Supportive Care for the Person with Dementia. Edited by Julian Hughes, Mari Lloyd-Williams & Greg Sachs. Oxford University Press. 2009. £59.95 (hb). 330pp. ISBN: 9780199554133

This is a book covering the care for people with dementia, from diagnosis to death. The ‘supportive care’ of the title refers to a model developed to guide the comprehensive support of people with a variety of long-term, life-shortening conditions. The approach owes a lot to the philosophy of palliative care in its attention to biological, psychological, social and spiritual needs but these considerations are extended, within supportive care, to encompass diagnosis, curative and life-prolonging treatments as well as palliation and dying. The book itself is one of a series of volumes focused on different diseases and is the first to apply this framework to dementia.

One of the delights of the book is the range of writings, with no fewer than 32 chapters packed into its 300 or so pages, including many contributions from well-known names as well as some newer voices. There are chapters from psychiatrists and old age physicians, general practitioners and palliative care specialists, psychologists, philosophers and many more besides. The mix is greatly enriched by contributions from individuals with dementia and family members of people with dementia, as well as chapters on often neglected topics such as Huntington's dementia and dementia in low-income countries. Overall the content provides an excellent and broad-based distillation of up-to-date knowledge. I imagine that for every open-minded reader it will provide fresh insights and new titbits of knowledge.

I blew hot and cold about the supportive care framework. The first chapter provides a seductive start for those of us who tire of the self-righteous positioning of biomedical and person-centred approaches. It holds out a promise of an all-singing, all-dancing way of ensuring that people with dementia get the services they deserve: ‘a complete mixture of biomedical dementia care, with good quality, person-centred, psychosocial, and spiritual care under the umbrella of holistic palliative care throughout the course of the person's experience’ (p. 7). But a recipe for something so ambitious is impossible to deliver. The final chapter eloquently summarises the strata of understanding that make up the model, but the third layer, the so-called logistical steps through which the model is put into practice, is sidestepped on the basis that application is context dependent. Frustrating! However, grand aspirations can be infectious and I find myself looking forward to a future volume reporting the improvements in care that have been introduced as a result of applying this approach.