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Signpost Book Reviews Vol 9.3 February 2005

This page shows books which Signpost has reviewed. If you would like to become a Signpost book reviewer, please contact Signpost. For guidelines click here.

For a full list of published reviews click here.

Meaningful Making – A practice guide for Occupational Therapists
Author: Claire Craig
Published by: Dementia Services Development Centre, University of Stirling
ISBN: 1857691806

What a shame I didn’t read this book 5 years ago when I first began working as an Occupational therapist with people with dementia.

It is a comprehensive account of the things that are considered by Occupational therapists when working with people with dementia. Occupational Therapy as a profession sometimes has difficulty explaining the complexity of its role, and what it seeks to achieve with patients. This book provides a comprehensive yet understandable framework with which we are able to compliment all that we have learnt by experience and from practical situations, such as leading groups and 1:1 activities.

Specifically, it discusses the challenges for Occupational Therapists in things such as assessment, activity analysis, communication and promoting well-being. It talks in depth about the value of therapeutic activity and gives sound advice and ideas about what to do, for example, reminiscence and life-story work. It gives anecdotes about the author’s own experience, what she has found useful, and tips about what works well.

The pencil portraits are delightful and eye-opening; describing the affect of dementia on people. Reading these can only enhance the quality of care that we provide to our patients. This book should be read by anyone working in the field of dementia, as it positively enhances person-centred care and the ability to see past the condition. It gives us permission to take time with people, to understand them, and to engage with them in an appropriate and fulfilling way.

Kate Legg, Senior Occupational Therapist, EMH OT Team, Portsmouth City PCT

Dementia and Social Inclusion

Edited by: Anthea Innes, Carole Archibald and Charlie Murphy
Published by: Jessica Kingsley Publishers, London
ISBN: 1 84310 174 2

This is a timely reminder of many of the pertinent issues faced by those to whom the subtitle - 'Marginalised groups and marginalised areas of dementia research, care and practice' - could be dedicated.

Even a cursory glance at the list of contributors clearly indicates that this publication has drawn on a wealth of highly-articulate, reliable and skilled writers. Gathered here are some of the most notable mainstays of dementia care development.

It could be sufficient recommendation to merely trawl some of the names, people who have enlivened conference debates and presentations over the last ten years: Bruce, Cantley, Craig, Killick and Manthorpe have all shone in lecture theatres and workshops.

What makes this particularly notable is that Innes, Archibald and Murphy have harnessed such individual voices to address the topics so cogently. Together they address the core issues, all too often neglected or marginalised, in dementia research and care.

Sexuality, communication, risk taking, ethnicity, incontinence and practices within remote rural communities are all subjects that draw threads from the very fabric of our society, and it is indicative of how wide the spectrum has broadened that these historically dispirit strands can be tackled constructively.

The sixteen chapters are divided into five sections - 'dementia and social change', 'marginalised socio-cultural' and 'marginalised dementia issues', 'representations and re-representations of people with dementia' and the concluding four chapters look, perhaps inevitably, towards 'future directions'.

The first chapter was written by the late Colin Bell, to whom the book is dedicated ('an inspirational social scientist and mentor') and his introduction propels the project forward through a series of highly-readable pieces.

It might seem churlish to pick out specific highlights, but particularly noteworthy are Archibald's consideration of sexuality, Manthorpe's assessment of risk-taking, McColgan's scholarly piece and Craig's 'reaching out with the arts' (chapter 12, pages 184-198).

McColgan draws on the movement towards opening up the debate within the media, where "there have also been celebrity tragedies linked to Alzheimer's disease (where Gubrium) described how the story of Rita Hayworth's Alzheimer's became public knowledge through her daughter's camp-aigning which was aimed at promoting more research into the condition. Ironically, part of this campaigning targeted the US President at the time, Ronald Reagan, whose own subsequent Alzheimer's disease also became public knowledge" (page 170).

Killick's concluding paragraph, in his postscript to Craig's piece asserts that, "It is the nature of marginalisation that it is unlikely to go away unless we adopt a proactive stance. It is the nature of dementia that those with the condition find it difficult to mount a consistent and coherent strategy to counter marginalisation. It is the nature of the arts that they can help to create a climate in which such imaginative leaps become a possibility. Therefore we must harness them in our attempt to make greater integration in society a reality" (page 197) and it serves as both a suitable reminder and an appropriate conclusion to this review of a highly recommended book.

