Abstract
Laura Gitlin and Nancy Hodgson’s recent book, “Better Living With Dementia” is timely. It is estimated that there are approximately 50 million individuals worldwide living with Alzheimer's disease or a related form of dementia (Alzheimer’s Association, 2018). As the world’s population ages, the growing number of individuals affected by Alzheimer’s disease and other dementias will undoubtedly continue to impose social and economic challenges. Recognizing that dementia is a major public health concern that has deleterious impact on individuals and communities, Gitlin and Hodgson address the topic of the dementia epidemic and offer evidence-based solutions that can significantly improve the lives of people living with dementia.
Both authors have been known for their longstanding interests in developing non-pharmacological interventions and support family caregiving. “Better living with dementia” presents their social-ecological model which emphasizes the complexity of dementia and serves as a practical roadmap to improve functioning through taking specific actions. This comprehensive model of dementia care includes the following levels: individuals, caregivers, living environment, neighbourhood and community, social policy, health and human services. Throughout the book, the authors explore each of the model’s elements and lay out specific steps that could be taken.
In addition to the Introduction, the book has 14 chapters and is divided into five parts: “About the person living with dementia”, “About the caregiver”, “About living environments”, “About social systems and policies” and “Taking actions”. In part I, which encompasses four chapters, the authors focus on the individual diagnosed with dementia. Chapter 1 provides an overview of different, but equally destructive, types of dementia; discusses the current state of knowledge regarding the diagnosis of dementia and lists challenges related to the diagnosis. This chapter also highlights the importance of early diagnosis and explains the trajectory of dementia. Chapter 2 sheds light on the experience of Alzheimer’s disease and other dementias from the perspective of an individual and analyzes how the condition affects different domains of life. This chapter also discusses the needs of individuals diagnosed with dementia and explores how the needs change as the condition progresses. The next chapter focuses on barriers related to comprehensive dementia care and discusses the most essential elements of current research on dementia: prevention, cure, care and services. The final chapter of the first part is devoted to treatment goals based on the stage of the patient’s condition, values, preferences and needs. In this very informative chapter, a reader is provided with a discussion on pharmacological and non-pharmacological treatment options.
Part II focuses on caregivers and comprises three chapters. Chapter 5 covers demographic data concerning caregivers and tasks they perform at different stages of dementia. This chapter also briefly discusses physical, emotional and financial consequences of caregiving. Chapter 6 summarizes assessment tools to evaluate caregivers’ knowledge and needs. This chapter also offers a list of evidence-based interventions to support caregivers. The final chapter in Part II is a critique of the current education and training of most formal caregivers and lack of clear requirements for continuing professional training. In chapter 7, the authors also discuss an interprofessional approach to formal caregiving, describe in detail the role of each team member and justify why a team approach is important.
Part III focuses on environmental gerontology. Chapter 8 includes a discussion on how home and community impact the quality of life of those living with dementia. The authors identify barriers to performing activities and present the reader with a list of low-cost modifications that can be easily implemented. Chapter 9 discusses the concept of dementia-friendly communities and provides a few examples of successfully launched projects in various countries.
Part IV Chapter 10 examines what services might be needed in particular stages of the disease and emphasized that in order to promote quality of life, the services should be person-centered, not service-centered. Chapter 11 offers a summary of 37 national dementia plans. The authors not only discuss the common elements of these plans such as raising public awareness about dementia, improving identification diagnosis and training the healthcare professionals, but also identify their missing elements (e.g. support of family caregivers). Chapter 12 summarizes the key points needed to transform dementia care.
In the final part, which includes two chapters, the authors focus on implementing solutions discussed in previous chapters. Chapter 13 includes hands-on instructions and quotes of individuals from all over the world who shared their action plans. The last chapter is a synthesis of all chapters with emphasis on the implications. Gitlin and Hodgson describe several approaches and strategies that can be implemented under different circumstances and point out essential issues and challenges that need to be considered.
One of the unique features of this book is that it can be recommended to professionals as well as the general audience. Unlike other books about dementia, this one integrates professional knowledge with practical know-how. This book may serve as an excellent resource because each chapter ends with the reference list and suggestions for more in-depth readings. It can serve healthcare professionals and social workers, as it provides a clear guideline of actions that can be taken to help individuals with dementia. It will help them to gain insight into how to help caregivers and care receivers to make informed decisions. Also researchers on dementia will benefit from reading this book because the authors summarize the current state of knowledge and suggest areas for future research.
Students may also appreciate this work because it provides them with fundamental information about dementia written in a clear and easy to understand language. Most importantly, the book will give them a greater understanding of the impact of dementia as well as what core competencies they should possess if they would like to work with individuals with dementia. Last, but not least – the book is targeted toward caregivers who can amplify their understanding of dementia and learn how to cope with the condition at its different stages.
The chapters are well organized and very readable. The authors cover complex topics with clarity and depth. Almost each chapter presents case studies to illustrate the authors' point and stimulate creative thinking for readers. Certain concepts are graphically displayed throughout the book which makes them easier to understand. Each chapter starts with a preview of the section and ends with practical suggestions how the research findings can be translated into practical applications. Included are also interviews with experts in the field of dementia: Dr. James Karlowish, Dr. Helen Kales, Dr. James Pickett and Dr. Jean Garjardo. What I find particularly important is that some chapters discuss ethical considerations with regard to providing care of certain strategies.
Taking into account that the available drugs for dementia only alleviate the symptoms but cannot reverse the neuropathological changes, this book makes an important contribution to the field, as it sets groundwork for non-pharmacological interventions and provides broad coverage of what can be done to enhance quality of life for people with dementia and promote their well-being.