Book Review

Geriatric Pharmacology

N Engl J Med 1993; 329:68-69July 1, 1993

Article

Geriatric Pharmacology
By Rubin Bressler and Michael D. Katz. 689 pp. New York, McGraw-Hill, 1993. $49.95. ISBN: 0-07-007660-X

The topic of this book -- the pharmacology of drugs used in elderly patients -- is an important one. Because the aging process modifies the metabolism and clinical effects of some medications, elderly patients are susceptible to adverse drug reactions, some necessitating hospitalization. This aspect of geriatric pharmacology is especially critical since the elderly use twice as many prescription drugs per patient as the general population.

Geriatric Pharmacology is made up of 24 chapters, contributed largely by physicians and pharmacists affiliated with the University of Arizona. Some of the chapters are excellent, such as those on pain control, incontinence, diabetes, osteoporosis, and rheumatic diseases, but others are less than optimal for practicing physicians. Most of the chapters were written by authors who do not seem to have first-hand experience with the use of prescription drugs in the elderly. These chapters consist mostly of summaries of recently published review articles, with contradictory information presented without comment. Some (such as “Antipsychotic Agents”) contain very little information specific to the elderly, and some important new drugs (for example, sertraline) are not even mentioned. Moreover, the authors fail to highlight clinically important information.

The book also suffers from poor editing. The use of subheadings is uneven, and the hierarchy of the headings is confusing. There are also some notable omissions, the most important of which is the lack of a chapter on dementia. The usefulness of some chapters (such as that on bacterial and viral infections) is limited by the omission of the trade names of pharmacologic agents. In contrast, some chapters (such as that on depression) contain too much basic information in both the text and the tables.

Despite these shortcomings, this book may be useful for a physician or pharmacist who does not have a recent textbook of pharmacology and whose practice includes large numbers of elderly patients. Used as a handbook and a guide to further reading, it may promote better and safer use of pharmacologic agents in the elderly.

Ladislav Volicer, M.D., Ph.D.
E.N. Rogers Memorial Veterans Hospital, Bedford, MA 01730