According to current estimates, by the year 2000, half of our aging population 85 and over will suffer from some type of dementia, mainly Alzheimer’s disease. This in-depth book, written by a caregiver whose father died of the disease, offers a new and comprehensive “prosthetic” health-care paradigm for health professionals, family members, and others looking after people with Alzheimer’s disease.

In contrast to the “biomedical model” (which centres on pharmacological and technological treatment) and the “custodial care” approach (with rigid rules), the prosthetic care method gears therapy to each Alzheimer patient’s progressive mental and physical deterioration.

In the book’s 600 pages, Moyra Jones details many inventive ways to organize and simplify the macro-environment (living space, people, and activities) into a “prosthesis” that compensates for the person’s functional and mental disabilities. Instead of focusing on symptom-relief with drugs and technology, the prosthetic model emphasizes human values and connections, gearing therapy to the pace of decline, and – since cure and improvement are impossible – on identifying and supporting remaining functions.

The book describes the stage-by-stage course of Alzheimer’s dementia, the parts of the brain progressively damaged, and how caregivers – both family and institutional staff – can help maximize the functions left, gently helping people do whatever they still can. Her system of “safeproofing” is somewhat like “childproofing” the environment, according to the decline, never forgetting the “essential personality” masked by increasing disability. For example, the author describes one previously meticulous gardener who started digging holes in his lawn, and how after the family’s initial dismay, they recognized it as a “gardening like” activity he could manage, and encouraged him to continue, even leaving out suitable, safe tools.

The author covers such issues as loss of memory and time awareness, wandering, obsessiveness, balance problems, driving, personal and toilet care, seizures, disinhibition, violence, restraints, vision impairment, language/speech losses, depression (a frequent accompaniment), disturbed thirst regulation, use and abuse of medications, visitors, terminal stages, and selecting a suitable institution. The book’s insight and many creative examples for helping and dealing with people who have the disease, together with numerous anecdotes, could be of great help to others dealing with and facing each aspect of the disease.