The Foundational Principles of Person-Centred Care
Person-centred care, pioneered by psychologist Tom Kitwood, is a framework that prioritizes the unique human being behind the dementia diagnosis. It is founded on the belief that a person with dementia still retains their personhood and intrinsic worth. This model views challenging behaviours not as symptoms to be managed, but as a form of communication signaling unmet needs or discomfort.
Key principles include:
- Valuing the Individual: Recognizing the person beyond their cognitive impairment, including their past accomplishments, personality, and life story.
- Understanding Their Perspective: Attempting to comprehend the world from their point of view, even if it differs from reality, and validating their feelings.
- Focusing on Strengths: Highlighting and nurturing remaining abilities and interests, rather than focusing solely on deficits.
- Fostering Relationships: Cultivating meaningful connections built on trust, respect, and emotional bonds with caregivers and family.
Practical Strategies and Tailored Activities
To effectively implement person-centred care, practical, everyday strategies are essential. These approaches must be flexible and adaptable, as the needs of a person with dementia change over time.
Practical Strategies
- Creating a 'Life Story': This involves documenting a person's background, values, relationships, and significant life events. This information is invaluable for caregivers to tailor interactions and activities that are personally meaningful.
- Involving the Individual in Decisions: Wherever possible, offer choices to maintain a sense of autonomy. For example, instead of asking, “What would you like to do?”, try offering limited options like, “Would you like to listen to music or sit outside in the garden?”
- Adapting the Environment: Modify the physical space to be supportive and calming. Use clear signage, personal photos, and objects that hold special memories. Good lighting and minimal clutter can reduce confusion and anxiety.
- Meaningful Engagement: Activities should be purposeful and based on past interests. For instance, a former baker might enjoy simple kitchen tasks, or a lifelong gardener could find joy in tending indoor plants.
Communication Techniques
As verbal communication declines, adapting one's communication style is critical. Effective strategies include:
- Using a calm, gentle tone and maintaining eye contact.
- Simplifying language and avoiding complex sentences or abstract concepts.
- Using non-verbal cues, such as gestures or a comforting touch, to convey reassurance.
- Practicing validation rather than correction. If the person believes they are in a different time, discuss the memories rather than correcting the factual error. This respects their reality and builds trust.
Comparison: Person-Centred vs. Traditional Care
Understanding the contrast between person-centred and traditional care models highlights the benefits of the modern approach.
| Aspect | Person-Centred Care | Traditional Care (Older Model) |
|---|---|---|
| Primary Focus | The individual's unique preferences, history, and strengths | Managing the disease symptoms and maintaining schedules |
| Goal | To enhance quality of life, well-being, and dignity | To ensure basic safety and physical needs are met |
| Communication | Empathic listening and validation; non-verbal cues | Often task-oriented and authoritative |
| Behaviour | Seen as a form of communication for unmet needs | Often viewed as a "problem" to be controlled |
| Environment | Adapted to be familiar, stimulating, and calming | Standardized and institutional |
| Activities | Meaningful, personalized engagement | Routine activities designed for a group |
Implementing a Person-Centred Plan
- Gather the Life Story: Work with family, friends, and old photos to create a comprehensive picture of the individual's life, interests, and routines. The earlier this is done, the more accurate it will be. This is a critical first step towards personalization.
- Assess Current Abilities: Continuously observe and assess what the person can still do. Focusing on their remaining skills helps encourage independence and maintains a sense of purpose.
- Tailor the Daily Routine: Build a flexible daily schedule around the individual's history and current capabilities. This provides structure and predictability, reducing confusion and anxiety.
- Create a Supportive Environment: Use personal effects and familiar sensory inputs like music or smells to create a comfortable, reassuring space. Adapt the physical layout for safety and ease of movement.
- Educate the Care Team: All caregivers, including family members, should receive training on person-centred principles, communication techniques, and understanding behavior as communication.
- Involve the Family: Keep family members informed and involved in care discussions. Their insights are invaluable and their participation can strengthen the care process and overall support network.
- Monitor and Adapt: Dementia is progressive, so the care plan must evolve. Regularly evaluate the effectiveness of strategies and be prepared to make adjustments as needs change. Tools like dementia-care mapping can help measure success. More information on such tools can be found via the National Institutes of Health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136800/
Conclusion
Supporting individuals with dementia using person-centred approaches is a compassionate and effective way to elevate their quality of life. By focusing on their unique story, validating their emotional reality, and adapting care to their changing abilities, we can foster well-being, reduce agitation, and preserve their dignity. This framework not only benefits the individual but also strengthens relationships and provides a more fulfilling caregiving experience for everyone involved.
