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Book, Multimedia, and Software Reviews |
In their introduction, the authors provide a "wish list" for their readers and admit that it is ambitious. It includes statements such as "we want this book to be a comforting companion for caregivers," "we want caregivers to learn a new approach," and "we want caregivers to move into the realm of healing acceptance." In a clever way, the authors achieve this by focusing on areas that can be most easily implemented. They emphasize early diagnosis, thus allowing time to make some family decisions and involve the person with AD in making these decisions before the disease progresses. They constantly advise the caregiver to get help, even basic help, by being specific when asking for help, and they also guide the caregiver to realize that their anger is at the disease, not at the person with the disease.
The scenarios provided in the book are a compilation of personal experience and the experiences of others in support groups and other families. Many of these scenarios are simple, real-life examples of how to solve issues or anecdotes about problems that many of the caregivers for people with AD are likely to experience. Examples of such scenarios include ways to make eating less messy and embarrassing and ways to validate anger. The scenario concept is best utilized in the section in chapter 3 titled, "Denial and the Family Unit," which discusses the complexities of the family unit and the fact that some members may never overcome denial. Using 4 examples, the authors describe different situations and how the families resolved the problems. The scenarios include a long-distance family member in denial, an elderly spouse in denial, family nonbelievers, and early onset denial. The authors emphasize organization among the family and working together efficiently while still acknowledging there will be tension and pain.
The other chapters in the book cover very critical material for those caring for people with AD and include communication, challenging behaviors, and day care and long-term care decisions. Another thoroughly covered aspect is the "driving dilemma," featured in chapter 7, "Dad's a Danger to Himself and Others," which discusses the very emotional consequences of the decision to revoke the driving privileges of a person with AD.
Throughout the book, the authors use lists of things to look for or questions to ask at critical times. For example, in chapter 7, the authors progress logically through multiple lists. First, they list unsafe driving behaviors, including inadequate defensive maneuvers and delayed reaction time. The authors then list possible consequences and finally give a list of what the family should agree on, including weaning from driving, researching alternative transportation, and monitoring driving. There are also lists to help assess driving (eg, keeping written records of poor ability, following the driver with AD without them knowing, and noting if errands take an excessively long time). These lists can help caregivers and family to progress logically through the decision-making process and help make some of the emotions less overwhelming.
During the discussion on long-term care decisions, the authors include lists of what to look for in long-term care, but they do not provide specific answers. In general, this allows the family to make their own decisions about what is acceptable, such as how often the staff will meet with families for updates. On the other hand, failure to supply answers might result in unrealistic expectations when the family is considering questions such as the ratio of aides available to residents at a given time. The authors do encourage the family to look at more subjective issues such as residentstaff interaction, resident stimulation, and the cleanliness of facility and the residents.
The chapters are each broken into subdivisions, which are clearly listed in the table of contents. There is no index, but the book manages well without one by providing the listings in the table of contents and by referencing the reader to other appropriate chapters when necessary. There is a short appendix explaining clinical terms such as "activities of daily living" and legal terms such as "power of attorney." There also is a comprehensive list of materials, including videos, that are available from the Alzheimer's Association, and a list of Web sites and contacts for the Alzheimer's Association. Finally, there is a list of various suggested readings, including practical caregiver manuals, consumer guides, and reflections.
The authors not only achieve their purpose of providing a guide for caregivers, but also offer a very sensitive and much-needed explanation of denial that could be applied to any illness or to aging in general. Many of the issues addressed in this book, particularly the discussions on denial, would be beneficial to health care professionals as well. The difficult issues discussed in the book—such as day care, long-term care, driving, and caregiver burnout—are not unique to AD. They are extremely relevant to the entire geriatric population and to those who are chronically ill.
This high-quality book for caregivers is practical, not condescending, and very easy to read. It is a book that should be strongly recommended to those coping with a person with AD. Although the book emphasizes AD, it should be recommended as extremely appropriate and useful for all families with older relatives facing many of the issues and decisions addressed in the book. It also should be recommended to members of the health care profession—working both with people who have AD and with geriatric clients—for a clear insight into the issues the family is facing.
C Childers, PT, MS, GCS, is Rehabilitation Director, The Remington Club, San Diego, Calif
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