Stephen Weeks BA(Hons), RMN, CPN based at Ossett CMHT, South West Yorkshire NHS Trust.

Designing Interiors for People with Dementia

Author: Richard Pollock
Published by: Dementia Services Development Centre, University of Stirling
ISBN: 1857691792

The booklet which is aimed at everyone concerned with the care of people with dementia. As the title and the authors indicate, this does not cover the actual design of buildings, which is possibly one reason that kitchen designs are not included. The only obvious question about this book concerns an illustration of a "feature fire" which presumably is not a real fire, but certainly looks like one. Whether or not the feature is a real fire, there is a case to be made for having a fire guard. Many of the illustrations do show good use of natural light and the use of attractive shades to suit room design in a small lounge as well as flush light in ceiling close to wall at position of each bedroom doorway. However, future editions would benefit from more illustrations to demonstrate the textual discussion of lighting would enhance the book.

The interiors demonstrate bright attractive developments which are welcoming and interesting interior to produce an enjoyable, comfortable and reassuring response in residents and their relatives. The attention to fixtures and fittings in the context of interior design provides a unique source for commissioners and managers of care homes. The excellent presentation style means that the information is accessible to anyone who studies the booklet, much more appropriate than a lengthy worthy but dense report.

Margot Lindsay, London Centre for Dementia Care, Dept of Mental Health Science, University College London.

The Essential Dementia Care Handbook: A good practice guide

Authors: Graham Stokes and Fiona Goudie
Published by: Speechmark Publishing, Oxon
ISBN: 0863882447

This book replaces the successful ‘Working with Dementia’ and highlights the developments in dementia care over the last decade. The authors state their aim being to give an ‘air of optimism and hope’ for the future treatment of people with dementia. By this they are not suggesting a breakthrough in medical science but more a discovery of the humanistic and social elements to dementia as well as psychological approaches to care. It consequently contrasts the medical interpretation that sees anti-social behaviour as mere symptoms of disease with a person-centred interpretation that suggests behaviour is communication of a need to be met rather than a problem to be managed.

Beginning with the diagnosis of dementia and other problems associated with ageing, this handbook considers assessment, the person-centred model of dementia, rehabilitation and therapy. The chapter on assessment seems relatively easy to follow and also highlights some of the pitfalls that can sometimes result if taking these assessment tools at face value. The chapters on therapy include work with people with dementia as well as for their families. Throughout this book are summary boxes and case examples. The former are useful to re-emphasis the salient points and the latter really help to bring the subject alive and to cross reference with people that you as a reader may have worked with in the past or are currently working with.

It is a relatively easy read and I would say a good starting point to gain an overview of where dementia care should be at. The adequate reference section allows readers to then develop particular interests further. The authors fulfilled their aims for me as I certainly feel enthused and positive about the potentials for dementia care.

Emma Webb, Trainee Clinical Psychologist, South Wales Training Course (Older Adults Placement)

Creating Successful Dementia Care Settings

Series developed by: Margaret P Calkins
Published by: Health Professions Press, London

Volume 1 – Understanding the Environment through Aging Senses

Authors: Sherylyn H Briller, Mark A Proffitt, Kristin Perez and Margaret P Calkins
ISBN: 1878812726

This is the first of a four volume series, ‘Creating Successful Dementia Care Settings’, described as "an easy-to-use reference to help care providers understand and more appropriately manage, through the environment, the broad array of behaviours and changing abilities that occur with dementia". The recent publication of this series is very timely given the emphasis that is currently being placed upon alternative ways of caring for individuals with challenging behaviour (Alzheimer’s Society, 2004) rather than the traditional use of anti-psychotic medication which has recently been the cause of much concern (Medicines and Healthcare Products Regulatory Agency, 2004).

This first volume focuses upon the normal sensory changes that occur with aging and explores how these impact upon a person’s basic functioning. The authors argue that these changes and consequent needs must be acknowledged and addressed before considering the unique needs of the individual as an older person with dementia.

