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Understanding Elder Abuse in Minority Populations
BOOK REVIEWS Understanding Elder Abuse in Minority Populations Edited by Toshio Tatara, Ph.D. Philadelphia, PA, Taylor & Francis, 1998 247 pages, ISBN 0-87630-919-8, $59.95 Josepha A. Cheong, M.D.
U
nderstanding Elder Abuse in Minority Populations is a fascinating collection of papers examining the problem of elder abuse in minority populations in the United States. This publication is a significant addition to the growing literature on the care of minority elderly persons. It is applicable to the fields of sociology, forensics, gerontology, social work, clinical research, public policy, and general and mental healthcare. In addition to being a scholarly text, this book is also fascinating reading that is likely to become de rigeur for anyone interested in or involved in the care of elderly—both minority and non-minority—populations. Editor Toshio Tatara, Ph.D., is currently a Professor of Sociology at Shukutoku University in Chiba, Japan. His extensive experience in the field includes serving as Director for the National Resource Center on Elder Abuse (NRCEA) from 1988 to 1992 and Director of the National Center on Elder Abuse (NCEA) from 1993 to 1998. At the time of its publication, this book was the first to focus on maltreatment of elderly persons within ethnic minority populations, and, as Tatara says in his preface, was “borne of the desire to bring to the public perspectives and information about elder abuse that have heretofore been missing....” He also states that many of the research-
Am J Geriatr Psychiatry 9:2, Spring 2001
ers and clinical practitioners recruited to this project came from the various minority groups discussed. This quality adds a unique perspective to the material. Although each chapter is different in organization and concepts, a general sense of subjective familiarity with the ethnic minority group examined comes through in the text. This is particularly evident in the chapters on the African American and Asian American communities. The book is divided into five parts. The first four parts are devoted each to a specific minority group: African American, Hispanic American (subgroups Mexican and Puerto Rican), Asian American (subgroups Korean and Japanese), and Native American Indian. Each section provides extensive statistics on the population examined. This background information examines both the minority population within the general United States population and, further, the elderly minority population within the minority group and the general United States elderly population. Useful, as well as fascinating, historical background on immigration and emigration particular to each group is provided. Also, each group’s unique cultural perspective and family structure are examined and described to provide a framework for analyzing the possible forces driving (and perpetuating) elder abuse. Finally, descriptions of current existing legislation and intervention models are included along with recommendations. Another consistent feature is the careful description of family dynamics within the cultural and ethnic context. These family dynamics are vividly demonstrated through the numerous, and often heartbreaking, vignettes presented throughout the book.
The fifth part examines the theory and practice of a multicultural perspective on elder abuse. Part 5 consists of three chapters that strive to provide an overview of the various aspects of minority elder abuse, regardless of the particular minority population. The focus of this section is primarily on the definition and impact of abuse, outreach, and intervention, and a statement of current standing; that is, “where we are today.” A different team of researchers and clinical practitioners wrote each chapter. This is both the strength and relative weakness of the book. The varying authorship is a strength, given the expertise of the contributors in their particular area. It is a relative weakness, given the lack of uniformity in organization of the various chapters and the unevenness of writing styles. The unevenness requires that the reader “shift gears” with each new chapter. For example, Chapter 5 (the Mexican American community) and Chapter 9 (the Japanese American community) are publications of completed research, complete with Methods section. Other chapters provide “how-to” instruction on outreach to the various minority populations. This is a relatively small criticism, given the scope and overall effectiveness of the book, however. Another strength of the book is the fact that each chapter can be read independently as a self-contained discourse on a particular topic. We would propose one recommendation to the prospective reader: Read the Preface, Chapter 1 (Introduction), and Part 5 (Elder Abuse in Multicultural Perspective: Theory and Practice) first, before proceeding to the sections focusing on the various minority populations. Reading the
177
Book Review aforementioned sections as a group provides a cohesive basis from which to build an understanding of the issues of elder abuse in minority populations. From a clinical geriatric-psychiatry perspective, this book is exceptionally useful in addressing and understanding caregiver issues for minority elderly persons in both abusive and non-abusive settings. As previously noted, this is a valuable addition to the literature in any discipline involved with elderly and ethnic minority populations. Josepha A. Cheong, M.D., is Assistant Professor, University of Florida, Departments of Psychiatry and Neurology, and Member, APA (Council on Aging) Committee on Ethnic Minority Elders.
Early Diagnosis of Alzheimer’s Disease Edited by Leonard F. M. Scinto, Ph.D., and Kirk R. Daffner, M.D. Totowa, NJ, Humana Press, 2000 368 pages, ISBN 0-896-03452-6, (hardcover) $125.00 Daniel L. Murman, M.D., M.S.
