INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, VOL. 6: 681-684 (1991)

BOOK REVIEWS

Community Life: A Code of Practice for Community Care. CPA Panel, chaired by Lady Lloyd. Centre for Policy on Ageing, London, 1990. No. of pages: 80. Price: f6.00 (paperback).

In 1984 the UK-based Centre for Policy on Ageing (CPA) produced a highly successful, government-sponsored little book called Home Life: A Code of Pratice, which contained a checklist of basic essentials of acceptable quality of care in residential homes and nursing homes. It now needs updating but it remains a useful handbook for statutory and independent sector organizations responsible for managing residential institutions for elderly people. With the UK government’s support, CPA has now produced this new little book as a complemen- tary volume covering practice issues in community care services, especially those providing domiciliary care.

It should be a best-seller. Everyone working in com- munity outreach programmes or in hospital or office practice should buy this booklet and organizers and managers should have it permanently sitting on their desks in front of them. The Code is commendably brief and very well written. It covers all the elements of good practice such as providing information to clients and

their families, case finding, assessment and monitoring procedures. At the heart of the book is a philosophy of orientation to individual wishes of the service user, and a very unusual focus of promoting the rights of the user as a full citizen. One of the more unusual recommen- dations is the proposal that there should be a written service agreement between the individual recipient and the ‘care’ manager responsible for organizing the ser- vices. There is a recognition that informal carers should be fully involved. This kind of service agreement is not a contract in the same way that there would be between a purchasing agency and a providing service but a useful statement of intent between an independent professional and the person who will depend on the service.

A guide like this cannot cover everything-it is rather woolly about the practical operational management which is required to put the guidance into practice and its focus is elderly people rather than those with mental illness or handicapbut it is an excellent start on estab- lishing some basic quality standards for delivering care to people living in their own homes.

ELAINE MURPHY Guy S Hospital, London

The Epidemiology of Alzheimer’s Disease and Related Dis- orders. ANTHONY F. JORM. Chapman and Hall, London, 1990. No. of pages: 234. Price: f25.

Capitalizing on his country’s reputation for earthiness, there is an Australian TV weather forecaster who charac- terizes good weather as ‘bonzer and bottler’ Anthony Jorm, who is Deputy Director of the Social Psychiatry Research Unit in Canberra, is rather more sophisticated in his descriptions. Starting with classification, research method, diagnosis and explanation of basic concepts, he carefully reviews the prevalence and incidence of Alzheimer’s disease (AD). The related disorders of the title are also-rans.

Psychiatric trainees like to fix a few numbers in their minds, if only to impress examiners, but as Jorm says, ‘ . . . there is no simple answer to the question “what is the prevalence of dementia?” The answer varies depending on the methods adopted for answering the

question’. This is scarcely surprising, but I have not read a better, more lucid account of why it is true. The state- ment also applies, of course, to incidence, survival, mortality, psychosocial correlates and risk factors for AD, all of which receive adept critical appraisal.

When reviewed from the perspective of a large number of field studies, the epidemiology of AD yields many conflicting and discrepant data, eg reversed malelfemale ratios or widely differing incidence rates. One of the great strengths of this book is that not only are such inconsis- tencies highlighted, but possible or probable explana- tions are also given in clearly understandable terms-and no impenetrable mathematics! In short, this reasonably priced book is very highly recommended to all who have an interest in AD, from trainees to professors. At the risk of being repetitious, I should say it is both bonzer and bottler.

ROBIN JACOBY The Maudsley Hospital, London

0 1991 by John Wiley & Sons, Ltd.