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BMJ No 7115 Volume 315 Medicine and books Saturday 25 October 1997
Caring for the Fourth Age: A Practical Guide to Medical Problems in Old AgeJ J OramArmelle Press, £16, pp 223
The increasing number of very old people with physical and mental incapacity has necessitated a continuing supply of simple, succinct, and practical books for lay carers and professionals. Dr Oram's response is a book that deals with the "giants of geriatrics" (mental impairment, falls, immobility, and incontinence), other common diseases of old age, and miscellaneous topics such as ethics, rehabilitation, and the demography of aging. Information is primarily related to the needs of patients, but the stresses of being a carer are also considered. There is a strong emphasis on developing practical rehabilitation programmes and organising effective social support. The importance of quality of life is another recurrent theme. A general description of a particular disorder is usually followed by a series of case studies. These are sufficiently descriptive to bring the reader into the ward or household and share the consultant's experiences and dilemmas. As in real life, intervention often produces a less than ideal solution. Other items of particular value are assessment scales, a flow chart relating to the delivery of services, a list highlighting the needs of carers, and contact details of useful organisations. Who are the book's intended readers? The preface suggests patients and carers, but they would require considerable motivation to read a detailed publication, only part of which is relevant to them. It is more likely that they would seek out short publications from organisations such as Age Concern England, the Alzheimer's Disease Society, or the National Osteoporosis Society. The book might be more relevant as the information source for a course organised for carers. It would also be of value to nurses embarking on post-qualification training in the care of elderly patients, to staff in residential and nursing homes, and to social workers, physiotherapists, occupational therapists, and similar professionals. Medical undergraduates would also find much to interest them but would probably require more information on diagnosis, investigation, and treatment. This is a concise and readable account of the provision of care for elderly patients, which should be of immense value to a wide range of lay and professional people. Not the least of the author's merits is his obvious enthusiasm for his specialty and rapport with his patients and carers. W J MacLennan,
emeritus professor, Rating: ***
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