On Your Own Terms: The Seniors' Guide to an Independent Life.

Cirino L, New York, NY 10019, Hearst Books, 1995, paperback, 376 pp, $17.50.

This book is a collection of ideas and resources to make life for the elderly less complicated and more comfortable and to enhance their ability to live on their own terms. It is written by a nonmedical person in a format and style that makes it very easy to read and understand.

Twenty-one chapters are divided into six parts: "An Independent Spirit," "Designing Your Diet," "Staying Active," "A Sense of Safety," "An Alert Mind," and "A Secure Future." Each chapter includes general information, specific tips, and resources related to the particular topic. The resource lists include descriptions, addresses, telephone numbers, services, and organizations and an approximate price for various publications, audiotapes, and videotapes. Although the author intended the lists to be selective rather than encyclopedic, they are very extensive for each chapter. Often, several versions of the same type of item are included, and the author refrains from qualitative comments.

Problems related to dressing, along with other related topics, are covered briefly in "Looking Your Best," which is included in part 1. Some ideas and specific suggestions for modifying clothing to facilitate easier dressing and, as with other chapters, a fairly comprehensive list of resources are provided for related activities of daily living tools and equipment.

Although the general information in "Staying Active" may be helpful, specific suggestions are, at times, lacking in completeness and accuracy. For example, in the 1-minute range-of-motion test, the only instruction for assessing lower-extremity flexibility is to "sit with your knees together, lean forward, and touch your toes." The starting position is never specified, and no other joints or muscles are addressed. This is unfortunate because ankle motion is so important to safe and efficient ambulation, especially in the elderly. Another example is the single exercise suggested for balance: "As you stand on one leg, tighten your thigh muscle and stand for thirty seconds. Repeat with the other leg. Increase the time until you can stand on one leg for one minute. Do the same thing first with one eye closed; then with both eyes closed." The inclusion of what seems to be a quadriceps femoris muscle set would make it much more difficult to maintain an appropriate position for dynamic standing balance. No safety precautions, such as standing near a sink or behind a couch, are included.

In "Overcoming Obstacles to Being Active," arthritis is discussed. The only time that physical therapy is mentioned specifically is in a paragraph titled "New Developments," in which readers are cautioned to check with their physicians because some products "may be harmful; others are simply a waste of money." Physical therapy and occupational therapy are, in fact, conspicuously absent throughout the book. In the section on back pain, the exercises described are "bent-leg situps, leg lifts, and stomach curls." Some of these exercises are specifically contraindicated in persons with osteoporosis, a disease common in the target population. In fact, the relationship between osteoporosis and weight-bearing exercise is covered only briefly, and walking is the only example provided.

The chapter entitled "A Sense of Safety" has some very good information and suggestions, especially those regarding bathroom safety. In the first-aid section, readers are cautioned not to think of first aid as replacing a physician's visit; however, other potentially serious problems related to first aid are overlooked. For example, no mention is made of the potentially serious threat posed to the person with diabetes by even minor skin or nail problems.

Although On Your Own Terms contains a wealth of useful information, some of it is incomplete or inaccurate. The resource lists that are presented throughout the book are perhaps the most valuable component, and virtually every senior should find something that would make a significant contribution to their quest for continued independence. I would recommend it as a good general reference for most seniors, especially in conjunction with a therapist's specific advice to clarify certain issues.

Andi Beth Mince; PT Armstrong State College Savannah, Ga

Ms Mincer is Assistant Professor in the physical therapy program where she has multiple teaching responsibilities, including the areas of geriatrics and orthopedics.