roles. The discussion of current theories and research is comprehensive whilst acknowledging their weaknesses and limitations.
Information about treatments offered to older people by modern psychiatry and other branches of medicine in combination with social and psychological care can be found in the clinical practice section. The authors also discuss differences between normal and pathological ageing as well as the important topic of prevention. The reader is presented with a thorough overview of therapeutic options, including pharmacotherapy, electro-convulsive therapy and treatments which are less commonly used in old-age services such as psychotherapy. There is also a valuable discussion of psychosocial interventions. The psychiatric services section ranges through topics from the need for specialised assessment and memory clinics to the importance of appropriately designed care homes and respite settings. The authors emphasise the importance of multidisciplinary work and liaison psychiatry involving cooperation with other disciplines. This section also addresses the important role of primary care and good communication with patients' families.
Moving accounts of dementia and depression by people who have experienced these conditions themselves add a unique quality to the specific disorders section. Relevant chapters raise problems such as the controversial issue of availability of cholinesterase inhibitors for specific groups of patients and the importance of sleep disorders in this age group. In the medico-legal section, the authors offer case discussions and provide a user-friendly reference to the latest changes in legislation, such as the Mental Capacity Act 2005, testamentary and consent issues. The reader can also find more sensitive and often neglected topics including maltreatment, sexuality, crime among older people, driving regulations, and ethics.
The Oxford Textbook of Old Age Psychiatry is an excellent book for training purposes and revision for all psychiatry trainees and medical students as well as senior doctors wishing to update their knowledge. The textbook provides a collection of well chosen topics with a clear structure and a fairly good index. There are clear headings and subsections, well structured tables and interesting figures including neuro-imaging. Partly as a consequence of the large number of authors, however, the chapters are rather heterogeneous. In addition, for trainees it would have been useful to have summary tables of important learning points and more use of case discussions to illustrate themes. Overall, this book is a sound reference text. The problems of old age psychiatry are presented in a broad context and it is a great compendium for psychiatrists and other health professionals.
