Caregivers: Drowning in a Sea of Cognitive Challenges, 2nd edition

For almost 30 years, Mace and Rabins' The 36-Hour Day has been the premier resource for professional and informal caregivers for persons with dementia. Thus it was in anticipation of a fresh perspective that I began to read Caregivers: Drowning in a Sea of Cognitive Challenges, by Delaune Pollard.

Ms. Pollard is an occupational therapist who presents seminars to health professionals and laypersons on the Allen Cognitive Level Screen, which is used as a model to explain the behavior of persons with cognitive deficits and the effects of their behavior on informal caregivers. This book is based on her seminars, and she describes her efforts as "weav[ing] together scientific knowledge, humanistic stories and practical information into a powerful resource book."

It is an ambitious work at 432 pages, and the table of contents appears quite promising. At first glance, the titles of the chapters suggest a logical flow, beginning with identifying the multiple challenges and burdens of caregiving, proceeding to an explanation of the factors that result in caregiver stress, and concluding with solutions and resources. When reading, however, I found that this book has so many flaws that I felt as though I were the one drowning in the challenge of wading through it.

Pollard writes in a style that may be an attempt to be conversational but is actually tangential and undisciplined. She starts a chapter or section by addressing the title issue but veers off topic quickly and completely. The editing shows no regard for rules of grammar, punctuation, or even getting a point across. A typical sentence is redundant and circular, as though it had been cut and pasted without thought, such as this one: "The physician told Jock his mother's medication would need to be monitored to control his mother's condition her medication would need to be continually monitored."

Not only is the author's writing difficult to follow, but she addresses the reader as though she is the only one who can fully empathize with and provide help for the victimized caregiver. Throughout the book she describes the behaviors of persons with cognitive decline as "spiteful," "selfish," and "abusive." She describes health, legal, and social service professionals as adversarial and generally not understanding or acknowledging the impact of deficits in cognitive functioning. She dismisses physicians' assessments as inadequate and inappropriate in the face of relatives' concerns about a patient's cognitive decline.

Pollard seems to be trying to create a fully comprehensive resource, but the result is a hodgepodge of sketchy and inaccurately addressed topics studded with buzzwords that often are not properly defined or credited. Even with the author's endorsement of the Allen screen as a caregiving tool, this book is simply a big volume of poorly gathered information that does not offer anything new to current insights and available tools for health care professionals or informal caregivers for those with dementing illnesses. Better resources can be found at the Web sites for the Alzheimer's Association ( www.alz.org ) and Family Caregiver Alliance ( www.caregiver.org ) and in that reliable old authority, The 36-Hour Day.