Books and other media
| Overall rating: | Excellent |
| Strengths: | International perspective and societal viewpoint on diseases |
| Weaknesses: | Some chapters lack up-to-date references for interventions |
| Audience: | Health policy planners, students in health care professions and anyone interested in societal effect of aging |
The book is organized into three sections. The first, on aging and health care, considers basic mechanisms of aging, principles and pitfalls of studying aging populations and evaluation of health services, including prevention. The international perspective is brought into sharp focus. According to the book, "by the year 2020 three-quarters of the planet's 650 million elderly will be in developing regions." The resource implications are profound, and Brazil provides a useful case study.
The second section deals with risk factors and health status. Chapters on nutrition, exercise, gender, migration and social supports bring together information scattered throughout the literature. The importance of involving elderly people in their own health planning is emphasized. I found the chapter on gender differences in mortality particularly fascinating. However, I was disappointed that the discussion of cardiovascular risk factors omitted the recent information on homocysteine. I believe that a stronger case for the treatment of hypertension could have been made, although this was remedied in a subsequent chapter.
Unlike many medical textbooks, this book emphasizes the societal viewpoint. Each chapter takes in the definition and magnitude of the problem, variations and determinants, interventions and health policy implications. The specific diseases are generally well presented, although I was disappointed that valuable data from the Canadian Study of Health and Aging on the epidemiologic and risk factors of Alzheimer disease were missing. Mention of the possible protective role of estrogens would also have been welcome. The section on treatment of osteoporosis could have included more recent information on bisphosphonates.
The central tenet of the book is to disturb the current complacency about aging. By helping those who allocate or control resources to understand risks and their magnitude, causal pathways and interventions, this book can help them set new and realistic objectives. The foreword states that "the view of aging as a crisis must be rejected: aging has a lead time of decades and provides society with the opportunity to prepare appropriate policies and programs." At nearly $150 for CMA members, this book is not for everyone; but for those who are interested in the way that an aging population influences health care, it represents excellent value for money.
Christopher Patterson, MD, FRCPC
Professor and Head
Division of Geriatric Medicine
McMaster University
Hamilton, Ont.