What is an approach staff can use with those who have dementia? A Guide to Person-Centered Care

Roughly 55 million people worldwide are living with dementia, a number projected to increase significantly over the coming decades. This reality emphasizes the critical need for effective care strategies, prompting the important question: what is an approach staff can use with those who have dementia? This guide offers authoritative insights into person-centered care, a vital framework for improving quality of life.

Quick Summary

The most effective approach for staff is person-centered care, which tailors strategies to the individual's unique needs, history, and preferences. It focuses on compassionate communication, consistent routines, validating feelings, and creating a supportive, predictable environment to reduce confusion and agitation.

Key Points

• Person-Centered Care: Focus on the individual's history, personality, and preferences, not just their diagnosis.

• Communicate with Empathy: Use simple, clear language, maintain eye contact, and validate feelings instead of correcting false realities.

• Create a Consistent Routine: Minimize confusion and agitation by establishing and maintaining a predictable daily schedule.

• Optimize the Environment: Reduce sensory overload and add familiar, personal items to increase comfort and security.

• Interpret Behavior as Communication: Look for the unmet need or trigger behind challenging behaviors, and address the cause rather than the symptom.

• Engage with Purpose: Utilize activities like reminiscence therapy, music, or sensory stimulation to foster connection and joy.

Understanding Person-Centered Care

At its core, person-centered care is an empathetic and respectful philosophy that places the individual with dementia, not the disease, at the center of all care decisions. This approach moves beyond simply managing symptoms to focusing on the person's remaining strengths, preferences, and life story. It recognizes that every individual's experience with dementia is unique, requiring personalized strategies rather than a one-size-fits-all model.

The Pillars of Person-Centered Care

Four main pillars support effective person-centered care:

1. Valuing the Individual: Recognizing the person's intrinsic worth and dignity, independent of their cognitive abilities. Staff strive to see the person beyond the diagnosis, acknowledging their past roles, relationships, and contributions.
2. Respecting Their Reality: Instead of correcting misperceptions or arguing about facts, staff enter the individual's reality. This avoids causing distress and builds trust by validating their feelings and emotions, which are very real to them.
3. Encouraging Independence and Choice: Empowering the person by offering choices in their daily life, no matter how small. This can include choosing their clothes, meals, or activities, which helps maintain a sense of control and self-worth.
4. Creating a Supportive Environment: The physical and social environment should be tailored to promote comfort, security, and engagement. This means minimizing noise and clutter, using clear signage, and incorporating familiar objects and photos to help orientation.

Communication is Key

For staff seeking to implement a successful approach, communication is the most critical tool. As dementia progresses, verbal communication can become challenging, making non-verbal cues and simplified language essential.

Effective Communication Techniques:

• Maintain a calm and respectful tone. Avoid speaking in a patronizing or condescending way, known as 'elderspeak'. People with dementia are highly sensitive to tone, body language, and emotions, even when words fail them.
• Use simple, direct language. Break down instructions into single, easy-to-follow steps. Instead of, "Let's go get dressed for lunch," say, "Let's put on your sweater," and pause for them to complete the action before the next step.
• Use non-verbal communication. Maintain eye contact at their level, use gentle touch (if appropriate), and use warm facial expressions to convey reassurance and affection. These actions can communicate care far more effectively than words.
• Be a detective. When a person struggles to find a word, look for clues in their body language or the context to understand their meaning. Asking clarifying questions like, "Are you talking about the cat?" is better than constantly correcting them.
• Wait and be patient. Allow plenty of time for the person to process what you've said and to formulate a response. Rushing them can cause anxiety and frustration.

Environmental and Behavioral Strategies

Beyond direct communication, staff can use practical, environmental strategies to support individuals with dementia.

Creating a Calm and Predictable Environment

• Establish consistent daily routines. A predictable schedule for meals, bathing, and activities can reduce anxiety and confusion. This consistency acts as a memory aid and provides a sense of security.
• Reduce sensory overload. Minimize background noise from radios, televisions, and loud conversations. Clutter-free spaces are less confusing and reduce the risk of falls.
• Enhance visual cues. Clear signs with pictures and large text for bathrooms or bedrooms can help with orientation. Using contrasting colors for furniture and walls can also help with spatial awareness.
• Incorporate personalized elements. Familiar photos, cherished belongings, or objects from a person's life story can create comfort and a sense of identity. These items can also serve as prompts for reminiscence therapy.

