A few years back, I sat on a conference podium with a colleague who spoke passionately about the ‘dementia tsunami’ that was fast threatening to inundate health and social care. The speech was a ‘call to arms’ of sorts; designed to raise awareness and mobilise resources to assist people living with this condition. Nonetheless, I felt uneasy at the ‘tsunami’ depiction, and voiced my concern at describing people with dementia as a natural disaster. My colleague and I discussed our differences afterwards, and while I had sympathy with their desire to construct a ‘burning platform’ that mandated action, I remained opposed to the depiction. I still see it in contemporary use from time to time, often in conjunction with the adjectives ‘grey’ or ‘silver’, and my objections persist….
The Pool Activity Level (PAL) Instrument has become the framework for activity-based care systems in a variety of health and social care settings for people with cognitive impairments. The Instrument is recommended for daily living skills training and activity planning in the National Institute for Health and Clinical Excellence Clinical Guideline for Dementia (NICE, 2006). The PAL checklist has also been proved valid and reliable by a recent research study. Following these endorsements, Jackie Pool has developed valuable new material for this third edition.
The book continues to include the Instrument itself and the photocopiable activity checklists and plans that help to match users' abilities with activities. An additional second section provides a selection of potential activities together with sources for obtaining them. The author includes guidance for carrying out these activities with individuals of different ability levels as revealed by the PAL Instrument Checklist. *These resources are available for loan to members of AANSW - if you would like to reserve them please email the Library on firstname.lastname@example.org
There is, as to be expected, a theological tone throughout the book but as well as the use of biblical quotes, philosophical and social-scientific theorists and ideas are also used to enhance particular points of emphasis. For example, Swinton critiques the use of Buber’s I-Thou/I-It distinction of personhood and relationships on the purely ethical level arguing that “this approach actually ends up leaving people with dementia in a vulnerable position” (p. 149).
John Swinton has produced a well-argued, theological and social scientifically referenced and reasoned book that is successful in its aim of moving beyond current tendencies to “perceive the subjective, self-aware, cognitive self as the necessary qualification for humanness and theological construction” (p. 15). Throughout the book, it is clear that Swinton is intending to open up the possibility that “knowing about God may not be as important as knowing God,” which, he argues, involves much more than memory, intellect and cognition.
I especially like Swinton’s use of embodied language throughout the book, which includes discussions on the embodied soul, personhood and humanness, identity and bodily memory, and our bodies as holy ground. A critique of the book could be that the content may not suit every potential reader, as there is an undeniable theological undertone throughout the monograph. That being said, the ideas that are discussed including, for example, problematizing the term personhood, discussing the importance of embodied practice, memory and embrace, and hospitality, can be read and related to from a non-faith perspective.
This book is successful in developing a practical theology of dementia that can be used and read by caregivers, people with dementia, ministers, hospital chaplain and medical practitioners. I also think that this is a book that would make an excellent contribution on Master’s courses in theology and be of value to any questioning practitioner, commentator or student, who is attempting to understand the position of dementia in contemporary society from a Christian and/or theological perspective.
There have been seismic shifts in world of dementia since the original publication. These are highlighted in the introduction to this second edition: the political commitment to dementia, which has taken place on a global scale; the rise in the public prominence of people living with dementia and the belated recognition of the diversity of the experience of people living with dementia. The second edition sets aims for these to form the key contexts for the book. It succeeds in this aim and does so whilst retaining the person-centered ethos that was a strength of the first edition.
The tone is set in this edition from the outset with a preface by Daphne Wallace and Barbara Woodward-Carlton who are able to offer their perspectives of living with dementia and caring for a close relative with dementia, respectively. The first edition consisted of 28 chapters from renowned experts, several do not make the second edition but nine new chapters are added. The second edition now comprises of 30 chapters themed around: the context of dementia care; conceptualizing dementia care; best practice dementia care for the person; care pathways and finally, making sustainable change happen in dementia care (changing the culture of care).
The changes made to existing chapters and the new chapters effectively bring the book up to date and re-establish this as the key text for all those interested in supporting, empowering and enabling people who are living with dementia. I was particularly pleased to see new contributions by the likes of Pia Kontos on selfhood and the body, Hannah Zeilig on representations of dementia in the media, and – focusing on recent developments – there is an interesting chapter on dementia-friendly communities by Cathy Henwood and Murna Downs.
The title Excellence in Dementia Care is perhaps a little misleading. Care practice remains central, but the new chapters and re-focusing of the book quite rightly address issues that go beyond “care” and explore broader concerns such as empowerment, public health, representations of dementia, arts and communities.
The changes to this key text not only make this a must-read for all those who have an interest in enabling, supporting and caring for people living with dementia and who are unfamiliar with the first edition; but arguably, also for those who already possess the first edition.