Geriatric Physical Therapy: A Clinical Approach.

In the preface, the authors state that the main objective of the text is to present therapists with a thorough review of advanced clinical information. The book was designed to offer a comprehensive source for the advanced applied science of normal and pathological aging, along with clinical problems, implications for therapeutic interventions, and considerations specific to the elderly. The targeted audiences include experienced clinicians, advanced master's degree students, and therapists preparing to sit for the geriatric specialty examination.

The book is organized into three major sections: applied gerontological concepts, patient care concepts, and administration and management.

Section 1 begins by presenting demographic information, and includes psychosocial, nutritional, and pharmacological aspects of aging. It also contains descriptions of various aging theories and compares and contrasts age-related changes in terms of physiology and anatomy. This section contains numerous assessment tools, including, among others, tools specific to musculoskeletal parameters and gait.

The second section broadly outlines principles and practice of geriatric rehabilitation. Suggestions for performing patient evaluations using the team concept and goal setting are provided, and various forms for recording data are included. information related to orthopedic, neurological, and cardiopulmonary treatment considerations is well organized, but orthopedic treatment approaches tend to be fairly general and do not include recommendations for duration or intensity of modalities. The authors did, however, include specific programs and protocols for patients with knee and hip replacements.

Neurological treatment considerations focus on cerebrovascular accidents and Parkinson's disease. The latter is dealt with in an excellent fashion, and specific evaluation and treatment procedures are clearly detailed. Stroke evaluation and rehabilitation techniques are specific to Bobath, Brunnstrom, and Carr and Shepard. The cardiopulmonary chapter details exercise testing and includes special considerations when prescribing exercise for the elderly. The second section includes an analysis of community-based screening programs and provides a wellconstructed foot screening tool. It also addresses communications in a broad manner, with topics specific to patient issues (ie, age changes and ethnicity) and therapist communications, including documentation and writing for publication.

The last section of this text begins with a sensitive analysis of attitudes and ethics, followed by a superb explanation of factors germane to learning in the elderly. A chapter on administration of geriatric services includes information on budgeting, personnel, organizational plans, marketing, and legal issues, but is very weak in terms of references specific to physical therapy. An appendix, however, contains numerous helpful guidelines for hiring, training, and managing employees.

The third section continues with a focus on the physical therapist as a consultant and identifies settings and activities for therapists choosing to pursue that form of practice. A chapter explores the process of becoming a consultant and includes (in an appendix) examples of self-introduction along with sample fliers and forms helpful for new and experienced consultants. One drawback to these materials is that some therapists may take exception to the authors' suggested dress as a consultant: "tailored slacks and a professional blouse."

The third section ends with an introduction to the process of scientific inquiry and research, and an extensive listing of resources for aged individuals and those caring for them. Computerized tools such as MEDLINE are mentioned, but resources specific to physical therapy (eg, Cumulative Index to Nursing & Allied Health Literature, APTA-NET, Physical Therapy On line Network) are omitted. Further, computer resources designed especially for the elderly and their caregivers (Seniornet) are not presented.

The authors intended this text to be a comprehensive source of information for physical therapists, but do not completely achieve that goal. In addition to the aforementioned inconsistencies, some shortcomings were noted in the form of contradictions between and within chapters. For example, although chapter 5 reports a decline of total extracellular fluid with aging, chapter 3 initially states that "extra-cellular water remains constant," but then notes it is "higher in older adults." Further, some information in chapter 10 seems to contradict information presented in an earlier chapter. The authors state on page 290: "Finally, the colors in the room should be those that make the older person most at ease, such as reds, oranges, gold and beige." On page 281, the authors write: "The colors red, yellow, and orange have been associated with excitement, stimulation and aggression. Red increases muscular tension and blood pressure. It could be used as a visual stimulant with the elderly ...." Readers may also be confused by other portions of the book related to color perception, patient interviewing, statistical reliability, and motor unit number changes with aging.

Another difficulty is that terminology does not always follow accepted convention. For instance, although the correct term is "pressure ulcer," the authors use the outdated term of "decubitus ulcer." Also, the book would benefit from including glossary, as extensive jargon requires readers to frequently consult alternate information sources. In addition, at times it is difficult to ascertain whether suggested treatment strategies reflect the opinions of the authors, the literature, or both. The book would be strengthened by attention to these factors, and by addressing the unfortunate number of typographical errors in text, illustrations, references, and referencing, which are distracting to the reader. If these collective weaknesses can be addressed in a subsequent edition, this text will become a more valuable resource for its intended audiences.