Each of the five senses – sight, hearing, smell, taste and touch –are covered in detail. Certain facts given are striking, such as a 60 year old person needing two to three times light than does a 20 year old to perform the same task, and seem fundamental knowledge for anyone working with older adults. Each chapter helpfully provides sections on "What Staff Can Do" and "What the Environment Can Do" in relation to the initial information outlined. A summary sheet is also provided, outlining an overview of each chapter, which the authors suggest could be used as handouts for training or to be given out to direct care staff.

Unfortunately reading certain sections felt quite laborious (such as that detailing eight different types of lighting that can be used in the environment), and one could not imagine busy, time and resource stretched facilities acting upon such detail unless this had been identified as a particular priority. However much of the information provided, such as the good practise guidelines for approaching and speaking to older people and incorporating touch into therapeutic activities, is useful and could be easily utilised by care staff in many different settings.

Dr Helen Watkins, Clinical Psychologist, Older Adult Mental Health Services, Pontypridd & Rhondda NHS Trust

Volume 2: Maximizing Cognitive and Functional Abilities

Authors: Sherylyn H Briller, Mark A Proffitt, Kristin Perez, Margaret P Calkins and John P Marsden
ISBN: 1878812734

Part 2 in this series explores various practical approaches to reducing the potential cognitive and functional disabilities people residing in residential settings may experience. Focusing on the ways in which both the social and built environment can contribute to these disabilities, in addition to the experience of dementia and the aging process, this text focuses on the ways that small changes to the environment and social exchanges can make a significant difference to residents' image and self worth, and quality of life. The book is aimed specifically towards people providing care in residential settings, but the approach taken, and suggestions made, could be very useful to all professionals working within the field of dementia care. The design of the book, firstly describing functional abilities and the importance of functional assessment taking into account both clinical and non-clinical factors, and then discussing separately several functions, including orientation, mobility, continence and dressing, lends itself to use as a reference tool, rather than a one-sitting read, due to the amount of repetition. With regards to specific abilities, how they can be impaired by physical, social and environmental factors, and how residents may experience disability in this area, each section is helpfully divided into four sections; 'what staff can do', 'what the environment can do', 'where to find products' and a summary sheet, further 'allowing for easy reference.

The person-centred approach advocated here highlights the importance of encouraging choice and independence, treating residents with dignity and respect, and not deskilling residents. Considering needs to be met as opposed to problems to be managed, the philosophy is to think about potential change and not just a person's limitations, taking into account what the person is able to do and how staff can aid them in doing what they would like to do. Throughout the book the authors suggest a huge number of social factors to be considered by staff in order to promote quality of life, including individualised care, obtaining detailed personal histories, using consistent approaches, offering as much choice as possible and evaluating abilities regularly, using case examples to highlight the importance these factors can play. Many examples of environmental influences and practical approaches to ensure the environment contributes to the reduction of disabilities are detailed, including building layout, lighting, floor surface, decor, furniture, equipment and the importance of personal belongings. Unfortunately some of the suggestions are perhaps slightly unrealistic for hospital wards, and both state-run and private residential homes, due to the expense involved - high financial costs and time expensive approaches. Additionally, readers in the UK are able to make less use of the 'where to find products' sections than their American counterparts, as every company mentioned is American. However, the book does put across to readers the importance of considering the social and environmental factors contributing to disabilities experienced by those with a dementia, and the value of a person-centred approach, in a simple and accessible way. Additionally, it offers plenty of practical advice and potential solutions to difficulties experienced by both residents and care- givers. For a quick insight into the ways in which specific functional abilities can be maximised by altering the social and built environment, this book could be a very useful reference tool.

Claire Sanford, Assistant Psychologist, Older Adult Mental Health Services, Pontypridd and Rhondda NHS Trust

Volume 3: Minimizing Disruptive Behaviours

Authors: Kristin Perez, Mark A Proffitt and Margaret P Calkins
ISBN: 1878812742

Volume 3 of this series addresses the important issue of how disruptive behaviours can be minimized within care settings. The authors chose to refer to these behaviours as disruptive due to the effects that they have on those around them and "even the residents who are exhibiting the behaviours". Although much of the book is very person centred in it’s approach I feel that this description has slightly negative connotations and that describing the behaviours as challenging would have re-focused the emphasis onto the challenge that these behaviours place upon us to understand them rather than the disruption they may cause.

