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Parkinson's Disease in the Older Patient
  1. Jackie Morris

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    Edited by J R Playfer, J V Hindle (Pp 370, £55.00). Arnold, London, 2001. ISBN 0340759143

    This is a welcome addition to the literature. The book has been published with the help and support of the British Geriatrics Society special interest group in Parkinson's disease and the Parkinson's Disease Society of the United Kingdom. Both organisations have been at the forefront of increasing public and professional awareness of the need for a holistic approach to the care of older people with this condition. Understanding of the pathophysiology, therapeutics, and progression of the disease, as well as the introduction of Parkinson's disease nurses and specialist clinics have all led to significant improvements in patients' quality of life. This well referenced publication will add to the knowledge base of neurologists and geriatricians in practice as well as in training.

    There are 21 chapters, in five parts, which address topics ranging from the historical background of Parkinson's disease to its diagnosis and assessment, written by Drs Macphee, Meara, and Forsyth. In the absence of a foolproof test for Parkinson's disease, these chapters go a long way to reminding readers of the importance of history, examination, assessment, and therapeutic challenge. The remaining parts include specific problems in Parkinson's disease, therapy and management, and research perspectives.

    The chapter by Dr MacMahon on the organisation of services, concepts of management, and health economics builds on his theory of effective management of chronic disease, emphasising the importance of staging Parkinson's disease in terms of diagnosis, maintenance, and complex and palliative care. His paradigm for Parkinson's disease disease management is used by many geriatricians and is described it in greater detail for the benefit of a wider audience of clinicians.

    There are also interesting chapters on rehabilitation and the interdisciplinary team, the Parkinson's disease nurse specialist, complementary and alternative medicine, and of course drug treatment by Dr Playfer, one of the editors. The other editor, Dr Hindle, has written a beautifully argued chapter on the complexity of neuropsychiatry in this syndrome, and autonomic problems are eloquently described by Professor Kenny and Dr Allcock. Unfortunately it is impossible to acknowledge all the authors, but no aspect of Parkinson's disease is left unchallenged. The development of a properly managed, cost-effective, and evidence based service is the underlying theme throughout the book.

    Without a multidisciplinary holistic approach to the care of older people with Parkinson's disease, we will continue to offer inhumane, crisis driven care for these challenging patients and their carers. “Parkinson's Disease in the Older Patient” provides the knowledge base.

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