Margolies, Luisa. My Mother's Hip: Lessons from the World of Eldercare. Philadelphia, PA: Temple University Press, 2004. 339 pages, $66.50, Cloth 1-59213-237-5, $22.95 Paper 1-59213-238-3.

Reviewed by Melissa Tabbarah, University of Pittsburgh

Illuminating, thoughtful, and engaging. From the first paragraph of the introduction in My Mother's Hip: Lessons from the World of Eldercare, Luisa Margolies' personal journey of caring for her parents captivated me. Her book weaves a story of a daughter caring selflessly for her parents subsequent to her mother's double hip fracture. It communicates the emotional aspects of caring for ailing parents, the conflicts and tensions that arise between different parties (i.e., siblings, parents, caregiver/clinician, and caregiver/parent), the challenges a daughter faces when trying to balance the care of her parents with that of her own family, and the frustrations of navigating the health care systems in the United States. In addition to her compelling personal account, she provides the reader with "lessons" that discuss the issues that arose during her mother's care.

The organization and flow of this book is simply wonderful. The chapters are chronologically ordered beginning with the onset of her mother's double hip fractures and culminating with the grief associated with the loss of both parents. Each chapter draws the reader into the kaleidoscope of challenges one faces when caring for ailing parents and provides the reader with insight into the process. Between the narrative chapters are separate sections of "lessons" that build directly on the chapters that precede them. The lessons provide valuable and current information on some of the topics that arise when caring for an older person. These topics include issues specific to aging and chronic disease, housing arrangements, ethical dilemmas, caring for elderly parents, and how our health care systems treat the elderly. The narrative effectively motivates the lessons and lends life and context to the more academic material. What I like best about Margolies' organization is that it provides the reader with flexibility. Someone interested in a personal account of caregiving will be satisfied, as would an instructor looking for an educational resource on issues associated with caregiving.

Substantively, this book highlights two aspects of caring for older Americans. First, it underscores the stress, exhaustion, frustration, and anger associated with caring for an ailing parent under our current systems of health care. Our current systems are fragmented and may compromise the mental and physical health of a caregiver, as well as further jeopardize the recovery of those in poor health. Second, this book makes painfully apparent how myopic our health care systems can be when treating patients. For instance, in this personal account, Margolies shares how one of her mother's physicians prescribed digitalis that had already been shown to cause a toxic reaction in her mother. This could have had fatal consequences. As her mother moved from the hospital, back to her home, then to a nursing home and then back to the hospital, her medical history was lost in the shuffle. Furthermore, each institution creates their own medical chart that can only be released with the signed authorization of patients. When we combine this fragmented system of medical record keeping with the inability of some patients to oversee and document their own care, disaster is eminent. Patients end up struggling to survive not only their medical condition but also the health systems they are imprisoned in. With the graying of our population, a health care professional who can manage multiple treatments protocols (from various clinicians, rehabilitation experts, dieticians, etc.) and multiple treatment facilities is needed more than ever.

Overall, I would highly recommend My Mother's Hip: Lessons from the World of Eldercare. This book offers caregivers, educators (undergraduate and graduate), allied health professionals, clinicians, health services researchers, and policy makers a personal account of how broken our systems of health care are in the United States. Whether one is currently serving as a caregiver or not, a stronger understanding of these issues is imperative as our society ages. With the aging of our population, we must act to re-instate the "care" in the treatment of our growing, vulnerable population of older Americans.