Book Review

Medical Problems in Women over 70: When Normative Treatment Plans Do Not Apply

N Engl J Med 2008; 358:1645-1646April 10, 2008

Article

Medical Problems in Women over 70: When Normative Treatment Plans Do Not Apply
Edited by Margaret Rees and Louis G. Keith. 247 pp., illustrated. Abingdon, England, Informa Healthcare, 2007. $100. ISBN: 978-0-415-37352-4

As a gynecologist whose mother is 97 years old and going strong, I found this book intriguing. I read it as a clinician, a medical educator, a potential caregiver, and a son. The premise of the book is certainly valid — as the elderly population grows in both absolute and relative terms, health care for women could be improved if clinicians and policymakers had ready access to evidence-based data that were specific about sex and age. With editors based in Oxford, England, and in Chicago, it is not surprising that virtually all the contributing authors of Medical Problems in Women over 70 come from Europe and the midwestern United States. The inclusion of perspectives from two continents contributes to the value of the information.

With its unique focus, the book benefits from novelty, but it also suffers because the reader might want more specific details than are available. The lack of data pertaining to women over 70 years of age is certainly not the fault of the editors and authors but instead reflects the paucity of studies that have looked at women of this age. As is pointed out throughout the chapters, it is difficult to draw definitive conclusions from our current literature because studies have historically looked only at younger populations or only at men.

The breadth of chapter topics points out a key concept in the care of elderly women — that traditional gynecology plays a limited role. Only three chapters cover what would be considered mainstream gynecologic topics: chapter 7, “Urogenital Aging,” chapter 11, “Prolapse,” and chapter 12, “Gynecological Cancer.” An additional chapter, “Keeping Sex Alive in Later Years,” represents one of the topics within gynecology that is often given short shrift both in the process of education and in everyday practice. There is little for the gynecologist to learn in these chapters. However, the information is neatly packaged for practitioners in other fields.

By the same token, gynecologists reading the book will receive lessons in other arenas that are invaluable and rarely taught, such as topics covered in chapter 2, “Health Effects in the Elderly from Heat and Cold,” in chapter 5, “Dementia, Capacity, and Consent,” and in chapter 9, “Medication and Prescribing.” The chapter on normative values of investigations in elderly women is a highlight because it focuses on the reality that “normal” is a relative term. We know this is true in pregnant women, but we sometimes fail to recognize it in the elderly.

By no means is this book a “how to” guide. The authors have collected the existing evidence-based literature in a useful fashion such that program administrators, governmental agencies, and individual physicians have a rational starting point. There is something for everyone in this book, which should be the first of many works focused on this growing sector of the world's population.

I found this book to be well worth reading. The bibliographies at the end of each chapter are invaluable in themselves. Margaret Rees, Louis Keith, and their contributing authors have given us the beginnings of a vision of the future of this field, and in doing so they have provided an admirable service to all of us doctors, nurses, therapists, sons, and daughters.

Frank W. Ling, M.D.
Vanderbilt University School of Medicine, Nashville, TN 37232
fling@whsobgyn.com