The Oxford Handbook of Geriatric Medicine (3rd edition): the geriatrician who is available for advice at all times
Dr Shane O’Hanlon is a Consultant Geriatrician and tweets @drohanlon
The past decade has seen a proliferation of textbooks in geriatric medicine – definitely a good thing for the specialty and our patients. But in this competitive space it has become more challenging to find a single book to recommend to non-specialty trainees or medical students! The Oxford Handbook series is of course very well known; the geriatric medicine volume was first published in 2006 and is now on its third edition (2018). It’s a handy pocket-sized guide - the book aims to be “a geriatrician who is available for advice at all times”.
So, what’s new here? The back cover lists these additions: the National Dementia Strategy and dementia screening, risk scoring management of TIA and the role of geriatricians in other specialties (there is a new chapter on the older surgical patient). It’s evolution rather than revolution - anyone who used the yellow Oxford Handbook or previous editions of this one will be on familiar ground immediately. The chapter structure follows the established layout of organ systems with a few other major areas also receiving a full chapter, e.g. Falls and funny turns, Drugs, Stroke. Overall the content is fantastic and is clearly written. The level of detail is such that most topics are reduced to one page - not enough for specialty trainees in geriatric medicine but perfect for those who want to quickly read a summary.
One of the major strengths of the Oxford “yellow book” was that you could whip it out and use it for practical purposes like the Snellen chart or a reminder for where to put ECG leads. I would like to have seen even more of this type of content included here. For example the thrombolysis chapter might benefit from a pictogram with patient outcomes, and the delirium chapter from a brief explanation that family members could read. There is however a great “How To” section that has some really useful topics such as doing a domiciliary visit, advising a patient about care home placement and conducting an MDT meeting. Other vital subjects covered include capacity assessment, breaking bad news, managing the driver who has dementia and dealing with suspected elder abuse. There is also a super one page summary of how to use a hearing aid!
From my own perspective as one of those geriatricians that has gone “off piste” into the worlds of surgery and oncology, I was glad to see these areas getting coverage, even if malignancy only gets 8 pages and perioperative medicine 12 pages. In a book of this size it’s understandable that things get left out: I couldn’t find anything on TAVI and just a couple of lines on thrombectomy. I wished DOACs could have been given more coverage since I find them very confusing! Some eyebrows may be raised at the two pages devoted to dipsticks to investigate for UTI and two more pages on drug treatment in delirium.
Those caveats aside, traditional geriatric medicine such as rehabilitation is extremely well covered. That chapter has absolutely everything that you need to work in the area, complete with lots of helpful pictures. The chapter on falls will be really valuable for anyone who has to do a falls review, and includes useful information on falls services and falls prevention. There is a strong section on ethics and law, including discussion of CPR, deprivation of liberty and advance directives. The financial section is also a great source for finding answers to common questions about how wills, pensions and benefits work.
Overall this is an excellent book for people dipping their toes into the warm welcoming pool of geriatric medicine. I do think it needs to reflect recent developments in the specialty a bit more in the next edition – for instance acute frailty units and the growth in importance of CGA. In the meantime I can strongly recommend this to readers of many backgrounds who wish to quickly upskill in the major areas of our specialty.