Abstract
The sequel has landed!
Hot on the heels of Assessment scales in old age psychiatry, comes the authors' next offering. This is a timely publication for a number of reasons, not the least of which is the RANZCP's own development of Clinical Practice Guidelines (CPGs) locally.
Though titled Clinical guidelines in old age psychiatry, the book also reviews consensus statements and practice policies. The authors' decision to include policy in a book concerned with the delivery of clinical care to older persons is entirely appropriate. After all, policy and service delivery represent the social-organizational aspects of care within the biopsychosocial framework to which most psychiatrists subscribe.
Clinical practice guidelines are described as ‘systematically developed statements to assist practitioners in making decisions about appropriate health care for specific clinical circumstances.’ [1] Their ultimate purpose is to improve the quality of practice. They differ from, but may overlap with, consensus statements, and may inform policies, protocols and integrated care pathways.
The authors attempt to define this potentially confusing terminology in their introduction. This is a highlight of the book, insofar as it serves to orientate the reader to the topic. The authors present an argument for the appropriateness of clinical guidelines in old age psychiatry, and describe a process for constructing, appraising, using and disseminating them. The shortcomings and legal issues relating to CPGs are reviewed and the lack of evidence demonstrating that CPGs actually improve patient outcomes is acknowledged.
The format of the body of the book is similar to that of the companion volume on assessment scales. Each guideline is reviewed, generally on a single page. A reference is provided, together with a contact address for the primary author. There is a statement about the purpose of the guideline and a summary of its content. Minimal commentary is provided in order to allow the reader to peruse and extract what is helpful.
Of the book's five chapters, the first three are clinically orientated. The chapter on dementia is by far the most comprehensive, reflecting the depth and breadth of endeavour in this field. It is subdivided into sections on diagnosis, assessment, treatment, management, behavioural and psychological symptoms and legal and ethical aspects. Depression, and other disorders, including schizophrenia, delirium and Parkinson's disease in older persons are covered in chapters two and three.
The book's final two chapters have a greater focus on policy. The section on ‘General statements’ includes reference to policy framework documents concerning mental health and other services for older persons. The final chapter titled ‘Care environments’ focuses specifically on the long-term care of older people, in settings we in Australia would term high and low level residential care.
This is an interesting book, well worth having a look at. It should be included in a library with a good ‘psychiatry of old age’ collection.
It has several strengths. It is, to the best of my knowledge, the first to review this subject. The chapters on the clinical disorders are thorough, insofar as most of the best known CPGs published in the English-language literature are surveyed. The summaries are well written and provide the reader with an understanding of the key points presented in each guideline.
Nevertheless, there are also shortcomings.
The lack of commentary does not allow the reader to really have a sense of where each guideline belongs in the pantheon of useful contributions to aged psychiatry. The authors really do expect you to have a look at the original and make up your own mind, which is noble but not really helpful if your pile of reading marked ‘urgent’ grows like mould!
In addition, the book loses its claim to comprehensiveness in the chapters that deal with policy/consensus statements and frameworks. These reveal an overwhelmingly British perspective. Indeed, 21/25 and 18/20 ‘guidelines’ reviewed in chapters 4 and 5, respectively, were British in origin. Old Age psychiatrists in Australia would be familiar with a number of policy and consensus statements that would be appropriate for inclusion [2–8]. Given that this book is not titled ‘Clinical guidelines in old age psychiatry in the UK’, this is disappointing and represents an opportunity for improvement in the second edition.