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Ambulatory Geriatric Care
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Thomas T. Yoshikawa, Elizabeth Lipton Cobbs, and Kenneth Brummel-Smith. 572 pages. St. Louis, Missouri: Mosby-Year Book; 1993. $49.00.
The typical scene shows the partners together, discussing the trials and tribulations of another office day. There among them sit the authors and their panel of experts. Finally, a textbook of both ambulatory care and geriatric medicine! The order says it all—the entire first part lays the foundation with the principles we use daily. Intertwined is practical advice. Other unique and helpful features include the Key Points section that begins each chapter; suggested readings in addition to standard references; practical, clear tables; good mnemonics; and highlight boxes.
Prevention and health maintenance are well discussed; diseases come last. They are presented as common geriatric syndromes. Even here, the authors take a strong geriatric stance by problems commonly ignored yet vexing to patients first, such as urinary incontinence, prostatism, sexual dysfunction, falls, and confusion. Syndromes are presented with their clinical relevance first, then clinical manifestations and diagnostic and therapeutic approaches.
The authors not only give suggestions but also offer advice on how to implement them and why they are important. Their advice concerns a range of issues, such as discussing difficult subjects with patients, setting up your office for the geriatric patient, and what to carry in your home-visit bag. The chapter on advance directives includes a discussion of the values domain; practical suggestions about caring for dying patients at home are also provided. The tough ethical issues of what services physicians may and may not provide are addressed up front. Excellent chapters on driving, hearing and nutritional assessments, oral care, and physical activity are included. The chapter on social and spiritual contributors to independence is thoughtful and helpful. An immensely practical and helpful discussion of all common psychiatric disorders of the elderly is included.
I could find only a few drawbacks in this book. For example, few figures are available, and some chapters omit recent references. Overall, however, references are current and appropriate.
In summary, this is the first textbook in many years that I had trouble putting down because I wanted to read more. If you buy one book this year, make this the one. It should be required reading for all geriatric medicine fellows, as well as internists, internal medicine residents, and other trainees and practitioners who care for older adults.
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