BOOK REVIEW

Medicines in the Elderly

David Armour, Chris Cairns, editors
London: Pharmaceutical Press, 2002, xx + 428 pages, ISBN
0-85369-446-10
Agency: Pharmaceutical Society of Australia
(www. psa.org.au), $123 (PSA members), $143 (non-members) plus $7.00 postage and handling
This book will be a useful reference for pharmacists involved in care of the elderly, either in the hospital, agedcare facility or domiciliary setting, and those teaching in
the area of geriatrics. Written almost exclusively by pharmacists it provides a wealth of information on diseases
in the elderly, and their management.
The initial chapters are What is old age? and Altered drug response in the elderly. The first provides an
overview of the ageing process and its consequences.
Importantly, the authors stress the need to treat the
patient, not the patients age. The second chapter provides a review of the pharmacokinetic and pharmacodynamic mechanisms contributing to altered drug response
in the elderly. These factors place elderly patients at
increased risk of adverse effects.
The book addresses diseases through a systems
approach as shown by the chapter list:
1. What is old age?
2. Altered drug response in the elderly
3. Gastrointestinal medicines in the elderly
4. Cardiovascular medicines in the elderly
5. Respiratory medicine in the elderly
6. Psychiatry and the elderly
7. Treatment of neurological disease in the elderly
8. Anti-infective therapy in the elderly
9. Metabolic and endocrine disease in the elderly
10. Osteoporosis and bone quality in the elderly
11. Musculoskeletal and joint problems in the elderly
12. Eye, ear and mouth problems in the elderly
13. The skin in the elderly
14. Palliative care in the elderly
15. Compliance, concordance and polypharmacy in the
elderly
16. Research in the elderly: ethics, consent and methodology
Each chapter commences with a summary of agerelated changes to the body system under discussion.
This provides a foundation for understanding how physiological ageing may predispose the elderly to certain
pathological processes.
In the cardiovascular medicines chapter an evidencebased medicine approach has been adopted and this
provides compelling arguments for how heart disease
should be managed in the elderly. However, this approach
is less evident elsewhere.
Many valuable tables and figures are provided. For
example, the chapter on metabolic and endocrine disease provides an excellent review of the management of
type 2 diabetes, including a treatment algorithm outlining the place of the glinides and glitazones.
The breadth of coverage of diseases and disorders
is good, although there are some significant omissions.
For example, urinary incontinence is not covered as a
separate entity, neither are falls. Conditions contributing

to each are discussed, but the management of these important problems is not brought together in a separate
section. Further, some topics appear out of place in their
respective chapters, for example, dementias are in the
psychiatry chapter and prostate cancer is discussed under metabolic and endocrine disease.
The final two chapters deal with compliance problems and their management, and research involving the
elderly. The former provides useful information on the
barriers to compliance and means by which to address
them. The latter summarises the problems to be addressed when undertaking research involving elderly
patients, in particular, ethical considerations, obtaining
consent, and research methods.
As the book is written in the UK there are some
differences in the availability of drugs and patterns of
drug use in Australia, however, these do not detract from
its usefulness. The material is up-to-date, with the latest
references quoted from 2001.
This is a timely and valuable publication given the
Governments commitment to enhance medication outcomes for elderly Australians through pharmacist medication management reviews.
Jeff Hughes, BPharm, Grad Dip Pharm, MPharm, MPS
Senior Lecturer, Clinical Pharmacy
School of Pharmacy
Curtin University of Technology
GPO Box U 1987, Perth, WA 6845
E-mail: J.D.Hughes@curtin.edu.au

Journal of Pharmacy Practice and Research Volume 32, No. 3, 2002.

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