Book Review

The Clinical Care of the Aged Person: An Interdisciplinary Perspective

N Engl J Med 1994; 331:1781December 29, 1994

Article

The Clinical Care of the Aged Person: An Interdisciplinary Perspective
Edited by David G. Satin, with Barbara A. Blakeney, Jennifer M. Bottomley, Margot C. Howe, and Helen D. Smith. 497 pp., illustrated. New York, Oxford University Press, 1994. $65. ISBN: 0-19-505290-0

In the crowded field of textbooks of geriatrics, this work is intended to occupy a new niche by covering the care of the elderly patient from the perspective of an interdisciplinary team. The result is a rich compendium of material, much of which is not available in this degree of detail in any standard textbook of geriatrics. It is a pleasure to read a chapter on the economics of health care that actually defines such terms as “balance billing” and “accepting assignment.” And it is useful to have an entire chapter on legal issues in the care of the aged, which covers estate planning, guardianship, and the determination of competence.

The chief drawback of this collection is its implicit assumption that a single book can be appropriate for all members of the interdisciplinary team. Some chapters, such as the one on ethical issues at the end of life, are likely to be helpful to a wide range of readers, but the target audience for other sections is less clear. The chapter on the physical health problems of the elderly is a fine review for nurses but probably too technical for social workers and too elementary for physicians. The chapter on drug therapy, though clear and comprehensive, is pitched at a level most suitable for medical students.

The authors' work arose from a series of seminars at Harvard Medical School taught by experts in fields including anthropology, engineering, law, and pharmacy as well as authorities from the traditional areas of medicine, nursing, and social work. They make a valiant attempt to incorporate the perspectives of other disciplines into their own work. The chapter on nutrition, in addition to reviewing the dietary requirements of the elderly, addresses topics relevant to social workers: meals-on-wheels programs, programs enabling elderly patients to obtain help with shopping, and assisted-living communities.

Many of the authors, however, miss the opportunity to present a truly integrated approach. Despite David Satin's careful dissection of the distinction between multidisciplinary and interdisciplinary work, the prevailing tendency even in this book is for each specialist to dwell on his or her own area of expertise. The chapter on geriatric rehabilitation, for instance, goes into tremendous detail about the effect of inactivity on a whole host of physiologic functions, including electroencephalographic sleep patterns, but does not discuss access to home physical therapy or regulations governing rehabilitation hospitals.

The book's concluding section, a model interdisciplinary discussion of a case, represents an attempt to demonstrate how to put theory into practice and to reveal teamwork in action. Unfortunately, the situation is artificial; 15 health workers are gathered to “plan the evaluation” of an older person with complex problems, and the transcript of their deliberations runs to 18 pages of small print, at the end of which there is a consensus that 1 team member should make a home visit to gather some basic data. The reader may despair of the practicality of the interdisciplinary approach. Moreover, the data cited earlier in the book on the effectiveness of teams in the care of the older person are hardly persuasive: when teams have been found useful, they have usually consisted of a physician, a nurse, and a social worker -- a combination that itself has been shown to improve only certain narrowly defined outcomes in a small number of situations. However, for those who are involved in the care of elderly people and who are already committed to an interdisciplinary approach, this collection will serve as an excellent reference.

Muriel R. Gillick, M.D.
Hebrew Rehabilitation Center, Roslindale, MA 02131