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Book Forum: Geriatric Care   |    
Geriatric Mental Health Care: A Treatment Guide for Health Professionals
ROBERT HOWARD, M.D., M.R.C.PSYCH.
Am J Psychiatry 2002;159:891-892. doi:10.1176/appi.ajp.159.5.891
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By Gary J. Kennedy, M.D. New York, Guilford Publications, 2000, 347 pp., $39.00.

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How I wish that I had written this book. Somehow, old-age psychiatry has always tended to attract the writers and editors of two opposite kinds of book: enormous doorstop reference volumes and flimsy touchy-feely offerings. So there’s always a huge potential market for a good textbook to bridge this gap, not least because the majority of older people with mental health problems are being treated by generalists or by specialists still in training. I would seriously recommend this book to any nurse or physician who looks after old people in hospitals (general or psychiatric), in nursing facilities, or at home. Gary Kennedy has produced a comprehensive, up-to-date, and evidence-based textbook that is accessible to nonspecialists, and he’s done it without watering down his material to the point where specialists will find the text too thin.

The usual suspects (dementias and delirium, anxiety and depression, psychosis and mania) are covered well and in a practical and informative manner. There’s an excellent section in the chapter on psychosis and mania within which Kennedy considers how best to achieve a therapeutic alliance with the patient and his or her family. In clinical reality, this is much more useful than advice on choice of an individual antipsychotic, but I can’t recall reading such a clear and sensible account of this important skill in another book.

Chapters on personality, somatoform, and pain disorders, on alcohol and substance abuse, and on sleep disturbances are of equally high quality. The reader will also find a refreshingly nonageist view throughout regarding the availability and usefulness of the full range of treatments for psychiatric disorders in older adults. For example, brief and long-term psychotherapies get appropriate coverage alongside pharmacological treatments for anxiety and depression. The book winds up with chapters on legal and ethical issues and mental health consultation in the general hospital, home, or nursing home. The single-author format is rare these days and works very well. Help from colleagues who have been generous with their time in reviewing individual chapters for the author has added to the book’s value, and there is nothing of the lopsidedness of content seen in rival volumes. The slightly awkward title really doesn’t do credit to the content and quality of the book. Geriatric Mental Health Care is a title that might give an unfortunate impression of covering practices that are not absolutely bang-up-to-date.

It’s difficult to glamorize the psychiatry of later life, but those of us in this field have to be very careful what we call ourselves and our specialty. For many years, old-age psychiatrists (as we currently call ourselves) in the United Kingdom referred to themselves as "psychogeriatricians." This made us sound like we had trained in geriatric medicine before developing a major mental illness. The current U.S. vogue for the term "geriatric psychiatrist" is no better and doesn’t always sit well with the appearance of many eminent practitioners. No one illustrates this better than the author himself. Kennedy, we learn, was born in 1948, but his photograph on the back flap of the book jacket reveals him to be remarkably youthful despite a suspect taste in bow ties. Such comments are motivated by pure jealousy on my part. This is a great book, and my own copy has already been "borrowed" by a junior colleague. I fear I won’t see it again.

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