Signpost Book Reviews  Vol  8.3  2004

Vicki Dent’s book is written as a resource for staff working in residential homes. As promised in her introduction, this book offers advice and information on developing an activity service, including information on documentation and evaluation.

In reading this book I appreciated the clear and comprehensive way in which Vicki Dent first provides some background chapters on ‘making group activities work’ before going on to describe examples of activities. In her introduction, Dent is careful to explain why activity should be seen as fundamental to caring for older people, and also considers issues of planning, evaluation and documentation. I felt this provided an important context for the details of the activities that follow.

It is easy to use this book. Vicki Dent takes the reader step by step through the whole process of running activities from assessment through to evaluation. She provides comprehensive, practical information in relation to each activity that is recommended, including benefits of the activity, equipment needed, procedure and hints and alternatives. Activities are organised in categories of the ‘ten areas of need’: physical, cognitive, creative, social, sensory, esteem, spiritual, cultural, emotional and educational/ employment activities. Dent also provides some helpful appendices, with sample forms and useful telephone numbers.

On the whole I felt that this book does what it sets out to do. It seemed to me that a busy activity organiser could pick this up and have the information they needed to run an activities programme. However, I was sometimes left with some doubts as to whether some of the activities suggested would really produce the range of benefits claimed. I’m not really sure how far a jigsaw will aid someone’s memory, and claims for ‘self-worth’ and ‘self-esteem’ are notoriously hard to prove. I also questioned the ethos of an approach to activities that seems to be about staff doing things for older people. Dent does discuss partnership working but says little about collaborating with older people in facilitating activities, much less about encouraging older people to initiate or facilitate activities themselves. Having said this, I would recommend this book as a thorough and well-thought out resource which seems very easy to use.

This is a valuable training resource aimed at care workers whom the author feels are marginalised by much of the formal training available. She rightly comments that care workers in daily contact with clients have a vital role in translating the formal obligations of caring into practical reality. To be able to do this effectively workers need to be informed meaningfully of their responsibilities. The manual is clearly written with this in mind.

Throughout the manual refers to the Training Organisation for the Personal Social Services (TOPSS) and the National Vocational Qualification (NVQ). At the start of each chapter references are given to the particular standard/item that this relates to. Thus anyone following one of these courses would easily be able to link this information in a concise way. Other statutory publications such as the National Minimum Standards and the National Service Framework are frequently referred to. This is done in such a way as to link all the information together in an understandable and accessible way. Guidance on how to access further information and reading is given at the end of each chapter.

There are twelve chapters covering areas of principles of care, roles, care planning, risk assessment, recording and supervision. Other chapters cover effective communication, abuse, challenging behaviour, death and dying. Case examples and case studies are used to help to illustrate points and to help to bring the discussion into the "real world" of care giving. Dictionary definitions are given to help this process along. Guidance is given to the trainer as how to lead these discussions, including excellent handouts and even advice on how to lead role-plays! Participants are encouraged to draw on personal experiences and to relate this to their work context. Clear guidelines are given to trainers to enable them to deal with issues that may arise.

The manual manages to make sense of incorporating necessary statutory requirements and the every day living needs of clients and those who are paid to care for them. I would recommend this training manual as an excellent resource for anyone who is involved in training. It has something to teach all levels of care givers.

Diana Sims.
Senior Occupational Therapist.
Clevedon Hospital, Bristol

The universality of the main themes addressed by Thorson are self-evident. "The evolving phenomenon of our continuously aging society raises important

practical and ethical issues .. (within) the field of gerontology", as the back cover informs the reader.

The aim to make this revised second edition even more comprehensive is re-affirmed, by the detailed conclusion that the research concentrates on "the areas of coping and attitudes, especially towards aging, death, and dying, intrinsic religiosity, and sense of humor". So, a few indicators there that this tome is written primarily in an American equivalent of English: this is acknowledged by the text being "made more international in scope by providing comparative information of aging in the United States and around the world."

That concludes the review of the back cover - now to assess the body of the book.

The author index runs to twelve pages of double-column tightly-typed names: from Abel, E.K. to Zubenko, G.S., the last of the eight zeds (or should that be zees?) Among the hundreds referenced, some intriguing names surface. Woody Allen shares an illustrated (some might say illuminating) box with

Jerry Lee Lewis, pithily titled ‘Looking for Love in All the Wrong Places’, wherein the aforementioned rocker was "hooted off of a London stage when it became known that had (sic) married his 13-year-old cousin. His explanation, "She wasn’t no virgin," was seen as "contemptible " (page 47).

In amongst Castro, Clinton and Hitler, we also encounter Marilyn Monroe’s second husband: "Life and death can be arbitrary of course" - fitness advocate Jim Fixx dropped dead while jogging in July of 1984; he was 52 years old. On the other hand, baseball star Joe DiMaggio, who died in March of 1999, was a heavy smoker and lived to be 84 (page 195). Similarly in-depth, itemised references’ run to 32 pages, with the ‘glossary’ covering a further eight: of particular interest are the scales which differentiate between old age (65+), young old (65-74), old old (75+) and oldest old (85+). Amongst such diverse information, one is inclined to take certain information on trust - which makes mistakes that are relatively easy to check all-the-more disconcerting. Groucho Marx shares two pages with his son, Arthur (who is allowed an extra sequence of references, beyond his father, as it were): when someone fails to spot errors it can undermine the trust of the reader in perhaps more critical areas:

"Groucho, who lived well into his 90s" (page 43) is simply not true – would that he had, whether cosseted like Bob Hope, or still treading the boards like George Burns. Unlike either of those centenarians, Marx lived to 86, not a mean feat after all those cigars, but hardly ‘well into his nineties’. Despite that gaffe, one cannot be unimpressed by the weight and diversity of the information gathered by Thorson and his highly eminent team of contributors.