The first chapter considers the historical perspective on managing disruptive behaviours and the current thinking around ways of assessing such behaviours. The subsequent chapters are each dedicated to certain common types of challenging behaviours: ‘wandering’, attempting to leave, rummaging and hoarding, combative behaviours and socially inappropriate behaviours. All of these behaviours are well recognised as creating particular challenges to staff working with this client group and many of the suggestions provided are practical and relatively easy to implement. Each chapter addresses possible reasons behind behaviours and suggests interventions directly related to client’s needs. Such interventions include ensuring that activities planned for clients attempting to leave their environment are related to the reasons behind this behaviour and creating places to rummage that address client’s possible need for sensory stimulation. Unfortunately although the particularly challenging issue of socially inappropriate behaviours is covered in some detail in the last chapter, the authors fail to consider how the environment may contribute to such behaviours and the chapter is not summarised in full in the overview sheet provided.

The authors rightly note that many of the suggested changes cost nothing and involve only a different use of the environment and do mention the importance of teaching direct care staff to take a different approach to particular situations. However the fundamental issues of resistance to change in these settings and the dominance of traditional medical ways of dealing with challenging behaviours is not discussed in any depth, and these are factors that are of much importance, certainly for readers/practitioners working in the UK. One wonders whether unless these issues are addressed, and practical ways of overcoming them suggested, all this good advice may just fall upon deaf ears.

Dr Helen Watkins, Clinical Psychologist, Older Adult Mental Health Services, Pontypridd & Rhondda NHS Trust.

Volume 4: Enhancing Identity and Sense of Home

Authors: John P Marsden, Sherylyn H Briller, Margaret P Calkins and Mark A Proffitt
ISBN: 1878812750

This volume could be more accurately re-titled 'Person-centred Care Meets Changing Rooms'. The diversity of the subject matter covered in the book is perhaps a reflection of the varied backgrounds of the five authors, who include a medical anthropologist and architectural researcher.

The book is divided into six chapters: Overview of Home-Based Philosophy of Care; Personalisation; Roles and Activities; Privacy; Autonomy and Control; and Residential Design. All the chapters have a clear and logical structure with plenty of useful, practical ideas aimed at assisting the person with dementia adjusting to their care setting. I particularly liked the introductions to each chapter which prompt the reader to consider their own needs and feelings before going on to examine how a person with dementia may feel in the same situation, thus encouraging the reader to empathise with their predicament. The ability to put oneself in the shoes of someone with dementia is surely at the forefront of person-centred care.

The sections entitled 'What Can Staff Do' cover a wide range of psychological and psychosocial interventions for those giving direct care as well as giving advice to managers on developing person-centred policies. Recommendations are, on the whole, very positive and practical to implement and based on a sound underpinning philosophy of individualised care. Unfortunately some key topic areas, such as reminiscence and reality orientation, only receive scant coverage. If the book is to achieve its aim of changing staff practices I feel a more in-depth analysis of these approaches would have been advisable.

The sections 'What the Environment Can Do' offer advice on modifications that can be made to the physical environment. Many of the recommendations are relatively easy to implement and are an obvious reflection of the author’s knowledge and expertise. Although the advice is heavily biased towards residential and nursing homes, some of the ideas, such as those relating to seating arrangements and usage of space, could be applied to hospital settings.

The final section of each chapter provides recommendations of where to find products relating to changes in the physical environment. As all the listings are for companies based in North America this will be of little value to the British reader unless they have an unusually large bank balance.

In summary, the book provides plenty of practical advice to improve the care environment of someone suffering from dementia and is based on a sound philosophy of individualised care. However, having not read the other three volumes I found the number of cross-referencing to the other books rather irritating. For those wishing to purchase the four-volume series there are obvious cost implications and I would suggest the series is marketed primarily at institutions rather than individuals.

Paul Bickerstaffe, Lecturer, University of Wales, Cardiff

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