This book describes a follow-up study of a group of people with dementia who were referred to three social services departments in 1994-1995 and underwent assessment. The chapter dealing with difficulties in identifying people with dementia in a social services referral population touched a particularly raw nerve for me, as we have just joined a mental health partnership in Manchester where our partners (namely Manchester social services) are struggling to identify how much of their resource goes into supporting elderly people with mental illnesses. After reading this book I am less perplexed (but just as cynical) about why they cannot quantify their commitment.

One bugbear of mine is the lack of information held by staff in residential and nursing homes about those in their care. Often they can tell me virtually nothing about the family and life history of their residents. Small wonder then, that proxy informants in this study knew so little about residents with dementia and their past lives and that in many cases social class could not be assigned.

On a positive note, more carers were aware of the diagnosis of their relatives, and used terms such as Alzheimer's disease, than in previous studies. This suggests public awareness of dementia is increasing: perhaps a first step in the battle against stigma.

Few referred cases could be resolved quickly and closed: elders with dementia needed long-term support. I felt this was the single most important finding (simple and self-evident though it is). The authors argue that regular reviews of care packages are essential because the needs of people with dementia will increase over time. The more cynical reader might suspect that this explains the drive to close cases: reviews, which detect increasing needs, are inevitably going to lead to increasing costs, so let us not review people. Obvious really. I think that the findings reported here would benefit from widespread publicity: in particular “the long-term nature of the support that study participants and other people with dementia in similar circumstances require”. Send a copy of this book to your counterparts in social services with the relevant bits highlighted!