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Book Reviews   |    
Geriatric Mental Health Care: A Treatment Guide for Health Professionals
Reviewed by Stephen L. Pinals, M.D.
Psychiatric Services 2001; doi: 10.1176/appi.ps.52.3.393
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by Gary J. Kennedy, M.D.; New York, Guilford Press, 2000, 347 pages, $39

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With our aging population, it is increasingly important for clinicians to be familiar with the health care needs of elderly persons. Geriatric Mental Health Care, by Gary J. Kennedy, M.D., is a timely, thorough, and well-written guide for primary care and mental health professionals who do any work with older adults. It can also be used by students and trainees across disciplines as a reference text for mental health issues, including evaluation and treatment of disorders, among older persons.

The breadth of topics covered in this book makes it a unique contribution to the field. Throughout the text, close attention is paid to the delicate interaction between biological, psychological, and social variables that may contribute to morbidity in elderly persons.

Dr. Kennedy begins with a concise overview of what he describes as an imperative to provide competent and comprehensive services to our aging population. This introduction is followed by a chapter reviewing depression and anxiety and chapters focusing on dementias and on psychosis and mania in elderly persons. With this layout for the opening chapters, the reader is able to more easily conceptualize overlapping etiologies, differential diagnosis, evaluation, and symptom management.

Chapters reviewing common disorders among older persons are balanced by chapters emphasizing wellness, disease prevention, and other important aspects of geriatric mental health care. For instance, special consideration is given to the importance of exercise and nutrition for seniors. An entire chapter is devoted to the recognition and reduction of suicide risk in order to emphasize and consolidate information on this crucial topic.

A practical review of legal and ethical issues reflects the pertinent and timely nature of these topics for clinicians treating geriatric patients. Particular attention is given to the assessment of decisional capacity, informed consent, medical futility, physician-assisted suicide, and various related subjects. An excellent review is provided of the various psychotherapies that are indicated for older adults. Dr. Kennedy successfully examines the indications and potential benefits of applying traditional individual psychotherapeutic interventions to geriatric patients.

As health care delivery changes, the clinician specializing in the treatment of geriatric patients is increasingly called on to serve as an educator and expert consultant to other professionals in various treatment settings. It is noteworthy that Dr. Kennedy gives special consideration to the complexities of providing consultation in nursing homes, on home visits, and to other health care agencies. Specific guidance on navigating this uncharted territory is both practical and valuable. Dr. Kennedy also provides concise overviews of other significant topics that are of particular concern but often underreported, including elder abuse and neglect, substance abuse, and late-life sexuality.

Geriatric Mental Health Care is a timely endeavor written by one of the leading educators in geriatric psychiatry to guide and instruct health care professionals at every level in working with the elderly. It effectively serves to orient clinicians toward the many challenges and rewards of working with geriatric patients, their families, and multidisciplinary treatment teams. The book is highly recommended to any clinician or caretaker seeking comprehensive and easily accessible information about geriatric mental health care.

Dr. Pinals is assistant director of geriatric psychiatry at Cambridge Health Alliance in Cambridge, Massachusetts.




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