Managing Behavioral Challenges

Behavioral expressions in dementia are often a form of communication, signaling an unmet need or discomfort. Rather than being seen as defiant or difficult, they should be interpreted with curiosity and empathy. The National Institutes of Health provides insights into managing neuropsychiatric symptoms associated with dementia.

• Identify the trigger. Observe the situation closely to determine what may have prompted the behavior. Is the person in pain, hungry, tired, or overstimulated? Address the underlying cause instead of the symptom.
• Validate feelings, redirect focus. If a person is distressed, acknowledge their feelings first, such as, "You seem upset." Then, gently redirect their attention to a calming or engaging activity.
• Maintain flexibility. What works one day may not work the next. Staff need to be adaptable and ready to try a different approach. Acknowledge that the disease is a process of constant change.

Comparison of Traditional vs. Person-Centered Care

Aspect	Traditional Care Approach	Person-Centered Care Approach
Focus	Managing symptoms and controlling behavior.	Understanding the individual and their needs.
Communication	Correcting misinformation; direct instructions.	Validating feelings; simple language; non-verbal cues.
Environment	Standardized, institutional setting.	Personalized, homelike, and supportive environment.
Routine	Strict, non-negotiable schedule.	Flexible, personalized routine that provides comfort.
Individual	A patient with a disease.	A unique person with their own life history and preferences.
Behavior	Seen as a problem to be fixed.	A form of communication signaling an unmet need.

Specialized Techniques and Activities

Engaging individuals with dementia in meaningful activities can significantly improve their mood and quality of life.

• Reminiscence Therapy: Using prompts like photos, music, or familiar objects to encourage discussion about past life events. This taps into long-term memories that often remain intact.
• Music Therapy: Playing favorite music can be highly therapeutic, evoking powerful memories and emotions and often improving mood and communication.
• Sensory Stimulation: Utilizing activities that engage the senses, such as aromatherapy, holding a soft blanket, or listening to soothing sounds.
• Montessori Method: Adapting tasks to a person's remaining skills to promote independence and meaningful engagement. This involves using simple, visual cues and breaking tasks into manageable steps.

Conclusion

The most effective approach staff can use with those who have dementia is undoubtedly person-centered care. By prioritizing the individual, practicing compassionate communication, and creating a supportive environment, staff can foster dignity and improve well-being. This requires empathy, patience, and a commitment to understanding the unique perspective of each person living with dementia. It is not about fighting the disease, but about supporting the person and enriching their life, day by day, moment by moment.

Frequently Asked Questions

How should staff handle repeated questions from someone with dementia?

When a person with dementia asks the same question repeatedly, the best approach is to answer patiently and calmly each time. Avoid showing frustration or pointing out that they've already asked. Sometimes, offering a comforting distraction or engaging them in a simple activity can help.

What is the best way to deal with agitation in a dementia patient?

First, try to identify the cause of the agitation, which may be an unmet need like pain, hunger, or discomfort. Remain calm and use a soothing voice. Redirect their attention to a calming activity or a quiet space. Avoid arguing or becoming agitated yourself.

Is it okay to use 'fibbing' or therapeutic lying in dementia care?

Yes, it is often a compassionate strategy. Instead of correcting a person with dementia and causing them distress (e.g., telling them their deceased spouse isn't coming home), entering their reality is often kinder. The goal is to avoid conflict and maintain their emotional comfort.

How can staff help a person with dementia maintain independence?

Staff can encourage independence by breaking down tasks into smaller, manageable steps. Offer limited choices, such as "Would you like the blue shirt or the red one?" rather than asking, "What would you like to wear?" Focus on what the person can still do, rather than what they have lost.

Why is a consistent routine so important for those with dementia?

A consistent routine provides a sense of predictability and security, which reduces anxiety and confusion. It helps individuals anticipate what will happen next and can trigger muscle memory for certain tasks, allowing them to participate more successfully.

How do non-verbal cues affect communication with dementia patients?

Non-verbal cues like tone of voice, facial expressions, and body language are extremely important. As verbal communication declines, a person with dementia becomes more reliant on these signals. A gentle, warm demeanor can communicate trust and safety, while frustration can cause alarm.

What if a staff member becomes frustrated while caring for someone with dementia?

It is crucial for staff to recognize their own feelings of frustration and seek support. Caregiving is demanding, and it's normal to feel this way. Taking a short break, talking to a supervisor, or using stress-reduction techniques can help. Staff training on dementia care includes coping strategies for these situations.