- Email: [email protected]
Health care for an aging society
98
BOOK REVIEWS
discussion of differences between male and female brains and I would have liked to follow up some aspects. The other aspect that is annoying for a British audience is the American spelling and terminology-but it is something most of us are used to by now! Notwithstanding the above criticisms, I like the book. I have been ‘using’ the book whilst preparing some new lectures over the past few weeks-always a good test of a book and it scored very highly. One of the excellent themes running through the book is homeostatic relationships. At the end of each chapter where one system has been discussed in detail there is an illustrated table showing the interrelationships between the system just discussed and all others in the body; so often when studying human physiology the body is neatly compartmentalized into discrete systems with no understanding of the interrelationships, and the approach used here is effective in helping to overcome this. Without doubt the illustrations in this book are outstanding-full colour throughout with a combination of diagrams (novel representations too-not just the standard ones you see in all the books!), plenty of colour photos, scanning and electronmicrographs, and some cadavre dissections. Even the index contains lovely illustrations! I do recommend you look at this book. It is a stimulating and enjoyable book to use, easy to read and provides a thorough and broad introduction to human anatomy and physiology. It would be good for Project 2000 teachers and students, and it is excellent value for money-always an important consideration. ROSAMUNDA. HERBERT,MSc.,
BSc., R.G.N.
Lecturer in Nursing Studies, King 3 College London, University of London, London SW10 OUA
Health Care for an Aging Society. Andreopoulos
Livingstone,
S. and J. R. Hogness (1989) Churchill
London. Price f25.00.
With no less than 30 distinguished contributors this book makes impressive reading. Despite an initial reluctance, because it deals solely with health care provision for aging Americans, I soon became engrossed. The book is aimed at policy makers, academic leaders, faculties and students and is designed as a resource to expand understanding of the issues and to provide a basis for discussion. In this I feel that it did succeed. Discussions on the policy implications of projected population trends and of the role of academic health centres predominate. The difficulty of making accurate forecasts also became clear. For example, will increased longevity be accompanied by a contracted or an extended period of morbidity? What interventions would be appropriate for health maintenance? These are important questions when one considers that the elderly in the US. comprise approximately 12% of the population but account for almost one-third of expenditure for personal health care. Some of the arguments presented in the book are refreshing. I was pleased to find a call for a new paradigm of aging which disconnects health from the medical model and the suggestion that departments of sociology should focus attention on the ‘crippling sterotypes about the elderly’; that they should do for agism what they have done for sexism and racism. This theme was tinged with pessimism for it was also suggested that a nation
BOOK REVIEWS
99
that has a narcissistic infatuation with youth is not likely to embrace a mature view of aging and the aged. My original misgivings that the book was really only relevant to those concerned with health care policy and delivery in the U.S., gradually disappeared as the anticipated and unanticipated effects of Medicare’s prospective payment system, which is based on diagnosis related groups and became mandatory in 1983, began to unfold and I started to draw disquieting comparisons with proposed changes in the health care system in the U.K. The lack of a coherent holistic national policy of health care has, it appears, led to a situation where 20% of the population, comprising the sickest and poorest, are excluded from the most costly health system in the world. Since 1983 the availability of hospice services has been reduced and there has been an acceleration of the already declining length of hospital stay, largely as a result of an increase in ambulatory surgery, the use of external diagnostic units and a shift to outpatient care. It was not clear to me whether the shorter length of stay for older people would be detrimental to them or beneficial. On the one hand it was pointed out that a shorter length of stay reduced the time available for patient teaching but we are also informed that iatrogenic illness has bee,n found in up to 30% of hospitalised elderly persons! However the shorter length of stay does, apparently decrease the experience afforded to interns with much of the clinical care driven out of acute settings. Medicine it seems is lagging behind with the largest and most rapidly growing area of health care being the most underrepresented in medical education. Despite a considerable surplus of physicians there is a massive shortfall in geratricians. Unfortunately the situation in nursing appears no better with little emphasis on gerontology or geriatrics in academic programmes. I found myself in agreement with the call for more research into the broader areas of health and health care and the socioeconomic and sociocultural aspects of aging, but I was unclear about the need for more or less biomedical research into the aging process. I was delighted to read that longitudinal, as opposed to cohort studies have shown that decline in intelligence or in body function is not an inevitable consequence of growing old but, when it occurs is due either to disease or disuse. I was also pleased to find that older people can gain as much from a fitness programme as younger subjects-at this point I almost put the book down so that I could get on my exercise bike, however by the time I had waded through the rest of the book I was too exhausted. I have not attempted to provide a complete summary of the book, just those bits I personally found most interesting. The humour introduced in the first chapter gives way to a complex web of discussions based on population projections morbidity tables, per capita expenditure, reimbursement schemes, bed occupancy, skill mix, ethics, medical training, biomedical research, nursing, pharmacy, dentistry and so on. It is not an ‘easy read’ and there is only one chapter about a model for caring for the elderly in the community. This is not a book about nursing, it is about ethics, economics and policy, those topics in which, as nurses, we should be interested but don’t usually find the time. DR BARBARAWADE
Director, The Daphne Heald Research Unit, Royal College of Nursing, Henrietta Place, London WIM OAB.
