Shanthi Kanagarajah, Geriatrician, Melbourne
The Companion is intended for use in conjunction with the Australian Medicines Handbook (AMH), the well-known and highly valuable drug formulary. It aims to assist those working in aged care, especially in residential facilities. The nearly pocket sized volume with a ring binding is easy to handle and the cover is probably resistant to contamination by bodily fluids.
The text itself is organised into common clinical problems in the aged care setting, with dementia and other neurological conditions heading the list. Following the instructions inside the front cover, I used the index to trace my way through typical clinical questions. Each topic is subdivided into consistent subheadings that include diagnostic issues and non-drug issues. The subsections on 'evidence' are a neat way of giving credence to the book's assertions.
There are useful summaries on conditions that one meets much more often in nursing homes than in textbooks of medicine - restless legs syndrome, managing stroke risk in people with advanced morbidity, and (not) crushing or splitting tablets. Several practice points and warnings are highlighted as call-outs, an effective device to focus one's attention to key messages.
The brevity of the work does present difficulties, for example there is no evidence section under insomnia. In Parkinsonism the problem of a poor clinical response to dopaminergic therapy is clearly stated, but the difficulty of existing postural hypotension (such as in multisystem atrophy) being aggravated by the drugs, is only hinted at. I found the inclusion of the section on irritable bowel syndrome puzzling, given that it may be 'less common in older than in younger people' and 'convincing evidence for the efficacy of drug treatments... is lacking'. Disabling stroke is a difficult management problem in nursing homes and hostels and a section on the therapeutics of spasticity would have been useful.
The Companion reasonably succeeds in its aim of assisting the busy aged care worker at the bedside. Doctors, nurses and pharmacists, particularly those doing medication reviews, should find this extremely useful. It is a 'first of its kind' in Australia.
