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From The CriticsReviewer: David O. Staats, MD (University of Oklahoma Health Sciences Center)
Description: This multiauthored book attempts to combine geriatric medicine and palliative medicine.
Purpose: The purpose is to assist physicians to reframe and broaden medical care of older persons to provide the right care in the right place at the right time for older persons. These are worthy objectives, as the population is increasingly aged, and since most deaths occur in older persons. This is an interesting first pass attempt at a synthesis.
Audience: The authors probably indicate this book is for attending physicians. I think it could be read by ethicists, students of geriatrics, and learners of palliative care. The authors are all recognized leaders in the field.
Features: Outstanding chapters in this book are those on variability of end-of-life care in the U.S. and making the healthcare system work. The former brilliantly analyzes the regional differences in end-of-life care as a function of the distribution of medical manpower and other healthcare resources, implying economic underpinnings of decision making. It also analyzes these differences as a function of the world view of the populations served. The latter chapter is an invitation to build a better mousetrap — how we, as a society, can use knowledge acquired in this area to create better policies and implementation based on better ways of thinking about the delivery of end-of-life care to an aging population. The chapter on communication with older persons at the end of life is also noteworthy. Some of the other chapters presume a knowledge of both geriatrics and palliative care that may not be there; others are too superficial for persons with a knowledge of one or the other areas.
Assessment: For trainees on a typical rotation, the American College of Physicians publication Physician's Guide to End-of-Life Care (2001) can be swallowed whole in the time allotted; this cannot. For trainees in either discipline, the extant textbooks of geriatrics and palliative medicine clearly give greater depth than this work. For a first pass at combing the two approaches, this is not bad.