Signpost Book Reviews Vol 11.2 October 2006

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Sexuality and Dementia
A guide for all staff working with people with dementia
Author: Carole Archibald
Edited by: Alan Chapman
Published by: The Dementia Services Development Centre University of Stirling 2005
ISBN: 1857691865
46pp

We live in a world of sexual freedom and equality, and often engage in frank and open discussion about sexual activity, yet the thought of older adults engaging in sexual behaviour or enjoying a sexual relationship, particularly if they are suffering from dementia, can often remain a cultural and societal taboo.

This book on sexuality and dementia aims to dispel this taboo and asks the readers to confront their own thoughts and feelings about the subject. It provides a clear and comprehensive guide which sets out to challenge preconceived attitudes and offers suggestions about how to respond and support people with dementia in those sexual situations that are often embarrassing and challenging for practitioners. It essentially embraces a person-centred approach to care and suggests that however the individuals express their sexuality, whether they be heterosexual, gay, lesbian, transgender or bisexual, care staff must respond and support in ways that maintain their sense of wellbeing.

The guide is organised in a workshop format with activities regularly placed throughout the text. The first section helps the reader explore their own attitudes and beliefs towards sexuality and promotes insight into the similarities and differences that are experienced as we grow older and if we develop dementia. It continues with an attempt to explode the myths surrounding older people and sexuality. This is followed by a discussion about how the expression of sexuality is compromised within care settings and the impact this can have on a person’s sense of well-being and self-esteem. Through case scenarios and activities the reader is encouraged to confront complex and potentially embarrassing situations and promote an improved approach to sexuality within care settings. The text goes on to cover gay relationships, partner and family carer issues, and sexual abuse. Throughout the chapters there are valuable highlighted areas of discussion and points to note.

There are four useful appendices. The first offers a framework for action, or care pathway; the second covers legislation and how this might affect decision making with particular reference to the Adults with Incapacity (Scotland) Act 2000 and The Convention of European Human Rights; appendix 3 offers references and further reading, and the final appendix includes websites and useful organisations.

The text is clearly written and offers good guidelines for staff working within these settings. Throughout the guide it is apparent that responding appropriately to the sexual needs of individuals can present many challenges but it is important to respond in non-discriminatory and person-centred ways that value and respect the individuals in our care.

Dr. Julie Wilcox
Consultant Clinical Psychologist
Regional Stroke Unit
West Wing
Cardiff Royal Infirmary

Spiritual Growth and Care in the Fourth Age of Life
Author: Elizabeth MacKinlay
Publisher: Jessica Kingley, 2006
ISBN: 1843102315
272 pp
£17.99

This is the latest book on Spirituality amongst the elderly by Elizabeth MacKinlay, the Director of the Centre for Ageing and Pastoral Studies in Canberra. MacKinlay’s work is well researched and she draws on a number of sources. The book is based on her model of spiritual tasks and the spiritual process of ageing that was first published in her earlier book in 2001. Thus we have sections on the ultimate meaning in life, finding intimacy, transcendence, finding final meanings, a response to ultimate meaning, and finding hope. Each of these sections is looked at in depth from the perspectives of the residents in care homes, the care staff and chaplains. At times the different needs and perspectives of the main faith communities is considered.

Much of this book relies on the work carried out in her 2001 book, The Spiritual Dimension of Ageing. The main difference is that the present book is focussing on those people living in residential care homes and who are not living independently, in other words the "Fourth Age" of life. MacKinlay has given us much to think about in this study in how we perceive the spiritual needs of not only the elderly but also with anyone suffering with dementia. However, at times I was left wondering exactly who this book is aimed at. On the one hand we have a basic description of the importance of listening, in the middle of a complex discussion on the move towards self-transcendence, or gerotranscendence as an important part of the process of ageing.

I found the conclusion and summary at the end of each chapter very useful in checking my understanding of the discussion, and indeed for referring back to the discussion. In all, a useful addition to the growing awareness of this subject, and an encouragement to take an holistic approach in our care of the elderly and the importance of spiritual needs.

Revd Martin Colton
Assistant Curate in the Rectorial Benefice of Whitchurch, Cardiff,
and Hon Chaplain in Cardiff and Vale NHS Trust

Vital Connections In Long-Term Care Spiritual resources for Staff and Residents
Authors: Barton, J, Grudzen, M, and Zielske, R.
Publisher: Health Professions Press 2003
ISBN: 1878812793
248 pages
£15.71

Beginning at the end, with the Afterword, the three authors note that ‘spiritual connections are at the core of people’s existence and give meaning to life’ (p.217). This last page gives the key to the whole book, which in its fourteen chapters examines how spirituality can be experienced during the later stages of life, and particularly for those who end their lives being cared for in institutions.

All three writers are unashamedly Christian, but there is much to be gained for those of other faiths, or of no faith at all, since the book is written to help staff deal with the patient’s own spirituality.

This is a workbook, which aims to cover all topics relevant to the care of patients living in care homes, hospices or hospitals, and is specifically relevant to those places where patients, or elders, are expected to live out the rest of their lives.

Each chapter covers one topic such as: the meaning of spirituality; dignity; intimacy; Alzheimer’s disease; the impact of change and coming to terms with death and dying. Each begins with a statement of the objectives of that chapter, followed by a series of exercises and discussion points, interspersed with pithy case histories. At the end of each chapter there are action steps, references, lists of recommended follow-up reading, resources and, where appropriate, contact names and addresses. Unfortunately, these, like the book itself, are American, but many similar groups exist here in the U.K. The writers suggest that not all chapters will be suitable for every patient, but that most readers will find much of the book of value.

Personally, I found the whole book hugely helpful, and look forward to reading it again, and putting many of its excellent suggestions into practice.

Beautifully written, this is a clear and insightful book, which actually lives up to its effusive introduction, I shall be buying a copy for my own use.

Marika Savage-Lewis
Chaplain; Cardiff and Vale NHS Trust

For a full list of published reviews click here.