This book is timely considering the worldwide increase in the prevalence of people living with dementia, as well as more recent initiatives for older people including personalisation and person-centred care, and the implications for future health and social care policy. The authors clearly understand the complexities of living with dementia and are empathetic to persons with dementia, family carers and professionals in their dealings with risk as it is lived with day to day. The authors state that the primary aim of the book is to create the opportunity ‘to think about your own position and practice in relation to risk and the position that others take’ (p. 20). In this aim the authors are successful, and the ‘think about’ boxes which summarise each section allow the book to be read with an introspective view of one's own experience of service provision for people living with dementia, and specifically risk assessment and management.
The authors introduce the book by engaging with the concept of risk, and provide a useful definition. They acknowledge that the negative outcomes of risk are most often suggested but that risk taking can also have positive effects on quality of life. The authors emphasise that the focus of assessment should not be on problematising dementia but on challenging traditional ‘tragic’ assumptions of the diagnosis. The introduction also provides case studies which illustrate the importance of exploring risk in relation to living with dementia. Chapter 2, ‘Living with Risk’, successfully explores different views of risk as experienced by people with dementia, family carers and professionals involved in their care. This will be particularly useful for practitioners to understand the perspective of the person with dementia, and also of the carer, on how they manage risk in their everyday lives and why they may make certain decisions. Chapter 2 also detours off on a very interesting look at dementia in developing countries. Yet as the book is otherwise thoroughly UK-focused, to my mind a look at what dementia means to other cultures within the United Kingdom, and how risk is managed as a result, may perhaps have provided more useful insights.
Chapter 3, ‘Working with Risk’, adequately explores the dilemmas professionals face in managing and assessing risk: particularly the emphasis on ‘safety and security’ which focuses on loss and challenging behaviour, rather than on positive risk taking. This chapter also goes into depth regarding the inadequacy of current assessment tools. The discussion regarding the tensions between legislative frameworks and person-centred care, and the often contrary needs of people with dementia, their family carers and even other service users is thought provoking. It includes the difficulties service providers can face trying to manage these tensions (often with limited resources). This chapter does not provide any easy solutions, but service providers will find it useful in inviting them to reflect on their own experiences of assessing risk and the judgements they or their colleagues may make.
Chapter 4, ‘Risk Management’, cites risk assessment and management frameworks and suggests that the reader reflect on the importance of the process and communication of the assessment. The authors highlight the need for frameworks to take into account life histories, and they propose a framework which includes perspective, weight of risk and the consideration of past strategies for managing risk.
Chapter 5, ‘Developing Practice in Risk Management in Dementia Care’, revisits some of the key points discussed in the book, which may be useful for readers wanting a quick recap or to use the book as a guide. The authors also introduce a model to illustrate their view that risk avoidance can be harmful and that there is an optimal level of risk exposure which can enhance quality of life. This chapter picks up an earlier discussion on the stigma that can come with a diagnosis of dementia. However, neither this nor its relationship to risk management are explored in any great depth, although a discussion would have been a useful addition. ‘Future Directions’ is a useful sub-section linking the wellbeing of older people in society with a positive understanding of dementia care. The book concludes with a reiterated ‘Risk and Dementia Assessment Framework’ earlier proposed in Chapter 4.
In summary, this book provides a useful, easy-to-follow guide for practitioners who are involved with delivering services to people with dementia, wanting to better understand and navigate the complexities of risk assessment and management.
