Psychological Aspects of Geriatric Rehabilitation.

Hartke RJ, ed. Gaithersburg, MD 20878. Aspen Publishers Inc, 1991, hardback, 287 pp, $48.

This book is part of a Rehabilitation Institute of Chicago publication series designed to enhance the knowledge and expertise of health care providers involved in rehabilitation. This particular publication focuses on the mental health of elderly clients with physical limitations who have different needs from the younger rehabilitation client. The 12 chapters are written by six different mental health workers, most of whom have affiliation with the Rehabilitation Institute of Chicago or Northwestern University Medical School.

The first three chapters provide an overview of the topic, with chapter 1 differentiating briefly between the needs of younger and older rehabilitation clients, chapter 2 providing an overview of normal physiological aging, and chapter 3 reviewing normal psychological aging. Chapter 4 focuses on how the older individual adapts to the rehabilitation setting. Problems related to loss of independence, to loss of peer support, and to the youth orientation prevalent in many rehabilitation centers are addressed. Several individual and group interventions are suggested.

The next three chapters focus on assessment of cognitive factors, emotional factors, and dementia. One author, Rentz, reviews a number of studies on the effect of cognitive dysfunction on rehabilitation outcomes and concludes that diminished cognition, in and of itself, does not mitigate against rehabilitation potential. She emphasized the value of a knowledgeable staff and programs aimed at the client's cognitive level. Trezona, another author, explores the effects of anxiety on learning and makes recommendations for improving the client's emotional state. An overview of dementia associated with physical disabilities is presented, and several evaluative forms are addressed.

Chapters 8 through 11 present a variety of management issues; the issue of working with patients with cognitive impairments and depression is explored from both psychotherapeutic and general staff perspectives. The value of psychotherapy with older clients is covered in chapter 11. The final chapter explores the role and problems of the caregiver and provides suggestions for ways that the staff of a rehabilitation center can help caregivers cope with the stress of the role.

Throughout the book, research findings and management suggestions are provided to form a comprehensive picture of the psychological aspects of rehabilitation with elderly individuals. This book is quite readable, with minimal duplication among chapters. A detailed reference list follows each chapter. The book is designed for use by all rehabilitation personnel, and general staff concerns are consistently addressed. Though not a text for students, the book would be useful to all practitioners working with elderly clients, regardless of setting, and would make a useful reference for entry-level or graduate students interested in geriatric care.

Bella J May, EdD, PT

Medical College of Georgia 

Augusta, Ga