When reading reviews or guidelines you may have found yourself asking, “How does this apply to my elderly patients?” For the elderly, crucially different physiological parameters apply, and polypharmacy is common due to the high co-morbidity of this age group. If you are looking for some concise answers (and you enjoy reading in German) Geriatrie für Hausärzte [Geriatrics for General Practitioners] is a good starting point.
Gabriela Stoppe and Eva Mann, the editors of this valuable book, cover a broad range of topics relevant to patients in their third and fourth life-stages. The book is organized into four parts: (1) context-relevant information about health care systems in Austria, Switzerland and Germany; (2) specific disorders and clinical problem fields; (3) general principles of pharmacological and non-pharmacological treatment; and (4) care provision relevant for elderly patients.
Part 1 provides an introduction to the existing primary care systems of the three aforementioned largest German-speaking countries. The role of the general practitioner (GP) in the provision of care for geriatric patients is characterized within existing medico-political structures and challenges. The reader is introduced to the individual countries' specific medical systems, inviting comparison with what might be of interest for GPs commissioning new services in the future.
The second part (arranged into more than 20 chapters) is abundant with practical descriptions of clinical fields, such as affective disorders, hearing problems, incontinence, male and female health, and frailty. Also included is specific information on disorders such as diabetes mellitus, stroke, and vascular disease. Within each chapter, the authors review the topic and the most relevant principles of diagnosis and treatment, and describe the specific differences relevant for the assessment and treatment of elderly patients. The authors review existing knowledge with a clear emphasis on the target age-group. The style of writing allows fluent reading without becoming bogged down by too much detail. Part 3 provides information about age-related physiological changes and their influence on pharmacotherapy. Particularly useful is the inclusion of tables on subjects such as psycho-pharmacology, containing information about starting and maximum dosages, plasma levels and side-effect profiles relevant to elderly patients. Space is also dedicated to psychological treatments, and a well-collated chapter about physical fitness includes advice for the GP on motivating patients and prescribing physical exercise (rehabilitation sports) – and this in Germany, even outside the insurance budget!
The final part, which is dedicated to the specifics of care provision, starts with a review of adequate geriatric primary care assessment, including the GP's work in residential and nursing homes as well as her or his role in home treatment, arranged in cooperation with other health care professionals. Other areas also covered are working with the carers of older patients, various ethical and legal aspects (e.g. the use of restraints), consideration about driving ability, as well as palliative care. These complex topics are all discussed in the accessible, fluent and informative style that is characteristic of the whole book. An appendix provides useful assessment tools, charts, and other resources, although these would be more useful if available in electronic format.
This publication's strength lies in its specific collection of age-related and treatment relevant matter. The information is made accessible without assuming an in-depth knowledge of diverse specialties. Even for the specialist, some of the given information provides new ways of explaining complex medical concepts to one's patients. The topics covered include virtually all relevant areas of importance in the treatment of elderly patients. There is even a chapter about dental problems and dentist-GP cooperation.
It is difficult to think of any important omissions – though perhaps physiotherapy and occupational therapy could have been included? For the non-GP reader, the level of referencing is perhaps rather frugal. For example, when discussing psychological treatments for elderly clients, one is given the somewhat misleading impression that there is not an extant and continuously solidifying body of international evidence already available. It might have been helpful to adopt a more systematic review-like methodology when outlining the content of the chapters, although this might have negatively affected the fluency of the writing, and thus the pleasure in reading the rounded views and opinions of national experts. After all, this is how the book differs from other publications on geriatrics. At times the frame of order, often following a strictly bio-psycho-social framework, could give a somewhat skewed perspective. However, the overall presentation of the material is well structured, and besides tables, there are plenty of diagrams and graphs to illustrate the elaborate concepts. The black and white print, representing a Germanic down-to-earth, matter-of-fact approach, is generally clear, keeping the focus on the text. The international reader might also enjoy some of the cartoons including the one on the book's cover: [Elderly patient being examined by a doctor]: “You are the only one, whom I am still touched by” – a gentle, compassionate humor, untainted by the politically correct tyranny of the Anglophone world.
In summary, this book provides an extensive, readable and all-encompassing collection of geriatric-related topics and their implications for primary care. The book also acts as a compendium for specific conditions with its carefully collated tables and lists. It may therefore not only be of interest to the German-speaking GP, but also become a valuable resource for the specialist needing the necessary cross-references to conditions of other specialties relevant to the treatment of their elderly patients.