BOOK REVIEWS
discussion of differences between male and female brains and I would have liked to follow up some aspects. The other aspect that is annoying for a British audience is the American spelling and terminology-but it is something most of us are used to by now! Notwithstanding the above criticisms, I like the book. I have been ‘using’ the book whilst preparing some new lectures over the past few weeks-always a good test of a book and it scored very highly. One of the excellent themes running through the book is homeostatic relationships. At the end of each chapter where one system has been discussed in detail there is an illustrated table showing the interrelationships between the system just discussed and all others in the body; so often when studying human physiology the body is neatly compartmentalized into discrete systems with no understanding of the interrelationships, and the approach used here is effective in helping to overcome this. Without doubt the illustrations in this book are outstanding-full colour throughout with a combination of diagrams (novel representations too-not just the standard ones you see in all the books!), plenty of colour photos, scanning and electronmicrographs, and some cadavre dissections. Even the index contains lovely illustrations! I do recommend you look at this book. It is a stimulating and enjoyable book to use, easy to read and provides a thorough and broad introduction to human anatomy and physiology. It would be good for Project 2000 teachers and students, and it is excellent value for money-always an important consideration. ROSAMUNDA. HERBERT,MSc.,
BSc., R.G.N.
Lecturer in Nursing Studies, King 3 College London, University of London, London SW10 OUA
Health Care for an Aging Society. Andreopoulos
Livingstone,
S. and J. R. Hogness (1989) Churchill
London. Price f25.00.
With no less than 30 distinguished contributors this book makes impressive reading. Despite an initial reluctance, because it deals solely with health care provision for aging Americans, I soon became engrossed. The book is aimed at policy makers, academic leaders, faculties and students and is designed as a resource to expand understanding of the issues and to provide a basis for discussion. In this I feel that it did succeed. Discussions on the policy implications of projected population trends and of the role of academic health centres predominate. The difficulty of making accurate forecasts also became clear. For example, will increased longevity be accompanied by a contracted or an extended period of morbidity? What interventions would be appropriate for health maintenance? These are important questions when one considers that the elderly in the US. comprise approximately 12% of the population but account for almost one-third of expenditure for personal health care. Some of the arguments presented in the book are refreshing. I was pleased to find a call for a new paradigm of aging which disconnects health from the medical model and the suggestion that departments of sociology should focus attention on the ‘crippling sterotypes about the elderly’; that they should do for agism what they have done for sexism and racism. This theme was tinged with pessimism for it was also suggested that a nation
BOOK REVIEWS
99
that has a narcissistic infatuation with youth is not likely to embrace a mature view of aging and the aged. My original misgivings that the book was really only relevant to those concerned with health care policy and delivery in the U.S., gradually disappeared as the anticipated and unanticipated effects of Medicare’s prospective payment system, which is based on diagnosis related groups and became mandatory in 1983, began to unfold and I started to draw disquieting comparisons with proposed changes in the health care system in the U.K. The lack of a coherent holistic national policy of health care has, it appears, led to a situation where 20% of the population, comprising the sickest and poorest, are excluded from the most costly health system in the world. Since 1983 the availability of hospice services has been reduced and there has been an acceleration of the already declining length of hospital stay, largely as a result of an increase in ambulatory surgery, the use of external diagnostic units and a shift to outpatient care. It was not clear to me whether the shorter length of stay for older people would be detrimental to them or beneficial. On the one hand it was pointed out that a shorter length of stay reduced the time available for patient teaching but we are also informed that iatrogenic illness has bee,n found in up to 30% of hospitalised elderly persons! However the shorter length of stay does, apparently decrease the experience afforded to interns with much of the clinical care driven out of acute settings. Medicine it seems is lagging behind with the largest and most rapidly growing area of health care being the most underrepresented in medical education. Despite a considerable surplus of physicians there is a massive shortfall in geratricians. Unfortunately the situation in nursing appears no better with little emphasis on gerontology or geriatrics in academic programmes. I found myself in agreement with the call for more research into the broader areas of health and health care and the socioeconomic and sociocultural aspects of aging, but I was unclear about the need for more or less biomedical research into the aging process. I was delighted to read that longitudinal, as opposed to cohort studies have shown that decline in intelligence or in body function is not an inevitable consequence of growing old but, when it occurs is due either to disease or disuse. I was also pleased to find that older people can gain as much from a fitness programme as younger subjects-at this point I almost put the book down so that I could get on my exercise bike, however by the time I had waded through the rest of the book I was too exhausted. I have not attempted to provide a complete summary of the book, just those bits I personally found most interesting. The humour introduced in the first chapter gives way to a complex web of discussions based on population projections morbidity tables, per capita expenditure, reimbursement schemes, bed occupancy, skill mix, ethics, medical training, biomedical research, nursing, pharmacy, dentistry and so on. It is not an ‘easy read’ and there is only one chapter about a model for caring for the elderly in the community. This is not a book about nursing, it is about ethics, economics and policy, those topics in which, as nurses, we should be interested but don’t usually find the time. DR BARBARAWADE
Director, The Daphne Heald Research Unit, Royal College of Nursing, Henrietta Place, London WIM OAB.