Rehabilitation and the Aging Population, vol. 4, no. 1: Physical Medicine and Rehabilitation: State-of-the-Art Reviews.

Rehabilitation and the Aging Population, vol 4, no 1. Physical Medicine and Rehabilitation: State-of-the-Art Reviews This collection of concise review papers is part of the series entitled Physical Medicine and Rehabilitation: State-of-the-Art Reviews. All of the contributors are associated with the University of Arkansas or the Veterans Administration Medical Center in Little Rock, Ark. The volume is directed toward physical medicine practitioners for the purpose of increasing their awareness of rehabilitation issues related to an aging population. The editors identified topics that they feel are not commonly addressed in the rehabilitation literature, although these topics are frequently addressed in the geriatrics literature. The editors do not discuss stroke and head trauma but do discuss the following topics in depth, focusing on multiple arenas: dementia, osteoporosis and fractures, degenerative joint disease, total joint replacement, amputation, and health care financing. A chapter on dysphagia is included, but it makes little reference to aging.

The chapters are up-to-date and concisely written. Unfortunately, this conciseness results in a lack of depth and focus in the discussion of some crucial issues of aging. In the chapters on total joint replacement, degenerative joint disease, fractures, peripheral neuropathy, and cancer, the contributors discuss only routine pathology and management, as if they took a general text and merely inserted the word "elderly" before the word "patient." Most of the material relates to patients of any age. The contributors also pay limited attention to the question of differences that can be attributed to the advanced age of the patient. Although they do point out differences in incidence, they rarely address differences in severity, presentation, sequelae, or management; when these questions are discussed, they are merely mentioned rather than emphasized. Certain concepts (eg, multiple problems in many organ systems, the wide variability in presentation and responses, and interactive effects of management such that treating one problem has a negative effect on another) are mentioned but fail to get the emphasis they deserve.

The chapters on dementia, psychological aspects of rehabilitation, pain management, incontinence, and ethics are better; here the authors direct their attention to issues of aging. Especially good is a chapter on skeletal muscle that treats decline of physical function in a positive way. The chapter on sex is informative and appropriate; however, the author fails to underscore the single biggest reason for change in sexual behavior, which is lack of a partner.

Overall, this book does introduce some ideas related to the rehabilitation of older patients. From this standpoint, the editors have accomplished their stated purpose.