Training Manual and Video for Dementia Care Specialists: Handbook of Dementia Care by Jean M. Stehman, Géraldine I. Strachan, Joy A. Glenner, George G. Glenner & Judith K. Neubauer, 1 996, Baltimore, MD: The Johns Hopkins University Press
A training manual, handbook, and videotape are included in this educational packet. Each of the resources is organized into six modules: 1) What is dementia? The scientific basis and research; 2) Positive interaction techniques; 3) Creating supportive physical environments; 4) Choosing and adapting therapeutic activities; 5) Leading successful group activities; and 6) Family dynamics /social support for caregivers. The resources provide a basic overview and introduction into psychosocial, daily care, environmental, and activity needs of people with dementia who retain moderate functional skills. The educational resources would fit well as a part of an orientation program for adult daycare or group homes that serve people with dementia. Nurses and nursing assistants would need to have their orientation augmented with more comprehensive guidelines for physical care, health, and illness interventions. Because of the introductory level and anecdotal nature of most of the material presented, it would be less useful in an academic setting.
The training manual provides an instructor's outline, multiple handouts, and many creative group learning activities. The handbook consists of an outline and accompanying handouts for each module. All of the material is basic and easy to understand. Handouts cover relevant and highly practical material, but are quite dense with few graphics to break up the text. Some of the intervention guides are overly simplistic with troublesome omissions. For example, in one handout staff are encouraged to crush psychotropic medications and add them to food if the medication cannot be swallowed and is not available in liquid form. No mention is made that states regulate this behavior closely in long-term care settings or that some medications cannot be safely administered in this manner. In the handout on assisting the person with bathing, the authors say "tub bathing should be attempted only if the person is agile enough to get in and out of the tub independently." This statement contradicts much of the available literature on bathing people with dementia. Also, on the same handout the authors state, "A person feels good after a bath; even the simple act of putting on a clean and attractive robe before going to bed increases morale and selfesteem." There is no support provided for these statements that contradict several empirical studies which support that people with dementia often consider the bath an exceedingly stressful and fearful experience. Yet other handouts are more thoroughly developed. One handout lists skills that may be retained and, next to each skill, lists multiple activities that utilize the skill. Another useful handout outlines common sensory problems and the environmental modifications that ameliorate the effects of the deficit.
The videotape is set in an adult daycare and features participants who retain the ability to ambulate and function in many group activities. The video illustrates and reinforces the material presented in the handbook and instructor's outline. Each video segment is keyed to a module, and could be used to introduce a module, or to review material covered. The authors are careful to emphasize adult interaction and activities, and yet a caregiver can be heard calling a resident "sweetheart" in the video. There is also too much repetition from one module to the next in the videotape.
The modules on therapeutic activities and group activities are goal-oriented and systematic in presentation. These sections are cohesive because practical interventions are based upon sound foundational knowledge regarding cognitive, perceptual and motor losses, psychosocial needs, retained strengths, and use of habitual skills. The module on managing behavior and physical care problems lacks a framework to organize many interventions.
In summary, this packet of educational resources provides many practical tips for assisting the moderate and higher functioning residents with dementia. The materials rely more on anecdotal and experientially based information than on theoretical or empirically based knowledge. Some sections are overly simplistic, but much of the material would be quite useful as a basic introduction into a wide range of topics on dementia care.