Book Review

Acute Emergencies and Critical Care of the Geriatric Patient

N Engl J Med 2000; 343:1900December 21, 2000

Article

Acute Emergencies and Critical Care of the Geriatric Patient
Edited by Thomas T. Yoshikawa and Dean C. Norman. 517 pp., illustrated. New York, Marcel Dekker, 2000. $135. ISBN: 0-8247-0345-6

With the marked increase in life expectancy achieved during the past century, we can expect that the elderly population will continue to grow disproportionately during the next 50 years. The oldest of the elderly, persons 85 years of age or older, now represent the fastest-growing group not only in developed countries as a whole, but also in emergency departments, intensive care units, and hospital wards. In recent years, much has been learned about the physiologic and pathologic consequences of aging and the varied clinical manifestations of disease in the elderly. The spectrum of illness in middle-aged adults is similar to that in older adults, but the prevalence of various entities differs. In elderly people with diminished functional reserve and coexisting illness, an acute disease often causes perturbations in multiple systems. Clinical presentations may be relatively nonspecific, and mortality is almost always higher than in younger patients. Consequently, diagnostic and therapeutic planning for older patients must be tailored to meet their differing needs and objectives. Unfortunately, there are comparatively few off-the-shelf works a busy clinician can refer to when caring for acutely ill elderly patients. Acute Emergencies and Critical Care of the Geriatric Patient will help to fill this void.

This book consists of four sections that cover the basic principles of critical care, topics related to surgical emergencies and medical emergencies, and special issues. A strength of the book is that each of its 25 chapters can serve as a stand-alone reference for rapid review. Yet the text flows nicely from chapter to chapter, making it easy to garner a comprehensive survey of this area of medicine. The chapters are consistently organized, with clear headings in outline style. As a multiauthored book, it benefits from strict adherence to this unified organization. There are many easy-to-read summary tablews as well as numerous figures that enhance the text. The chapters are well referenced, are organized according to system, and provide useful, though somewhat broad, surveys. Throughout, several thematic issues — including reduced functional reserve in various organ systems (homeostenosis) and atypical or muted clinical presentations — and an emphasis on general principles combine to form a cohesive and useful work.

The first section of the book, “Principles of Geriatric Critical Care,” focuses on older patients in the emergency department and critical care unit, with particular attention to geriatric pharmacology and the unique nursing needs of the elderly. The second section, “Surgical Emergencies,” provides a review of preoperative evaluation, emergency anesthesia, common injuries, the acute abdomen, and vascular catastrophes. Although it is solid and filled with interesting teaching pearls, this section suffers somewhat in comparison with the other sections, especially because of a tendency toward oversimplification of complex concepts.

The chapters in the section entitled “Medical Emergencies” are very well written and provide an outstanding survey of internal medicine in the acute care of elderly patients. Although the chapters overlap somewhat, they are generally complementary and reinforce important facts and concepts. The final section in the book, “Special Issues of Aging,” deals with a variety of other important topics related to geriatric acute care, such as elder abuse and acute loss of vision.

This book would be a very good supplement to a complete textbook of medicine. Consistently emphasizing relevant general principles, it will enhance readers' understanding of many problems in the acute care of elderly patients. It will be an excellent resource for all those who care for the elderly in acute care settings.

Robert S. Crausman, M.D.
Brown University School of Medicine, Pawtucket, RI 02860