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264 pp
5.5x8.25
12 tables 1 figure
"...an insightful and constructive view of persons with dementia and their caregivers."
Carroll L. Estes, Institute for Health & Aging, University of California, San Francisco
Stress for care providers and distress for clients with varying degrees of dementiathese are the dynamics Karen A. Lyman discovered in her study of eight Alzheimer's day care centers in California. Speaking as an advocate for both day care providers and people with Alzheimer's disease, the author presents a model of "what works" in Alzheimer's care.
Many strategies developed by caregivers are self-defeating, Lyman found. Drawing on personal reflections, interviews, and anecdotes, she demonstrates how caregivers' struggle to maintain order through often unnecessary control contributed to patients' increased sense of self-doubt, anxiety, and incompetence. Negative expectations by caregivers brought on depression and rapid intellectual decline in patients, a "sense of hopelessness" that has been called "therapeutic nihilism."
Lyman identifies unsupportive institutional policies, restrictive environments, and poorly organized programs as chronic sources of stress. The alternatives she offers meet caregivers' needs and permit clients a degree of self-determination and identity. Her model for care will be of great interest to gerontological professionals, policy makers, and family members dealing with victims of Alzheimer's disease.
"[A]n insightful, comprehensive analysis of the unique reciprocal relationship between people with Alzheimer's disease and people who care for them. The author's compassionate concern emphasizes the need for innovative methods of care which alleviate stress for the care-giver and distress for the patients...an important book for policy makers, health care administrators, medical and nursing students, and all others who care."
Maggie Kuhn, Founder and National Convener of the Gray Panthers
Preface
Acknowledgments
1. An Introduction to Dementia and Caregiving
The World of Dementia Care
Care as Control
The Medicalization of Senility: A Historical Shift
The Biomedical Model of Dementia
A Socioenvironmental Model of Dementia Care
Conclusion
2. Losing It: Stress and Distress in Alzheimer's Day Care
Energy: Demanding Work
Losing People: Losing Control
We/They: Social Support
The Caregiving Relationship
The Price of Stress: Quality of Care
Conclusion
3. Care and Control: Managing Stress by Medicalizing Deviance
Assessing "Level of Severity"
Infantilization: The Medical Model of Care
Social Control
Social Distance
Staff Stress and Quality of Care in a Nonmedical Program
Conclusion
4. Medicalization, Stress, and Care: Contrasts between Two Day Care Centers
Medial and Nonmedical Programs: Structural Conditions
The Medical Model of Caregiving
Contrasts in Work-Related Stress
Contrasts in Quality of Care
Conclusion
5. The Physical World of Day Care: Environmental Stress and Control
Environmental Stress: Four Facility Design Features
Environmental Control and Medicalizing Deviance
Facility Design and Staff Stress: A Case Study
Conclusion
6. What Worked: Providing Quality Care with Minimal Staff Stress
A Model Program at Valley Day Care Center
Conclusion
7. What's Next: Research, Practice, and Policy Implications
Research Implications
Practice Implications
Policy Implications
Conclusion
Appendix A: Research Methods and Researcher Role
Appendix B: Tables
Notes
References
Index
Karen A. Lyman is Professor of Sociology and Coordinator of the Gerontology Program at Chaffey College in California. She publishes widely and in 1991 received the American Sociological Association Outstanding Medical Sociology Dissertation Award.
Health, Society, and Policy, edited by Sheryl Ruzek and Irving Kenneth Zola.
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Health, Society and Policy, edited by Sheryl Ruzek and Irving Kenneth Zola, takes a critical stance with regard to health policy and medical practice, ranging broadly in subject matter. Backlist titles include books on the legal and professional status of midwifery, the experience and regulation of kidney transplants, the evolution of federal law on architectural access, and a political/ethical argument for making the community responsible for universal access to health care.
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