The Merck Manual of Geriatrics, ed 3.

The Merck Manual of Geriatrics, ed 3 Beers MH, Berkow R, eds. Rahway, NJ 07065, Merck Research Laboratories, 2000, hardcover, 1,533 pp, illus, ISBN: 0911-910-88-3, $32.50.

Through an interdisciplinary approach, which is heavily weighted toward physicians' area of practice, this third edition provides a comprehensive and thorough approach to the field of gerontology. Because of the vast amount of material covered within the text, most topics have very brief discussions aided by tables of data and figures to illustrate points.

The overall format of the book provides for easy navigation. Within the text, reference points printed in red direct the reader to tables and related pages. Also, the reader can easily flip to the beginning of each chapter using the notched tabs on the outer edge of the page. The references and appendixes are easily found through red-marked edges.

The information in the text is objective, and it is based on the most current research available, with contributions from more than 150 content experts. The text contains 16 sections with a total of 134 chapters. The first section, "Basics of Geriatric Care," uses a broadbrush approach to issues of aging in this country. Topical chapters include the biology of aging, demographic trends, assessment methods, team methods, care of patients who are dying, and health care funding issues.

The following sections in order include: "Falls, Fractures, and Injury"; "Surgery and Rehabilitation"; "Psychiatric Disorders"; "Delirium and Dementia"; "Neurologic Disorders"; "Musculoskeletal Disorders"; "Metabolic and Endocrine Disorders"; "Hematologic Disorders and Cancer"; "Pulmonary Disorders"; "Cardiovascular Disorders"; "Kidney and Urinary Tract Disorders"; "Gastrointestinal Disorders"; "Men's and Women's Health Issues"; "Dermatologic and Sensory Organ Disorders"; and "Infectious Disease." The text is completed with 4 appendixes that cover laboratory values, various measures, commonly used medications, and a resource list.

Section 3, "Surgery and Rehabilitation," provides a cursory glance at the role of rehabilitation for geriatric clients. Furthermore, this section has an interesting arrangement of topics. It begins with surgical considerations for elderly patients and then suddenly progresses to rehabilitation and exercise. The first 4 chapters are devoted to surgical issues, and the last 4 cover rehabilitation. Physical therapy is included within the general chapter on rehabilitation, whereas occupational therapy and exercise have individual chapters.

Chapter 28 discusses rehabilitation. However, because of the limited space and the text's focus on physicians, the chapter presents a very basic level of rehabilitation encompassing a combination of physical therapy, occupational therapy, and speech therapy services, along with psychological counseling and social work services, in 3 pages. There is a subsection, which discusses physical therapy, that objectively covers common interventions and modalities. This subsection also has several tables of normative values such as joint range of motion and muscle strength grades using 0-to-5 scales matched to the terminology from zero to normal. The figures aid the chapter's presentation, although a drawing of gait training depicts improper ambulation techniques and labels the care provider an "aide."

Chapter 29, "Rehabilitation for Specific Problems," provides a discussion of rehabilitation techniques for specific diagnoses such as heart disease, stroke, hip fracture, and amputation. Chapter 31 attempts to cover all the dimensions of exercise. The book does not devote a chapter or even a portion of a chapter to speech-language pathology.

Although the rehabilitation chapters are short, information regarding rehabilitation concerns is scattered throughout the text. For example, chapter 21 discusses gait disorders. Nine pages are devoted to gait issues and interventions for elderly people, with a brief mention of the contributions of physical therapy within a sentence discussing resistive exercises. This chapter gives the impression that the physician would perform all gait analyses, prescribe and teach exercises, and provide the interventions. A single paragraph discusses assistive devices such as walkers or canes.

As a physical therapist, I believe that the paucity of information regarding all potentially helpful avenues in which therapists may play a role represents a potential shortcoming of the text for all users. Although the third section does provide adequate information regarding physical therapy interventions, other sections do not. For example, section 7, "Musculoskeletal Disorders," has 9 separate chapters dealing with various issues in bone and muscle. A few, rare sentences refer to physical therapy interventions for the disorders.

Although many physical medicine modalities and interventions are mentioned, few descriptions of these modalities and interventions acknowledge that the health care provider may be a physical therapist or occupational therapist.

It is difficult to include all the medical and scientific information available for geriatrics in one reference text. However, the Merck Manual of Geriatrics attempts to objectively cover a vast array of material. Although it is somewhat simplistic in its coverage of rehabilitation generally and physical therapy and occupational therapy specifically, the text is nonetheless a valuable source of information for practicing clinicians. This book is an excellent text to encourage students to purchase and for clinicians to have available within clinic settings that provide services to elderly patients.

Cheryl LaFollette Anderson, PT, PhD, GCS Alexandria, Minn

Dr LaFollette Anderson is a clinician, researcher, author, and educator in rural Minnesota.