Textbook Geriatrics: Not Yet of the Essence

• Textbooks
• Geriatrics
• Chronic disease
• Decision making
• Age factors

Internal medicine and geriatrics are largely overlapping fields. General internists and most specialists primarily see elderly patients, and geriatricians must deal with the full spectrum of diseases that internists care for. Great debates have been held over whether geriatricians are generalists, subspecialists, or even superspecialists; these debates often have political subtexts that range from the wranglings of academe to federal policy about loan repayment. Efforts to distinguish geriatrics from the work done by good general internists have focused on several areas, all of which attempt to reply to the generalist's question, “Most of my patients are elderly; what's different about geriatrics?” As a group, some differences are clear. Elderly persons, on average, are more likely than younger adults to have disease, to require help from others, and to die shortly. “Normal” aging from this statistical view looks a bit worrisome, but elderly persons are also a very heterogeneous group. Elderly persons who are aging “successfully”—that is, who have avoided serious illness and maintained healthy lifestyles—can postpone but not avoid the effects of the passing years.

We review three major geriatrics textbooks—Brocklehurst's Textbook of Geriatric Medicine and Gerontology(1) (hereafter referred to as “Brocklehurst”); Geriatric Medicine, edited by Cassel and colleagues (2); and Principles of Geriatric Medicine and Gerontology, edited by Hazzard and associates (3)—and try to infer how editors and authors see the field. To this end, we outline four differences in emphasis between geriatrics and general internal medicine: the problem of asymptomatic disease in a frail but functional elderly person, the paucity of evidence about elderly patients from randomized trials, the approach to syndromes common in elderly patients, and the social work dimension of geriatric medicine. For each area, we list “probes” to examine how the texts approach specific problems. These probes were chosen solely because …