The Shift from a Medical to a Personal Model
For decades, the dominant medical model viewed dementia primarily through the lens of cognitive deficits and symptoms. The person with dementia was often defined by their diagnosis and the capabilities they had lost. This perspective can lead to a dehumanising, task-oriented care system, where routines and medical management override the individual's needs and preferences.
Developed in the UK by Professor Tom Kitwood in the 1980s, the person-centred approach was a radical departure from this model. Kitwood championed the concept of 'personhood'—the intrinsic uniqueness and value of every individual, regardless of their cognitive impairment. A person-centred approach views dementia as a personal experience shaped by the interplay of an individual's personality, life story, physical health, and social psychology. It reframes the condition as a journey where the person remains at the heart of their care, and their strengths and abilities are recognised and celebrated, not just their deficits.
Key Pillars of the UK Person-Centred Approach
Understanding the Individual
At the core of the person-centred approach is the understanding that to provide effective care, one must first know the person behind the diagnosis. This involves more than just their medical history; it requires building a detailed 'life story' or 'getting to know me' profile. This profile includes:
- Personal history: Significant life events, career highlights, family, and relationships.
- Interests and hobbies: Favourite music, pastimes, and cherished activities.
- Preferences: Likes, dislikes, and daily routines related to food, sleep, and social interaction.
- Culture and beliefs: Religious or spiritual practices, as well as cultural norms that shape their perspective.
By gathering this information, caregivers can create a personalised care plan that resonates with the individual's identity, fostering a sense of continuity and familiarity that is crucial for emotional well-being.
Valuing Relationships and Communication
The person-centred approach places significant emphasis on the quality of human relationships. It views a person with dementia as a 'social being' whose sense of self-worth is maintained through positive social interactions. Caregiving is therefore seen as a partnership built on trust, respect, and empathy, rather than a hierarchical relationship where one person is in control.
Effective communication is paramount and adapts as the person's abilities change. This involves:
- Non-verbal cues: Paying close attention to body language, tone of voice, and facial expressions.
- Validation: Responding to the individual's feelings rather than correcting factual errors or challenging their perception of reality.
- Simple language: Using clear, concise language and asking simple, closed questions to avoid overwhelming the person.
Creating a Supportive Environment
The physical and social environment plays a critical role in the person's experience of dementia. A person-centred approach advocates for creating a safe, familiar, and stimulating environment that reduces anxiety and enhances independence.
Strategies in this area include:
- Familiar surroundings: Maintaining a home-like setting, particularly in residential care, to promote feelings of comfort and 'at-homeness'.
- Sensory stimulation: Using personalised décor, familiar music, or gardening activities that evoke positive emotions and memories.
- Clear signage: Using visual cues and colour-coding to help with orientation and navigation.
Empowering Autonomy and Choice
Despite cognitive decline, individuals with dementia retain the right to make choices about their own lives and care. This is protected under UK law, such as the Mental Capacity Act 2005. The person-centred approach works to maximise autonomy, respecting the person's preferences and involving them in decisions wherever possible.
This can be achieved by:
- Offering small choices: Such as what to wear or eat, to give them a sense of control over their day.
- Using advance care planning: Allowing individuals to make decisions about their future care while they still have the mental capacity to do so.
- Encouraging independence: Finding the right balance between offering assistance and allowing the person to continue with tasks they are capable of.
Comparison: Person-Centred vs. Traditional Care Models
| Aspect | Person-Centred Approach | Traditional/Task-Oriented Approach |
|---|---|---|
| View of Dementia | Sees the person behind the diagnosis; dementia is one part of their story. | Views the person through the lens of their diagnosis and cognitive deficits. |
| Focus of Care | Holistic well-being, dignity, and personal identity are paramount. | Focuses primarily on managing symptoms, medical needs, and task completion. |
| Patient Involvement | Involves the individual (and family) in all care decisions where possible. | Follows predetermined routines and protocols with little individual input. |
| Communication Style | Emphasises empathy, validation, and non-verbal cues. | Relies on verbal instruction, potentially causing frustration or anxiety. |
| Environment | Adapts the environment to be familiar, safe, and stimulating. | Often institutional and lacks personalisation. |
| Outcome Measures | Qualitative improvements in well-being, mood, and social engagement. | Quantifiable clinical outcomes and task completion rates. |
Implementation in the UK Healthcare Context
Implementing a person-centred approach across the UK healthcare landscape presents challenges, particularly in balancing it with existing systemic pressures. Care providers face hurdles such as understaffing, time constraints, and the difficulty of measuring person-centred outcomes compared to more traditional, clinical metrics. However, organisations like the Alzheimer's Society provide crucial guidance, training, and resources to help formal caregivers and families adopt this model effectively.
The Care Quality Commission (CQC), the independent regulator of health and social care in England, also places a strong emphasis on person-centred care in its regulations. It mandates that providers ensure service users receive appropriate care that meets their needs and preferences, actively seeking their views on their care and treatment.
Moreover, the development of personalised budgets in England is a policy initiative designed to extend individuals' choice and control over their social care, aligning with the principles of person-centred care. While this presents its own challenges, especially for those with declining capacity, it reflects a wider ambition to empower individuals with dementia.
Conclusion: A Paradigm of Compassion and Dignity
In the UK, the person-centred approach represents a fundamental paradigm shift in how dementia is understood and managed. Rather than defining a person by their illness, it honours their individuality, history, and emotional well-being. By focusing on relationships, respectful communication, and personalised support, this model empowers people with dementia to live with dignity and purpose. While its implementation faces systemic challenges, the widespread adoption of its principles across UK healthcare and social care remains vital for providing compassionate and effective dementia care for the future.
For more detailed guidance on supporting a person with dementia, the Alzheimer's Society provides extensive resources on their website [https://www.alzheimers.org.uk/].