However, an overriding concern is the salience of much of the material for a European readership. Table 4.6 (page 107) considers U.S. Hispanic Population by Age – dividing Mexican, Puerto-Rican, Cuban, Central and South American, and Other Hispanic groupings, while Table 4.7 (page 111) looks at the United States American Indian Population, categorising nine tribes. Few Europeans will need reminding of some of the (different) funding issues for American health care, without the supplemented glossary definition of ‘medicaid’ "A welfare program in the United States that pays hospital, medical, and nursing home costs for those unable to pay for their own care" (page 240).

If the myriad issues arising from globally increasing life-expectancy levels could be transferred to other geographical areas, this template would benefit an even wider audience. As it stands, every identified contact address has a zip code. One is not undervaluing the importance of widening the parameters of the debate, but is hoping for a universal overview of what are truly universal issues.

Stephen Weeks, RMN is a CPN based at Ossett CMHT, West Yorkshire.

This is one of the thinnest textbooks I have come across for many years but, despite this, extremely expensive (£35). Ms. Kindell, the author, has a very credible background however so hopefully we are paying for the quality teaching her experience and training prepared her for.

The book covers how different dementia related problems and pathologies affect eating. Slowly the reader is led through an assessment which is very comprehensive, including as it does such items as perception, vision and supervision as well as the obvious physical factors such as chewing and swallowing. The pages are very clearly laid out and the paper is of an excellent quality, ensuring the book will be durable in a busy home/ward.

A lengthy discussion on the merits of tube feeding ends an excellent examination of "assessment and management issues related to food and drink and swallowing" but appears to be at a different level of analysis to the rest of the chapter and reads a little like a separate article bolted on. This being said, it summarises the arguments well, if weighted heavily towards the world view of the BMA. It is likely that decisions about what level of intervention will be appropriate or humane will have taken place well before a doctor turns up! My experience tells me that tube feeding in dementia is very rare outside a general hospital ward and would guess that it is over emphasised in importance in this book.

If "refusal" of food in very late stage dementia is so prolonged that tube feeding is thought necessary then hospice/palliative care is probably preferable and I rarely see a demand for such people to be transferred to a bed in a non-specialist medical or "geriatric" ward, certainly even more rarely by families.

The assessment sheets included in the book appear useful and easily photocopiable - though it is not clear whether the cost of the book includes a license to use the materials in practice, a note at the bottom of each of the pages in this section states that "You may photocopy this page for instructional use only". It would be nice to have had these criteria cross linked to the Bibliography or to the relevant section of the book but I am nit picking. Whether I would want to use these instruments as opposed to Watson's Edinburgh Feeding Evaluation in Dementia Scale (EdFED) is a moot point. EdFED is not without its critics but is now almost as ubiquitous as Waterlow or Glasgow in the list of stock assessments in clinical areas. To try and replace it is an ambitious task and one I fear Ms. Kindell doesn't quite manage.

Dementia Care, for all our efforts in evidence seeking, is an art as much as it is a science, a domestic assistant with excellent communication and social skills is likely to be as effective in helping someone to eat as a PhD with no guile or empathy and ,save for a few pages at the beginning of the book on the various signs and symptoms of, say, Picks disease, these are skills barely covered. Another area I feel is a little thin is the involvement of families and carers. The [otherwise excellent] Management strategies refer the reader to any number of individuals, doctors, occupational therapists and nurses included when seeking information. For instance, when considering "does the person have visual difficulties?" (Page 95) carers or families are not mentioned at all.

I would love to be able to recommend this book; indeed parts of it are most informative and instructional and would be an asset to any ward/ home. I don't feel they justify £35 though; the relegation of carers and the family to afterthoughts is difficult to forgive in the 21st century.

Gary Blatch, RMN
Dementia Link Nurse at South East Partnership Trust

All That Paraphernalia

This book contains some 31 drawings of John’s mother, Kath, and is dedicated to her memory. In his introduction to the book, John describes the complex nature of his relationship with his mum. Whenever John spent time with her, he would draw. The resulting selection from those portraits forms the focus of the book.

The front cover of this edition of Signpost features one of the drawings in the book, and serves to illustrate John’s striking style – a style that conveys much more than a personal likeness.

Accompanying the drawings is a loose narrative that tells the story of Kath’s journey into frail old age and the eventual diagnosis of dementia.

I found it an engaging read, and the drawings are unlike anything else I’ve seen – it’s the sort of book that I keep picking up and "dipping into."

John has published the book himself, and it’s a snip at £10.00 + p&p.

Contact John direct:

John Trigg
The Old Sunday School
Voundervour Lane
Penzance
Cornwall TR18 4BE

(01736) 331396

Not a book, but an exhibition that is currently touring the British Isles, "Art Works…" showcases the talents of people affected by mental illness, either first or second hand. The exhibition is made up of drawings, photography, sculpture and creative writing, selected from almost 1800 entries.

Featured artwork is both sublime and ridiculous; some of it touching, some shocking but all deeply affecting. For me, the most remarkable and memorable works include the photograph by J Blake of his grandmother, who had Alzheimer’s disease, on a hospital trolley and the incredibly brave self-portrait of a woman who had been previously treated for breast cancer coming to terms with her changed body. The exhibition is free and a definite "must see" if you’re in the vicinity.

If you can’t make a viewing, have a look at their website, www.artworksinmentalhealth.co.uk.