S
cinto and Daffner provide a comprehensive and timely introduction to the early diagnosis of Alzheimer’s disease (AD). The editors stress that early treatment of AD is not feasible in the absence of early, accurate diagnosis. Although much attention has focused on the development of treatments that may slow the progression of AD or delay its onset, similar scientific effort must focus on the development of more accurate methods for early diagnosis and AD risk determination. The success of disease-modifying treatments will de-
178
pend on this improved ability to diagnosis patients at the earliest stages of their illness or better predict future development of the disease. To address the issue of early diagnosis of AD, the editors have brought together an outstanding group of contributors who thoughtfully review and synthesize this rapidly growing area of research. The text begins with an introduction on how markers for AD could be identified and used in presymptomatic, pre-clinical and clinical stages of the disease. This introduction also reviews the epidemiologic criteria for a clinically useful test (e.g., sensitivity, specificity) and the difficulties that arise in evaluating a potential new test or marker that must be compared with a “gold standard” of autopsy-confirmed AD for a definitive diagnosis. The next three chapters review the current clinical and pathologic criteria for the diagnosis of AD, and provide a summary of the pathophysiology of AD as we know it today. These four chapter give an excellent foundation for understanding the opportunities and problems inherent in improving the early diagnosis of AD and serve as a context for the rest of the book. The volume then critically reviews the approaches that have been used for the prediction and early diagnosis of AD. The editors divide the review of the multiple candidate markers into three main research strategies, which are summarized in the next six chapters. Specifically, they begin with a chapter that reviews approaches that identify genetic factors increasing the risk for future development of AD. Next, several chapters summarize strategies that attempt to identify early evidence of atrophy or dysfunction in brain regions affected by AD and to
distinguish these changes from normal aging and other causes of dementia. This approach is summarized in chapters on structural imaging, functional imaging, and neuropsychological testing. Finally, two chapter review strategies that attempt to measure by-products or effects of the underlying pathological process of AD. These chapters are well-referenced summaries of the tremendous number of molecular and biochemical markers (“biomarkers”) that have been proposed for detecting and diagnosing AD. The final two chapters of this book discuss the implications of early diagnosis of AD in the development and use of therapeutics and the ethical issues that arise in the early diagnosis of AD, especially in “pre-symptomatic” testing. These final chapters broaden the scope of this book and give insight into potential use of markers of AD in drug development and the potential misuse of genetic information without adequate confidentiality safeguards. In summary, this is an outstanding reference that summarizes the scientific literature focused on the prediction and early diagnosis of AD. The editors have drawn upon 20 contributors who are leaders in this rapidly expanding field. Each chapter is well written and referenced and conceptually fits into a very readable text. This book will be of great value to researchers, but will also be of value to clinicians who wish to understand the context and importance of current and future developments in AD prediction and diagnosis. The editors have avoided the pitfall of producing a text that will be quickly outdated by comprehensively reviewing the subject in a broader context that will be of value no matter
Am J Geriatr Psychiatry 9:2, Spring 2001
U
nderstanding Elder Abuse in Minority Populations is a fascinating collection of papers examining the problem of elder abuse in minority populations in the United States. This publication is a significant addition to the growing literature on the care of minority elderly persons. It is applicable to the fields of sociology, forensics, gerontology, social work, clinical research, public policy, and general and mental healthcare. In addition to being a scholarly text, this book is also fascinating reading that is likely to become de rigeur for anyone interested in or involved in the care of elderly—both minority and non-minority—populations. Editor Toshio Tatara, Ph.D., is currently a Professor of Sociology at Shukutoku University in Chiba, Japan. His extensive experience in the field includes serving as Director for the National Resource Center on Elder Abuse (NRCEA) from 1988 to 1992 and Director of the National Center on Elder Abuse (NCEA) from 1993 to 1998. At the time of its publication, this book was the first to focus on maltreatment of elderly persons within ethnic minority populations, and, as Tatara says in his preface, was “borne of the desire to bring to the public perspectives and information about elder abuse that have heretofore been missing....” He also states that many of the research-
Am J Geriatr Psychiatry 9:2, Spring 2001
ers and clinical practitioners recruited to this project came from the various minority groups discussed. This quality adds a unique perspective to the material. Although each chapter is different in organization and concepts, a general sense of subjective familiarity with the ethnic minority group examined comes through in the text. This is particularly evident in the chapters on the African American and Asian American communities. The book is divided into five parts. The first four parts are devoted each to a specific minority group: African American, Hispanic American (subgroups Mexican and Puerto Rican), Asian American (subgroups Korean and Japanese), and Native American Indian. Each section provides extensive statistics on the population examined. This background information examines both the minority population within the general United States population and, further, the elderly minority population within the minority group and the general United States elderly population. Useful, as well as fascinating, historical background on immigration and emigration particular to each group is provided. Also, each group’s unique cultural perspective and family structure are examined and described to provide a framework for analyzing the possible forces driving (and perpetuating) elder abuse. Finally, descriptions of current existing legislation and intervention models are included along with recommendations. Another consistent feature is the careful description of family dynamics within the cultural and ethnic context. These family dynamics are vividly demonstrated through the numerous, and often heartbreaking, vignettes presented throughout the book.
