Assistant Clinical Professor Department of Psychiatry Stein Institute for Research of Aging University of California San Diego
The field of geriatric psychiatry has existed as a defined field for almost half a century—long enough that it is important to keep sight of the early days of the field and place the development of the field within a historical context. The first three chapters of the third edition of the Principles and Practices of Geriatric Psychiatry, coedited by Mohammed Abou-Saleh, Cornelius L.E. Katona, and Anand Kumar, focus on the historical background of geriatric psychiatry. In my mind, that is among the more striking aspects of this comprehensive and well-compiled book. One of the more engaging reads in this volume is the third chapter, by Claire Hilton, titled Commentary on “In the Beginning” by Felix Post. In this chapter, the author reproduces an autobiographical work originally written by the late Felix Post and adds a brief commentary and historical note. The chapter traces the origins of the psychogeriatrics department at Maudsley Hospital in London and offers a glimpse into the evolution of the first specialty geriatric psychiatry program in the United Kingdom. The authors pay homage to the significance of Felix Post’s work. Senior practitioners will likely identify parallels between the story of Felix Post and the evolution of specialty geriatric services in many other parts of the world—as a response to the clinical recognition that the older population was growing and merited special clinical attention and that significant therapeutic change was possible, contrary to what had been postulated by early 20th century psychiatrists.
The volume comprises 140 chapters, organized into 11 sections. Six of these sections make up the bulk of the volume and focus on the major categories of psychiatric disorders in older persons: neurodegenerative disorders, affective disorders, schizophrenia and paranoid disorders, anxiety disorders, personality disorders, and substance use–related disorders. The volume also features comprehensive sections on diagnosis and assessment of older persons, learning and behavioral studies in older persons, and the previously mentioned section on the historical background of geriatric psychiatry. The final section of the volume focuses on a variety of issues including culture, service provision, and training-related issues in geriatric psychiatry.
A section that stands out, though, is the second section of the book titled Normal and Abnormal Ageing. This section comprises 14 chapters that discuss physical and neurological changes associated with the aging process. This section also includes the chapters Sexuality and Non-Traditional Relationships in Older Persons, Economics of Ageing and Mental Health, and The Influence of Social Factors on Mental Health. Although these are all valuable, well-written chapters, these may perhaps have been better fitted for the final section of the book rather than the one these were included in. This is, however, a minor concern. A chapter that stands out in this section is Successful Ageing. In this chapter, the author, Ann Bowling, acknowledges the innate problems with studying a topic like successful aging, where no clear definitions or even consensus agreements exist. The author does note that “success” with aging can be defined in several ways, including a high degree of life satisfaction, availability of psychological resources, and good physical health. The author also notes the importance of incorporating older persons’ subjective views of their own aging into studies of this topic. Successful aging, as a topic, represents a new paradigm for geriatric psychiatry, in that it focuses on broadly defined positive outcomes rather than on symptom alleviation or narrower outcomes such as functioning.
The sections on specific psychiatric pathology are comprehensive and well-written, and the authors include highly regarded authorities on the respective topics. The section on neurodegenerative disorder has chapters dedicated to major European studies of dementia, including the landmark Lundby Study conducted in Sweden in the mid- and late 20th century and the ongoing Cognitive Function and Ageing Studies. These chapters will be of interest to trainees and early-career psychiatrists, who may not be familiar with these studies.
The sections on schizophrenia, affective disorder, and anxiety disorders incorporate sections on the nosology of these conditions. Conceptually, this is an interesting and useful element of research on these topics that is often underdiscussed in standard textbooks of geriatric psychiatry.
Although this volume is a joint British and American collaboration, the editors have been careful to invite authors from other parts of the world—the volume has well-written chapters on late-life mental illness in South Asia, China, and Africa. American readers may note, however, that there is little discussion of issues related to older Hispanic/Latino populations, which is somewhat of a limitation. There are several chapters focused on service delivery that are specific in context to either the United States or the United Kingdom, which may be of limited interest for readers outside of these regions.
Overall, this book is a comprehensive overview of geriatric psychiatry that covers all major clinical areas and stands out for highlighting a historical perspective on mental illness in late life. It is a valuable contribution to the literature and should be of particular use to residents and trainees in geriatric psychiatry. However, the breadth of ground covered by the editors also makes this book a useful reference guide for practicing general and geriatric psychiatrists, nurses, social workers, and other health care professionals involved in caring for older adults with mental illness.
Ipsit Vahia, MD
Assistant Clinical Professor
Department of Psychiatry
Stein Institute for Research of Aging
University of California
The author declares no conflict of interest.
© 2012 Lippincott Williams & Wilkins, Inc.