Psychiatry in the Elderly, 2nd ed.

It is gratifying to see the steady increase in psychiatry’s interest in the elderly. An increasing number of comprehensive and excellent textbooks on the topic of geriatric psychiatry and geriatric psychopharmacology are now available in the Untied States. This interest extends to Great Britain as well, where excellent volumes such as Principles and Practice of Geriatric Psychiatry, edited by Copeland and Abou-Saleh (1), have been published. Psychiatry in the Elderly is the second edition of another extraordinary British geriatric resource. With an occasional exception, the contributors to this outstanding volume are all psychiatrists in Britain or in Commonwealth nations. Although their names may not be well-known to American readers, their distinctly British perspective provides a nice counterpoint to American authors.

Reflecting the British style, the contents of this book focus on manifest behavior, cognition, and emotion of the elderly, sociological and neurobiological phenomena, and treatment. What is not discussed are psychodynamic formulations or psychoanalytic concepts of the normal aging process. Readers who are interested in Eriksonian concepts of integration versus despair or discussions of the psychodynamics of identity change in retirement, late-life illness, etc., will have to look elsewhere. Even chapters titled “Neurotic Disorders in the Elderly” (a curious inclusion for a book that uses the ICD diagnostic scheme) and on “Personality” lack psychodynamic discussion.

Psychiatry in the Elderly, however, offers perspectives that are not always as readily available in American texts. The chapter on sexuality in old age is superb, discussing the details of sexual life in old age without any hint of embarrassment. Another chapter discusses common ethical dilemmas that psychiatrists face when working with older people, such as quality of life, substituted judgment, and allocation of resources. Still another chapter is devoted to the abuse of elderly people. This chapter is buttressed by important data on the incidence and prevalence of abuse of elderly individuals as well as a discussion of crimes perpetrated against the elderly and even by the elderly. There is an extraordinary chapter (with photographs and building plans) on the need for better environments for people with dementia. Another wonderful chapter deals with the problems of caretakers of the elderly, especially those with Alzheimer’s disease, and there is a no-nonsense chapter on the economics and financial realities of the elderly and the need for long-term care services.

The chapters on specific disorders and their diagnosis and treatment are equally straightforward but do not offer information that is not otherwise already available to American readers. Diagnostic issues are presented from the British perspective. For example, there is a wonderful discussion about the problems using the term “pseudodementia” and an equally wonderful discussion of the usefulness and problems of the diagnostic category known as “late paraphrenia.” Psychopharmacological treatment is presented in a relatively brief single-chapter overview but is also part of each treatment chapter. American readers are likely to find the psychopharmacology discussions adequate, but there are now available several American texts of geriatric psychopharmacology that provide considerably more detailed discussions of the use of medications than would be expected in a single large volume.

Psychiatry in the Elderly would be a particularly welcome addition to the library of any psychiatrist with interest in the elderly or any geriatric psychiatrist practitioner. However, since similar American volumes are already available, the usefulness of this excellent book for American readers is probably as an augmenting rather than primary resource.