INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, VOL. 6: 191-194 (1991)

BOOK REVIEWS

Dementia-Care: Patient, Family and Community. Edited by NANCY L. MACE. John Hopkins University Press, Baltimore, 1990. No. of pages: 384. Price: 634.50.

This is an exceptionally comprehensive look at all aspects of dementia from diagnostic issues to alternatives in long- term care and public policy.

The book has three components, the patient, the family and the community. The chapters regarding the patient are extremely thorough and summarize what is needed for a holistic biopsychosocial evaluation of an individual with dementia, including an exceptionally pertinent chapter on neuropsychological assessment.

Dr Weaverdyck discusses the objectives of assessment, noting the two purposes, diagnosis and description. This contribution is different from most in that it presents in depth a description of the role of assessment, which is to identify and describe the signs and symptoms of a disorder. To make it more practical, she uses a case approach. The chapter summarizes the vast area of neuropsychological assessment, making it particularly useful in the design of cognitive interventions to assist caregivers in defining and/or selecting goals for interven- tion. Another excellent chapter is the review of manage- ment of problem behaviours. Ms Mace presents not only research data but also a very practical discussion of com- mon problem behaviors, attempts to change behavior, and the subsequent issues related to behavior change. The chapter on incontinence, a subject not always included in texts on dementia, is timely and a significant issue in the management of dementia. The authors pres- ent the physical, psychosocial, and environmental com- ponents of urinary incontinence and provide very concrete incontinence assessments and practical ways to intervene, but aptly note that success of interventions depends on the availability and motivation of caregivers.

The family section provides an in-depth look at the clinician and family as an interacting support sytem. The chapters detail legal and financial concerns, and the issues involved in an environmental design of home set- tings and looks at respite care as a necessity to preserve the family caregiver and provide a therapeutic setting for individuals with dementia.

The last section, dealing with the community, moves from a patient and family approach to the macro approach of formal long-term care services and designing programs to serve families and individuals with dementia. The continuum of extended care is explored from levels of nursing home to residential care to devel- oping and building volunteer programs and how they can assist individuals in caring for demented relatives.

The final chapter, by Dr Cook-Deegan discusses the need for change in public policy. The author describes the functions of government and how the federal govern- ment in the United Sates of America is already involved in providing care, though maybe not as comprehensively as those in the field would wish.

This book is an excellent compilation of state of the art information relative to dementia and the subsequent course of the disease. It addresses many topics, and would be an excellent resource as a text. The only area not covered in the book, an integral part of the question of providing long-term care for individuals and families with dementia, is the ethical issue of providing that care. The sole criticism is that it is unclear who the book is targeted at. It appears that it is intended more for an academic audience than for the wider audience of staff care providers.

PEGGY SZWABO GEORGE T. GROSSBERG

St. Louis University Division of Geriatric Psychiatry

Issues in Geriatric Psychiatry. Edited by N. BILLIG and P. V. RABINS. Advances in Psychosomatic Medicine Vol. 19. Basel. Karger, 1989. No. of pages: 183. Price: f43.30.

What is psychosomatic medicine and who does it? Such interesting questions can not be quickly answered here, nor are they answered by this book. Indeed, many readers eagerly scanning for advances in psychosomatic medicine might be surprised to find chapters on education,

decision-making capacity, psychopharmacology and nursing home residents. In reality the volume comprises a varied menu of issues of current interest to American geriatric psychiatrists.

The remaining chapters look at delirium, excess disabi- lity in dementia, sleep disorder, sexuality, hypochondria- sis, agitation, and geriatric consultationbiaison psy- chiatry.

For North American readers the book must be of great interest. Some contributors are well known to an inter- national audience-Lipowski, for instance, delivers his

0 1991 by John Wiley & Sons, Ltd.

192 BOOK REVIEWS

usual very high standard on delirium-but basically the book seems rather written by Americans for an American audience.

Nevertheless, I enjoyed reading this collection of var- ied topics and would like to see it available in libraries. But, outside of North America, it is a book more for

the specialist than the trainee and most will feel that it shows too selective a range and too brief treatment of some topics to tempt them to buy it at this price.

ROB JONES University of Nottingham

Biological Psychiatry. MICHAEL R. TRIMBLE. Wiley, Chichester, 1988. No. of pages: 494. Price: L45.00.

Dr Trimble’s intention has been to write a text that will provide an informative database for interested psychi- atrists who wish to explore the biological foundations of their specialty. He has achieved this, and in a style that is sufficiently selective in its method that the naive reader will not be overwhelmed by complexity but will come away with some clear measure of the important issues.

Particular chapters to be recommended would be the ‘Historical introduction’ and the two chapters on ‘Princi- ples of brain function and structure of relevance for the psychiatrist’. The chapter on ‘Investigations’, gives the best beginners’ account I have yet read of the principle behind magnetic resonance imaging. The chapter on the biological psychiatry of schizophrenia is comprehensive yet manageable. As expected there are excellent chapters

on dementia, concluded by a useful account of ‘Some outstanding issues’, and on psychiatric aspects of epi- lepsy.

The book is at its weakest in discussion of the biologi- cal basis of personality disorder and neurosis. In this chapter the reader is at one point faced with a poorly signposted discussion of a whole series of essentially unrelated topics ranging from the EEG in psychopaths to laterality in hysteria.

What will the interested psychogeriatrician not find readily in this book?: discussions of psychiatric disorder secondary to other brain and physical diseases, eg stroke, multiple sclerosis, Parkinson’s disease, (these are scat- tered throughout the text, but are not necessarily compre- hensive). If this is what he is after he must turn to Dr Trimble’s earlier book, Neuropsychiatry, or other well- known texts on organic psychiatry.

SIMON FLEMINGER Maudsley Hospital, London

Communication Disorders in Ageing. R. H. HULL and K. M. GRIFFIN. Sage, California and London, 1989. No. of pages: 195. Price 68.95.

This book deals with communication disorders in abnor- mal ageing, unfortunately, since most of the elderly are healthy and have normal, but age-related, communica- tion problems. They are increasingly hard of hearing, hard to hear, benignly forgetful, garrulous and have diffi- culty comprehending complex language or using their inner language to think and problem-solve.

Some chapters in this book are straightforward, such as those on aphasia and dementia. Unfortunately these touch on management issues and are unsubstantiated. Some chapters deal with ‘counselling’, ‘the dying client’ and organization theory-they are laden with jargon and do not rise above pseudoscientific humbug.

The chapter on laryngectomy could be omitted since its prevalence is three per one hundred thousand, it has a probable declining incidence and the advent of speech valves assists the production of alaryngeal voice. Simi-

larly, chapter four addresses Parkinsonism, but since in normal ageing many develop Parkinsonian like features as well as bulbar features, a section on progressive neuro- logical impairment and speech disorders might have been more informative.

There are some practical observations-a discussion of the effect of glare on highly polished and urine-resist- ant floors, furniture for the visually impaired and some suggestions for altering the environment for the hearing impaired.

Personally, I wouldn’t part with nine quid for a book that misses major themes and despite a few good ideas is couched in jargon and claptrap such as ‘To communi- cate effectively with dying patients, health professionals must look beyond physical beauty, and appreciate age and the productivity, love, and suffering that went into that life, appreciate courage, and appreciate the spiritual loveliness in that person’.

I. M. THOMPSON Monash Medical Centre, Melbourne