Book Reviews

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• Marianne Matzo, PhD, APRN, BC, GNP, FAAN Book Review Editor

Nurses working with older adults require a core body of knowledge abut the aging process, disease management, and information specific to roles and environmental settings. Ethical issues in caring for older adults also vary based on the setting. Two books reviewed here address knowledge required to care for elders, the first by advanced practice nurses caring for elders in primary care settings and the second for nurses caring for hospitalized elders. A third book addresses ethical issues for seniors across a variety of settings.

Geriatric nurse practitioners (GNPs) function across settings in the health care continuum working with elders to promote health and to manage acute and chronic conditions. As primary care providers in a variety of settings, GNPs require the knowledge to assess health status, plan and implement care, and to coordinate care while collaborating with other health care providers. A comprehensive text providing GNPs with information that can be used to implement this role and to provide effective care to older adults in primary care settings is Advanced Practice Nursing with Older Adults: Clinical Guidelines by Valerie Cotter and Neville Strumpf. Key to the focus of this text is the authors’ definition of primary care as “community-based practice, nursing home care and much in between.” Accordingly, this text provides state of the art evidence-based guidelines for geriatric care in primary care settings.

The introductory chapters discuss the role of the GNP and principles guiding care of older adults. The authors provide an overview of topics unique to the care of older adults, including a review of demographics, ethical issues, comprehensive assessment with examples of specific tools, atypical presentation, lab values, medications, and health promotion and prevention. Several chapters thoroughly cover common health problems of older adults such as cardiac, respiratory, genitourinary, diabetes mellitus, thyroid disorders, dementia, delirium, depression, and stroke. These chapters follow a standard outline that provides information on the pathophysiology, clinical presentation, physical examination, diagnostic tests, and interventions for specific problems. Where appropriate, expected client outcomes are included so the GNP can determine effectiveness in providing care.

In addition to presenting information on managing common problems, the authors thoroughly cover 2 additional topics: elder abuse and neglect and palliative care. The chapter on palliative care provides in-depth coverage of symptom management and discusses issues related to advance planning.

Strengths of Advanced Practice Nursing with Older Adults: Clinical Guidelines are the comprehensive coverage of common health problems with a focus on patient and family education as well as the content on palliative care. A limitation of the text, published in 2002, is that the content on hormone replacement therapy does not reflect the latest research. Nonetheless, the depth and format of the material presented makes this book an invaluable resource for all advanced practice nurses caring for older adults in primary care settings.

Hospitalization for frail seniors can be fraught with negative consequences. Nurses working with seniors in acute care settings are in the position to improve outcomes. To achieve improvements in quality of care and quality of life for hospitalized elders, nurses need to have knowledge about their unique needs, in particular, assessing for and planning to prevent complications. A major resource that provides specific information on best practices for hospitalized elders is Geriatric Nursing Protocols for Best Practice (2nd ed.). The protocols in this book were developed through a national initiative: The Nurses Improving Care for Health System Elders (NICHE). Protocols included in the book were piloted at NICHE hospitals.

The second edition of Geriatric Nursing Protocols for Best Practice includes updated protocols as well as expanded, revised, and new chapters. The first new chapter provides information on evaluating clinical practice guidelines including a useful evaluation paradigm. The focus of the second chapter is on assessing the effect of implementing best practice protocols on outcomes through the use of performance measurement. Chapters that outline the specific protocols have been updated not only with new evidence, but also with clearly delineated objectives and case studies, which show practical application of the protocols.

Selected chapters in the second edition have been updated with new material or a new focus. “Sleep Disturbances” has been changed to “Excessive Sleepiness” and includes new assessment tools. The chapter on falls has been expanded to include information on reporting falls. “Preventing Pressure Ulcers” has been updated by covering the prevention and treatment of skin tears. Information on pain management in patients with dementia and updated material on pain assessment has been added to the chapter on pain management. The expanded chapter on discharge planning now includes content on the caregiving role.

The second edition of Geriatric Nursing Protocols for Best Practice is an improved version of the first edition. The updated, expanded content and the useful case studies are strengths of this edition, which continues to be a valuable resource for all nurses caring for hospitalized older adults. I recommend the second edition of Geriatric Nursing Protocols for Best Practice as required reading for every nurse who manages hospital units with elder patients. In fact, I would like to see a copy of this book in use on every medical-surgical and critical care unit in the United States.

Nurses working with elders in all settings face ethical dilemmas and require particular knowledge about the nature of these dilemmas and how to deal with them. Biomedical Ethics Reviews: Care of the Aging includes essays that pose questions about the ethics of caring for and treating seniors. Shelia Neysmith raises the question of the inequities of caregiving based on class, sex, and race and outlines a new landscape for long-term care that translates individual needs into social rights. Allyson Robichaud, writing on “Disrespecting Our Elders,” speaks to the issues of dependency, making the point that care provided to dependent seniors would be considered unethical if provided in the same manner to children. To highlight her argument, she uses examples from nursing homes that are outdated, such as describing groups of restrained residents sitting in the hall. I don’t think this author is in tune with the current efforts toward person-centered care. Several of the references for her essay describe nursing home settings in 1990s.

Other essays in this challenging volume address issues of including demented residents in clinical trials, promoting autonomy in elders living at home, autonomy in long-term care settings, pain management in older adults, and filial obligations to parents. Overall the essays in Biomedical Ethics Reviews: Care of the Aging are thought-provoking and address important ethical issues for older adults, but they don’t provide the practical information that the other books reviewed here do. This book is recommended for readers who want to challenge their thinking and broaden their knowledge about ethical issues in the care of older adults.