Adelaide: Australian Medicines Handbook; 2014
Electronic version also available
This companion is intended primarily for general practitioners, nurses and pharmacists working in aged-care settings. It is also relevant to the care of frail older people living in the community.
The book contains almost 70 chapters, each addressing one or more common clinical problems in aged care. The chapters are arranged by organ system, and structured to cover key diagnostic issues, considerations before starting treatment, non-drug and drug treatments, safety and useful resources. The book has a number of helpful tables and appendices. The advice is based on best available evidence, although neither this nor the recommendations are graded. The Editorial Advisory Committee and reviewers are an impressive group of experts.
It is odd that there is no chapter about chronic kidney disease. Prescribing in renal impairment is discussed briefly in the introduction, but with no mention of strategies to slow progression or avoid nephrotoxicity (although the risk from non-steroidals is stated in the chapter on osteoarthritis).
The other notable gap is lack of a chapter on quitting smoking. Although a number of the chapters recommend smoking cessation, nicotine replacement and other pharmaceutical aids are not discussed.
Some chapters are more comprehensive than others. The chapter on depression recommends psychosocial interventions and physical activity, but does not mention other lifestyle changes, including quitting smoking and a healthy diet, for which there is growing evidence. The chapter on diabetes does not discuss management of albuminuria. Absolute vascular risk assessment and management is a particularly challenging area in elderly patients but is not covered in detail. A future edition of the companion could usefully provide more comprehensive guidance.
Any textbook is inevitably incomplete. The Aged Care Companion is of undoubted value in the care of older people, but even alongside the Australian Medicines Handbook does not provide all the answers