Elizabeth MacKinlay has established herself as a leading voice in the area of the pastoral care of older people. She combines her work as an Anglican priest with that of the Director of the Centre for Ageing and Pastoral Studies in Canberra, Australia. She is also chair of the Australian Capital Territory Ministerial Advisory Council on Ageing. Her book Spiritual Growth and Care in the Fourth Age, also published by Jessica Kingsley, won the 2006 Australasian Journal of Ageing book award. The genre of this book is familiar to British readers, in gathering together the papers from a national conference on ‘Ageing and Spirituality’ hosted by MacKinlay's centre. The aim of the book is to explore the effects of disability on people in later life and it focuses on how people with either life-long disabilities or acquired disabilities of ageing may live spiritually meaningful lives. The book presents ways of moving towards more effective relationships between carers and older people with disabilities; ways in which to connect compassionately and beneficially with the spiritual dimension of an individual. The contributors emphasise the importance of recognising and affirming one's personhood, rather than focusing on one's disability. Writers here highlight the value of relationship in giving meaning to life as a basis for exploring and honouring a person's unique individual spirituality. Some key questions that the book hopes to answer might be summarised as follows. What does it mean to live with disabilities? What does it mean to be a person with disabilities? What does it mean to care for someone who has disabilities? How does spirituality assist people in living with disabilities and what spiritual strengths can be drawn on by carers?

There are 17 chapters including MacKinlay's introduction (Chapter 1) and conclusion (Chapter 17). The authors are all Australian with the exception of Malcolm Goldsmith (Chapter 10) and John Swinton (Chapter 2). The book largely succeeds in its aspirations and emits the inevitable unevenness of writing, but there is a wealth of treasure within the chapters. There is energy and engagement and passion as practitioners attempt to find a voice with which to express their aspirations to develop more effective and creative relationships between carers and older people. From this reviewer's perspective the more stimulating articles came from those individuals who were reflecting on their own experience of older people and care. Subject areas covered include reminiscence, depression, music therapy, art, ritual, humour, memory, community and the multi-faith dimension and perspective. In these essays the reader is reminded that it is almost impossible to give an overall account of the sheer diversity of ways in which people age, but that there is a growing body of knowledge about the pastoral and personal challenges that face those people who fall out of the category of ‘ageing well’. The essays on dementia are particularly good for the authors challenge the reader to see dementia in a different framework and profound wisdom is offered about personhood and our values.

Three particular challenges are offered by this reviewer. First, in our secular age, set amongst a market place of spiritual associations and commitments, the book lacks any critical exploration of the meaningfulness or otherwise of theological language. Perhaps more space might have been given to examine the usefulness of theology and theological discourse as a tool in our approach to the spiritual care of older people. There is much more work to be done in this area. Secondly, the book lacks any discussion of the socio-economic dimension. Sadly, the quality of care, its organisation and delivery, is bound up with any society's preparedness to invest and release resources to develop innovative and quality services to older people, especially those living with dementia. It was surprising that this issue was not discussed at any length in the book, where one's ability to cope with disability surely is shaped by the economics of the social-care world.

Thirdly, in cultural terms, many of us have appreciated the releasing opportunities that have emerged from wanting to shift the paradigm of old age from that of diminishment, decline and death to something more positive and creative. The debate and rhetoric around age is surely and properly dominated by those living in the Third Age who see growing older as an adventure and not a problem. Is this rhetoric simply a way of putting off the inevitabilities of living with some kind of disability as the Fourth Age impacts upon us? What is the relationship between these two paradigms and how can we balance optimism about the possibilities of age with a realism about the inevitable diminishments associated with the ageing process? Are we ever to be liberated from such denials? While this is not part of this book's brief, spirituality and the ageing process must always, surely, be discussed within these wider cultural and social paradigms. We look forward to MacKinlay's future work and hope that she will continue to hold before us the importance of an approach to the older person which takes in all of their needs, including the spiritual. It is to be hoped that her Centre will also be able to give voice to those practitioners who have something important and powerful to say about their lived experience of working with older people.