This past semester, my seminary (Christian Theological Seminary) was honoured to host Virginia and Wayne Bell as they led a conference on Spirituality and Aging. As we approach a time in which the issues of aging will take increasing prominence, as the baby-boomers reach a collectively-older age than any generation in history has reached, the issues surrounding health care for the elderly are of primary importance, and part of that health is mental (which includes spiritual) health. The Bells have spent much time investigating and helping in the area of Alzheimer's, a disease that affects mind, body and spirit. Virginia Bell, together with a colleague, David Troxel, collaborated on two books (one of which is the the subject of this review) presenting an innovative way for care of those with Alzheimer's: `The Best Friends Approach to Alzheimer's Care'.
Virginia Bell, MSW, is currently Program Consultant with the Lexington/Bluegrass Chapter of the Alzheimer's Association. She is a graduate of Transylvania University and the University of Kentucky, and has lectured widely at national and international conference. Her co-author, David Troxel, works with the Santa Barbara chapter of the Alzheimer's Association.
`"The Best Friends Approach to Alzheimer's Care" reflects a growing optimism in the field of Alzheimer's care that much can be done to improve the lives of people with the disease and to transform caregiving from a terrible burden to care that is manageable. This book represents the development of the first comprehensive model of care, which is easy to understand and learn.'
At the start of the book, Bell and Troxel describe the various experiences of those with Alzheimer's. By looking at the depression, confusion, and detachment that those with Alzheimer's experience, the caregiver gains a greater understanding and compassion for those suffering. Perhaps the most important key insight comes from a nurse and teacher, Rebecca, who began to experience symptoms of Alzheimer's at age 59.
`I dislike social workers, nurses and friends who do not treat me as a real person.'
Despite her slowly declining cognitive abilities, she is still able to sense that people are regarding her differently, as a patient, as an object, as a 'third person' rather than a real person.
Persons with Alzheimer's experience loss, sadness, confusion, isolation and loneliness, fear, frustration, anxiety, paranoia, anger, and embarrassment. The Best Friends model takes all of these into account as a normal part of everyone's life.
The second chapter gives a basic overview of Alzheimer's, giving symptoms, diagnosis, services, caregiving issues, and research news. The Best Friends model requires no specialised medical or scientific knowledge -an appendix is included in the book for those who wish to pursue those topics in more detail.
The following chapters develop the aspects of care along the Best Friends model. This requires first assessing the strengths and abilities of the person receiving care (and this may require a daily update). An understanding of what persons with Alzheimer's may require is included as an `Alzheimer's Disease Bill of Rights'. These are important, and often overlooked, so I shall reprint them here:
Every person diagnosed with Alzheimer's disease or a related disorder deserves the following rights:
To be informed of one's diagnosis
To have appropriate, ongoing medical care
To be productive in work and play for as long as possible
To be treated like an adult, not like a child
To have expressed feelings taken seriously
To be free from psychotropic medications, if possible
To live in a safe, structured, and predictable environment
To enjoy meaningful activities that fill each day
To be outdoors on a regular basis
To have physical contact, including hugging, caressing, and hand-holding
To be with individuals who know one's life story, including cultural and religious traditions
To be cared for by individuals who are well trained in dementia care
A key point to being a Best Friend is that the caregiver becomes a memory aid to the person -friends know each others' histories. Being reminded of past accomplishments, family connections, personal beliefs and traditions helps tremendously. It gets them involved in their own lives again.
Friends do many things: they share history, they do things together, they communicate, they build self-esteem, they laugh often, they work at the relationship, and they are equals. These carry over as key concepts in the Best Friends model. Bell and Troxel go into some detail about how to handle situations for the full-time caregiver, the volunteer, and for those who visit persons with Alzheimer's in care. Specific situations and general principles are presented in a clear, intelligible manner with great application potential.
An important part of the process of understanding and dealing with those with Alzheimer's is to understand oneself. Thus, there is a section on Being One's Own Best Friend. How do we react and respond? Do we give ourselves enough care? How can we care for others if we do not care for ourselves? How do we respect the needs and desires of those we care for while recognising and respecting our own needs? These are important questions, and Bell and Troxel address it by illustrating the relationship between Rebecca and Jo, her Best Friend.
`Because any of us can be touched by Alzheimer's disease, can have bad things happen to us, our friends, or our families, the ultimate message the authors wish to convey is this: We should treat everyone important to us as we would our own Best Friend.'
Seeing the Helping Hands Adult Day Care program, which is the fruit of the philosophy of this work, was a life changing event for me. The caring and love shown by the staff of Helping Hands are living testiment to the dedication of workers to improve the quality of life for clients affected by the devastation of Alzheimer's Disease and other dementias. If all facilities, both assisted living and nursing homes, truly invested in this approach, life would indeed be different for the persons affected by this disease and their caregivers. A definite must for those struggling with the problems of caregiving those with Alzheimer's disease.
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I read this book as part of training to lead activities in an adult day center. It is thorough, concise and very reader friendly. This is an excellent resource for training programs and for anyone wanting to develop skills in working with persons with Alzheimer's Disease or dementia. This book is a must have.
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This is a really great text outlining a different slant on how to care for the Alzheimers disorder. I love the concept utilized in this book, and have seen it at work in a local Adult Day-Services center. As a retired nursing professional I would like to see more use of this type of therapeutic care for the mentally impaired. I hope that the book will help to educate those who care for the aged, and AD persons. The families of those patients could be helped in their respite care.
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if only everyone who cares for the elderly could not only read, but learn and practice this approach, we would make great strides in geriatric/alzheimer's care
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Last year I had a back injury that left me immobile for two months. During that time I read four back books to "empower" me with knowledge and tips for recovery. Dr. Homola's book (now with post-it-notes stuck in numerous chapters) was the most helpful. From helping to determine causes of pain, to outlining simple excercises you can do without buying expensive equipment, this book was the only one I really needed to read. It's a book I'll keep on hand as a helpful resource for years to come.
