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Aging together: dementia, friendship & flourishingcommunitiesSusan H. McFadden and John T. McFadden. The Johns HopkinsUniversity Press, Baltimore, MD, 2011. 235 pp. ISBN978-0-8018-9986-7 (hardcover). A$52.

The United Nations estimates that by 2050 worldwide morethan one in five persons will be aged over 65 years. Currently,10% of people aged over 65 have Alzheimer’s disease and, ifthe UN projections are realized, the number of people withAlzheimer’s will increase dramatically, rendering the poten-tial for disease burden inestimable. In light of these gloomypredictions, the publication of Susan McFadden and JohnMcFadden’s Aging Together: Dementia, Friendship & Flour-ishing Communities is both refreshing and timely.

The authors persuasively argue that rather than conceiving ofAlzheimer’s as a disease, it must be reconfigured as a condi-tion that affects the brain for any number of biopsychosocialreasons. Ultimately, we must resist all impulses to medicalisethe person with Alzheimer’s and, instead, view the conditionwithin a cognitive framework of identity and personhood.While what the authors propose as being ‘a radical view offriendship’ is a re-conceptualisation of the Aristotelian modelof complete friendship, their discussion of how we mightremain ‘in friendship’ with the person with Alzheimer’s seemsprogressive in the face of current practices and conventionalattitudes. The authors argue for the formation of communi-ties in which we can care for each other without the fear andanxiety that forging relationships and friendships withpeople suffering dementia seems to variously bring.

There are times when sentiments expressed by the authorsjar; convenient and perhaps ill-conceived appraisals offriendship such as ‘it is through relationships that genuinefreedom is expressed’ deny the existence of relationships thatcan equally stifle such liberties. The authors also make spuri-ous assumptions about personhood and community. To be aperson, the authors claim, ‘is to be vulnerable and dependentupon others’. Community, they assert, is ‘a web of relation-ships of mutual dependence and obligation among vulnerablepeople’. Arguably, community may also be associationsbetween like-minded folk who, rather than being completelyvulnerable, can also be interdependent and wholly relational.

Although the authors declare from the outset that, as Chris-tians, they write from a theological worldview perspective, toassume that ‘as soon as we begin to think of relationships asdefining what it is to be human, we have entered the realm ofspirituality’ is to deny that to be human is to also be inrelation with self, which, by implication, must allow us toconcede that being in relationship is not a necessary condi-tion for spirituality. Such personal reflections and beliefs,

however, do not detract from the book’s invaluable andcompassionate contribution to the future welfare of personswith dementia.

While the authors note that the book is ‘addressed primarily topersons who have not given much thought to what will happento their own friendships when forgetfulness increases’, it willalso have broad appeal to those working in the field of agedcare and dementia. Moreover, this book will also appeal to amore general readership with an interest in the dynamics offriendship and how we might come to increasingly value therelationships that can be forged with persons with Alzheimer’sand dementia within intentional communities.

Carol HartInstitute for Social Participation, La Trobe University,Melbourne, Victoria, Australia

Cognitive behavioral therapy with older people:Interventions for those with and without dementiaI. A. James. Jessica Kingsley Publishers, London and Philadelphia,PA, 2010. 256 pp. ISBN 978-1-84905-100-2 (soft cover). RRPA$48.95.

This book provides an overview of cognitive–behaviourtreatment (CBT) for adults, older adults and for those withcognitive impairments. A strength of the book is its emphasison the heterogeneity of older adults. It presents a clearand simple framework for depicting such heterogeneity –proposing that older adults in treatment can be positioned inone of four quadrants of care, depending on their level ofphysical and cognitive impairment. The book challengestherapists to adapt their techniques to take into account theseimpairments, and to base strategies on the formulation of theproblem and client. A variety of strategies is outlined, includ-ing those that are relevant for clients with cognitive impair-ments. To support the overview, the book presents a long listof helpful and current references.

The book is organised in three parts. The first provides anoverview of CBT and adaptations of CBT for older adults,while the second comprises a review of assessment protocols,case formulation models and change techniques. The thirdpart presents two case studies, one about a 67-year-old ladywith depression and the other, a 90-year-old man withdementia. While the first case exemplies that little may berequired to adapt CBT for older adults, the second casehighlights the need to engage carers and staff in modifyingbehaviours of concern.

A weakness of this book, in my view, is that it attempts tocater for beginner therapists, as well as for more advanced

DOI: 10.1111/j.1741-6612.2011.00578.x

241Australasian Journal on Ageing, Vol 30 No 4 December 2011, 241–242© 2011 The AuthorAustralasian Journal on Ageing © 2011 ACOTA