Dementia

by Mary Marshall (Editor), Kate Allan (Editor)

Working with people with dementia and their carers is one of the most exciting fields of social work. The dramatic increase in numbers makes it a high priority for health, local authorities, private and voluntary agencies. At the same time, the field offers constantly changing approaches and improving techniques. Multidisciplinary work is needed to such an extent that it challenges all the recent legislation and guidance on community care; new models of services are being tried all the time and it is so free from protocol and procedure that imaginative practice is still very possible. This book, by leading professionals in the field, explores the new skills needed. These include counselling, the creative use of the past, groupwork, empowerment - particularly important in a low status field such as this, family therapy, care management, and network analysis. Also covered is multidisciplinary work. The book is intended to build on what readers already know, while exploring new dimensions of work in the field and introducing new ideas.

115 pages, Paperback

First published May 8, 2006

About the author

Mary Marshall has worked with older people for more than twenty-five years as a social worker, researcher and lecturer. She is now Director of the Dementia Services Centre at the University of Stirling. She has edited and written several books, and contributed to others, on the subjects of dementia and old age.

Reviews

[Paul · Rating 4 out of 5]

I have worked with people who have dementia for most of my adult life and have seen pretty much all of the ways that society mistreats those in the middle to later stages and who are most vulnerable.
This brief book addresses one issue in this area. Occasionally the media reports on someone with dementia who has left their place of residence and become disoriented or lost. Sometimes they are found; occasionally it is too late and a body is found. This particular behaviour is called “wandering” and is a very common aspect of dementia; if you spend some time in a care home which specialises in dementia, you will observe it all the time. “Wandering” is a pejorative term and really should not be used.
The reasons for this sort of behaviour in people who have dementia can be many and varied: separation anxiety, habits of a lifetime (used to walking? So are many people with dementia), confusion and searching (looking for a deceased relative and a previous home), physical discomfort (walking can often relieve physical discomfort), boredom (you try living in a care home!), loneliness, curiosity, avoidance, fear, perseveration (linked to frontal lobe dementias – constant repetition), copying someone else, spatial agnosia (getting lost), looking for a toilet, sundowning (many people with dementia are very active in the late afternoon and evening), to name only a few.
This book is useful because it is both theoretical and practical. The conceptualisation of risk and its management are outlined well.
I want to end this review with a story from the book; a daughter telling the story of her mother. An active and busy life as a carer; dementia progressed slowly with the usual slight mood and personality changes. The progression continued with less and less lucid moments; the lucidity expressing how much she hated what was happening to her. Inevitably a care home was necessary to give the family a break. The daughter takes up the story:

“What I am now going to tell you is what I have pieced together from the procurator fiscal, the police and the care home manager.
She got out of bed, carefully avoiding the pressure pads which would alert the staff. She made the bed and put on her dressing gown. She left her room and she entered a rabbit warren of basement corridors, and somehow, in the dark, managed to clamber into a room used as a store cupboard. She negotiated her way across the room and somehow managed to locate the one and only external door which, when they installed the alarm system, they had not wired up. She managed to open it in the dark.
Given her physical condition, I consider these acts to be the equivalent of a fit, young SAS soldier carrying out a successful hostage rescue against fairly insurmountable odds. Maybe it felt that way to her too, in the early hours of the morning, when she first felt the rush of cold air on her face.
She set herself free into the night: a soaring, delighted in the end, I am sure to find release. And so she died.
It was minus five degrees, the ground was white with hoar frost. She always said she never wanted to be a burden to anyone, and now she didn’t have to be. I believe she died happy knowing that she had got her wish.”
This is a useful and practical textbook which illustrates a particular aspect of dementia which can be puzzling and distressing to family and friends.