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Alzheimer's Disease: Policy and Practice across Europe
  1. J Herzberg
  1. Consultant Old Age Psychiatrist and Hon Senior Lecturer, East London and City Mental Health NHS Trust, The Royal London Hospital (Mile End), London E1 4DG, UK; jherzberg{at}londondeanery.ac.uk

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    Edited by M Warner, S Furnish, M Longley, B Lawlor. Oxford: Radcliffe Medical Press, 2002, £24.95, pp 216 (paperback). ISBN 1 85775 416 6

    I agreed to review this book with rather mixed feelings, being eurosceptic but a firm believer in high quality socialised health care. I was therefore pleased to find that I enjoyed reading it very much. Alzheimer's disease is currently of great topical interest as new treatments have been licensed and therefore detection of early cases is vital. In the UK there is also a new national service framework for older people.

    The editors set out to show that Alzheimer's disease and other dementias pose a set of challenges to policy makers which are different from those raised by any other form of disability. The second theme relates to the complexity of the needs of sufferers and their carers, which requires a coordinated approach to policy and implementation. There is great disparity in the way that issues are handled across the EU—for example, in Scotland 56% of doctors will disclose a diagnosis of dementia to the patient compared with 19% in Italy, but most patients wish to know their diagnosis! Data show that GPs are often ill equipped to make a definitive diagnosis and, even when they do so, they may be unaware of the local support services available for families. The chapter on “Carer burden” highlights the difficulties and rewards of the care giving role. Virtually all EU policies count on family support, yet few member states offer substantial practical or financial support. It is not just a matter of money; there is also inadequate access to the kinds of psychological interventions which can decrease the burden for carers.

    In a chapter on “Services for people with dementia and their carers”, interesting examples are given of supported living in group home settings in Sweden and France. The need for support worker training programmes is highlighted and a useful list of training requirements presented. As a practising old age psychiatrist who often complains about the lack of support services available to my patients, I was surprised to see that UK services have developed a greater degree of specialisation than in most other EU countries. A final chapter describes how Europe can move towards developing coherent policies for dementia sufferers by accepting coherency statements which will provide a framework for raising the level of investment in services. This book will be useful for policy makers in health, social and voluntary services, commissioners, and interested clinicians.

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