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Clinical guidelines in old age psychiatry
  1. James Warner

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    By A Burns, T Dening, and B Lawlor (Pp 208, £29.95). Published by Martin Dunitz, London, 2002. ISBN 1-84184-0297

    Do we really need a book on clinical guidelines for old age psychiatry? Read this book and I think you will agree with me the answer is yes! I suspect many clinicians, like myself, have an innate dislike of guidelines. They are perceived as constraining clinical freedom, are generally (inevitably) reductionist in their approach, and may be used as a stick with which to beat us. Furthermore, the provenance of some guidelines is dubious but once published they garner a mantle of authority that is difficult to neutralise.

    This excellent book summarises 129 guidelines, statements, official reports, and policy documents on an enormous variety of issues including diagnostic criteria and treatment of most disorders an old age psychiatrist is likely to encounter, service standards, and legal and ethical issues. Some of the more interesting, and important, areas are genetic testing for Alzheimer's disease, advice on capacity and decision making, electronic tagging, advice on bathing persons with dementia, and use of music therapy. Many governmental publications are summarised into a page or so, including “Forget-me-not”, the National Service framework for older people, “No secrets”, “The way to go home”, “The coming of age”, and other essential reading. I also recommend the introduction, which has a balanced overview about how guidelines are constructed, their use, and their shortcomings (including legal issues). If I have one suggestion for the second edition, it is that there be a brief critical appraisal of each guideline, although the authors do provide a template for the reader to do this.

    The same stable have produced another excellent compendium, Assessment scales in old age psychiatry by Burns et al (1999), that must have saved countless hours of researchers' time and is in my view an essential companion to anyone undertaking research in the discipline. Clinical guidelines in old age psychiatry has a broader audience and is likely to prove just as valuable.