The fifth part examines the theory and practice of a multicultural perspective on elder abuse. Part 5 consists of three chapters that strive to provide an overview of the various aspects of minority elder abuse, regardless of the particular minority population. The focus of this section is primarily on the definition and impact of abuse, outreach, and intervention, and a statement of current standing; that is, “where we are today.” A different team of researchers and clinical practitioners wrote each chapter. This is both the strength and relative weakness of the book. The varying authorship is a strength, given the expertise of the contributors in their particular area. It is a relative weakness, given the lack of uniformity in organization of the various chapters and the unevenness of writing styles. The unevenness requires that the reader “shift gears” with each new chapter. For example, Chapter 5 (the Mexican American community) and Chapter 9 (the Japanese American community) are publications of completed research, complete with Methods section. Other chapters provide “how-to” instruction on outreach to the various minority populations. This is a relatively small criticism, given the scope and overall effectiveness of the book, however. Another strength of the book is the fact that each chapter can be read independently as a self-contained discourse on a particular topic. We would propose one recommendation to the prospective reader: Read the Preface, Chapter 1 (Introduction), and Part 5 (Elder Abuse in Multicultural Perspective: Theory and Practice) first, before proceeding to the sections focusing on the various minority populations. Reading the
177
Book Review aforementioned sections as a group provides a cohesive basis from which to build an understanding of the issues of elder abuse in minority populations. From a clinical geriatric-psychiatry perspective, this book is exceptionally useful in addressing and understanding caregiver issues for minority elderly persons in both abusive and non-abusive settings. As previously noted, this is a valuable addition to the literature in any discipline involved with elderly and ethnic minority populations. Josepha A. Cheong, M.D., is Assistant Professor, University of Florida, Departments of Psychiatry and Neurology, and Member, APA (Council on Aging) Committee on Ethnic Minority Elders.
Early Diagnosis of Alzheimer’s Disease Edited by Leonard F. M. Scinto, Ph.D., and Kirk R. Daffner, M.D. Totowa, NJ, Humana Press, 2000 368 pages, ISBN 0-896-03452-6, (hardcover) $125.00 Daniel L. Murman, M.D., M.S.
S
cinto and Daffner provide a comprehensive and timely introduction to the early diagnosis of Alzheimer’s disease (AD). The editors stress that early treatment of AD is not feasible in the absence of early, accurate diagnosis. Although much attention has focused on the development of treatments that may slow the progression of AD or delay its onset, similar scientific effort must focus on the development of more accurate methods for early diagnosis and AD risk determination. The success of disease-modifying treatments will de-
178
pend on this improved ability to diagnosis patients at the earliest stages of their illness or better predict future development of the disease. To address the issue of early diagnosis of AD, the editors have brought together an outstanding group of contributors who thoughtfully review and synthesize this rapidly growing area of research. The text begins with an introduction on how markers for AD could be identified and used in presymptomatic, pre-clinical and clinical stages of the disease. This introduction also reviews the epidemiologic criteria for a clinically useful test (e.g., sensitivity, specificity) and the difficulties that arise in evaluating a potential new test or marker that must be compared with a “gold standard” of autopsy-confirmed AD for a definitive diagnosis. The next three chapters review the current clinical and pathologic criteria for the diagnosis of AD, and provide a summary of the pathophysiology of AD as we know it today. These four chapter give an excellent foundation for understanding the opportunities and problems inherent in improving the early diagnosis of AD and serve as a context for the rest of the book. The volume then critically reviews the approaches that have been used for the prediction and early diagnosis of AD. The editors divide the review of the multiple candidate markers into three main research strategies, which are summarized in the next six chapters. Specifically, they begin with a chapter that reviews approaches that identify genetic factors increasing the risk for future development of AD. Next, several chapters summarize strategies that attempt to identify early evidence of atrophy or dysfunction in brain regions affected by AD and to
distinguish these changes from normal aging and other causes of dementia. This approach is summarized in chapters on structural imaging, functional imaging, and neuropsychological testing. Finally, two chapter review strategies that attempt to measure by-products or effects of the underlying pathological process of AD. These chapters are well-referenced summaries of the tremendous number of molecular and biochemical markers (“biomarkers”) that have been proposed for detecting and diagnosing AD. The final two chapters of this book discuss the implications of early diagnosis of AD in the development and use of therapeutics and the ethical issues that arise in the early diagnosis of AD, especially in “pre-symptomatic” testing. These final chapters broaden the scope of this book and give insight into potential use of markers of AD in drug development and the potential misuse of genetic information without adequate confidentiality safeguards. In summary, this is an outstanding reference that summarizes the scientific literature focused on the prediction and early diagnosis of AD. The editors have drawn upon 20 contributors who are leaders in this rapidly expanding field. Each chapter is well written and referenced and conceptually fits into a very readable text. This book will be of great value to researchers, but will also be of value to clinicians who wish to understand the context and importance of current and future developments in AD prediction and diagnosis. The editors have avoided the pitfall of producing a text that will be quickly outdated by comprehensively reviewing the subject in a broader context that will be of value no matter
Am J Geriatr Psychiatry 9:2, Spring 2001