Foreword - Bob Price

People are said to 'suffer from dementia'. In the 1960s, when I first came into contact with people with dementia, there is no doubt that there was a lot of suffering. 'Senile dementia', as it was known in those days, was considered to be an inevitable consequence of ageing. Residential care took place mostly in asylums for the mentally ill. The overcrowded wards were characterised by long dark corridors that smelt of human excrement and the pervading odour of the favoured drug, paraldehyde. Staff might have been well meaning, but care was purely custodial and reflected attitudes of cynicism and pessimism. Conditions gradually improved, but it was not until 1987 that 'senile dementia' was removed from the Mental Health Act of New South Wales.

Over the past twenty years there has been a complete revolution in our understanding of dementia, and the ignorance of the 1960s and 1970s has been filed in the archives of past practice. Although there is still no prevention or cure for the diseases that cause dementia, we can now say with confidence that we do know how to care for people with dementia. Today we say that there are 'people with dementia' but we do not accept that they have to 'suffer' because of it.

For each person the journey to 'dementia land' is a unique experience. Each person travels it in an individual way. Along that road there are numerous negative forces that are capable of triggering the uncomfortable emotional responses that underlie the unwanted challenging behaviours of dementia. On the other hand, there are many opportunities for people with dementia to enjoy success, to feel safe, and even to have fun.

Contemporary care practice recognises that individuals with dementia are unable to identify and avoid pitfalls on their journey. Similarly, they are unable to imagine and seek out their own opportunities for positive emotional moments. Their destiny is in the hands of their caregiver...