Geriatric psychiatry is certainly a specialty that has grown over the past several years. Numerous advances have been made, and we continue to learn more about the pathogenesis and molecular genetics of dementia, as well as possible treatments. Transformations in our social milieu have brought about changes in our provision of services to the elderly, with a greater emphasis on standards of care and quality of life. With this third edition of Psychiatry in the Elderly, Jacoby and Oppenheimer have attempted to reflect the developments that have taken place since the previous editions of the book, published in 1991 and 1997. This most recent text is a compilation of chapters written by different authors, all chosen because they are experts in their respective fields. The result is an overview of geriatric psychiatry that is far more readable and “user-friendly” than the usual reference textbook.
This review was undertaken via a unique, interactive process. The text was concomitantly read by a psychiatric resident new to the field and an experienced geriatric psychiatrist, and their subsequent dialogue identified convergent and divergent perspectives.
Part 1 of the book on basic science consists of 8 chapters. The first chapters provide a good summary of “normal” changes associated with aging. Advances in neurochemical pathology and molecular biology of dementia are then effectively described. As a read from beginning to end, these chapters on scientific developments seemed to the resident somewhat out of place, given that the disorders they refer to are addressed much later in the text. The student of mental health, therefore, may not be able to integrate and profit from this material as well as a more experienced clinician or scientist.
Part 2 covers topics related to clinical practice. The chapters about the assessment of adults are very practical and well organized. Their authors support a holistic approach, with individual, biological, psychological and social emphases. Caregivers and environmental systems are given appropriate consideration in the well-being of the elderly.
Part 3, entitled Psychiatric Services, is an interesting section on issues related to service delivery. Although the focus is primarily on systems in the United Kingdom, all readers will gain important perspectives and new insights into the issues of effective service delivery. Included is a thoughtful chapter on what makes an ideal home for people with dementia and factors to consider when designing such a place. We were pleasantly surprised to come across this material in this text and felt that it spoke to the multi-dimensional approach of the editors.
Part 4, on specific disorders, devotes a chapter to each of the main diagnoses encountered in the field. In general, this section is very readable and provides a practical overview of each disorder. The subtitles and the use of tables to highlight key points make for an organized and accessible presentation of the material. The advantage of having different authors for each chapter is that it allows for experts to lend their clinical expertise and personal perspectives to the book. The disadvantage, of course, is that the chapters are at times variable in form and content. The chapters on Lewy body dementia, depressive disorders and delirium, to name but a few, are exceptional. They are comprehensive, with a good emphasis on clinical practice. A section titled “What to tell the patient and caregiver” is particularly practical from the point of view of the psychiatric resident with little experience.
Part 5 of the book, entitled Sexuality, Ethics, and Medico-legal Issues, includes topics on the social realm of the elderly, such as competence, driving and elder abuse, which are all well described. There is an appropriate mix of theoretical background and clinical practice in these chapters. Again, the social context here is the United Kingdom, which with its own laws and value system may not be directly applicable to readers in other parts of the world. The material is pertinent and comprehensive nonetheless. The use of cases to illustrate various ethical issues is particularly effective.
Despite some chapter-to-chapter variability, overall, this book is a very readable overview of psychiatry in the elderly and includes relevant and up-to-date references. The authors provide useful clinical pearls based on their own experience and perspectives. The value of the book lies not in its role as a reference text; instead, it would likely best serve those learning about geriatric psychiatry or those experienced and seeking to review topics. From the perspective of the psychiatric resident reading such material for the first time, this book provides a good solid foundation from which one can then delve deeper. From the perspective of a practical geriatric psychiatrist, it provides an excellent tool to consolidate information and glean fresh and useful new perspectives.