Don’t forget the carers

Counseling the Alzheimer's caregiver: a resource for health care professionals. Mary S Mittelman, Cynthia Epstein and Alicia Pierzchala. Chicago: AMA Press, 2002 (vii + 346pp). ISBN 1579472621.

This is an excellent book for staff, researchers or policy makers whose business it is to assist people with dementia and their families. The book amply lives up to its subtitle — it is the best practical guide I have seen for workers in the field, who often struggle to support dementia caregivers through the myriad problems they have to face. Theoretical topics are vividly brought to life with clinical vignettes, and the book is well written and easy to navigate, with a short index that I could not fault. There is plenty of advice about most problems likely to be encountered during the long ‘career’ of someone with dementia — from early diagnosis to death. There is a guide for staff to assess caregiver needs, covering topics such as changes in relationship roles, unsafe driving, problem behaviours and the need for services such as nursing home care. Other family members are included in the approach advocated by the authors, and there is an emphasis on empowering caregivers and their families to solve future problems, with support from the professional counsellor when necessary. The breadth of approach is illustrated by interesting topics such as “the caregiver’s role in hospital”. Here, caregivers are advised how to deal with hospital staff in a tactful manner while negotiating the hazards of a hospital stay. These authors, from the United States, advocate a thorough approach to caregiver support that surely is rarely achieved in Australia or, for that matter, in most of the world. They prescribe a number of education and counselling sessions with the caregiver alone, then with the caregiver and other family members. Caregivers can access a counsellor at any time to deal with new problems. In a landmark clinical trial, this expensive-sounding program led to improved caregiver wellbeing and impressive delays in subsequent admissions to nursing homes. Although economic studies have not yet appeared, this program may well be cost-effective. It is somewhat sobering to ponder on the enormous gap between what is possible to help dementia sufferers and their families and what actually occurs in Australia, where dementia care remains fragmented and crisis driven. Nevertheless, the book provides adequate detail to assist policy makers, and the practical guidance should prove invaluable to all involved in dementia care. I strongly recommend it. David G Bruce Professor Department of Community and Geriatric Medicine Fremantle Hospital, Fremantle, WA