What is person-centred care approach in dementia?

Dementia affects over 55 million people worldwide, highlighting the critical need for compassionate care. The person-centred care approach in dementia shifts the focus from the illness to the individual, promoting a deeper understanding and higher quality of life for those living with the condition.

Quick Summary

Person-centred care in dementia is a philosophy that focuses on understanding and respecting the individual's unique life history, personality, and needs, rather than solely on their diagnosis. It emphasizes building a supportive environment to foster dignity and well-being.

Key Points

• Dignity First: Person-centred care values the unique identity and dignity of the individual with dementia, looking beyond their diagnosis.

• Individualized Approach: Care plans are tailored to the person's unique history, preferences, and emotions, not a one-size-fits-all model.

• Empathy and Validation: Caregivers are trained to validate feelings rather than correct factual errors, reducing distress and building trust.

• Meaningful Engagement: The focus is on providing personalized, purposeful activities and fostering relationships to improve emotional well-being.

• Holistic Well-being: This approach addresses not only physical needs but also emotional, social, and spiritual health, nurturing the whole person.

• Reduced Agitation: By understanding and meeting unmet needs, person-centred care can significantly reduce behavioral challenges associated with dementia.

Understanding the Core Principles of Person-Centred Care

The person-centred approach is not a rigid set of rules but a flexible philosophy rooted in empathy and respect. At its heart, it recognizes that a person with dementia is still a unique individual with a life story, preferences, and emotions. The framework, often associated with pioneers like Tom Kitwood, is built upon several foundational pillars that guide how care is delivered.

Valuing Personhood

This principle acknowledges the intrinsic worth of every person, regardless of their cognitive abilities. It means seeing past the dementia and recognizing the unique self that remains. Caregivers are encouraged to affirm the individual's identity, history, and achievements, reinforcing their sense of self-worth and dignity. This positive validation is crucial for maintaining a person's sense of self and for reducing feelings of distress or anxiety.

Sharing Power

Unlike traditional, hierarchical models where care is dictated by staff, person-centred care promotes a partnership between the caregiver and the person with dementia. This involves encouraging the individual to make choices and participate in decisions about their daily life, such as what to wear, what to eat, or how to spend their time. While cognitive decline can limit decision-making capacity, caregivers can offer simple, manageable choices to maintain a sense of autonomy.

Adopting a Holistic View

The approach looks beyond a person's medical and physical needs to encompass their emotional, social, and spiritual well-being. This involves creating a care plan that is comprehensive and tailored to the individual's entire being. It recognizes that factors like environment, social interaction, and emotional state play a significant role in a person's overall health and happiness.

Providing a Supportive Social Environment

The social atmosphere is a critical component of person-centred care. It involves fostering meaningful relationships and interactions between the person with dementia, their caregivers, and their family. Creating a calm, reassuring, and engaging environment helps to reduce anxiety and promotes feelings of security and comfort. This includes staff training that emphasizes patience, understanding, and respectful communication.

Benefits of the Person-Centred Approach

Implementing this approach has shown significant positive outcomes for individuals with dementia, their families, and caregivers.

• Reduced Behavioral Challenges: When a person's underlying needs (such as loneliness, boredom, or physical discomfort) are understood and addressed, many behaviors that are often labeled as 'challenging' or 'difficult' can be reduced. These behaviors are seen as a form of communication, and personalized care helps interpret and meet those unmet needs.
• Enhanced Well-being: By focusing on the person and their strengths, not just their deficits, this approach helps to preserve dignity, self-esteem, and emotional health. This leads to a higher overall quality of life.
• Improved Relationships: The emphasis on building trusting, empathetic relationships strengthens the connection between the person with dementia and their caregivers. This benefits both parties, reducing caregiver stress and increasing satisfaction.
• Decreased Medication Use: Addressing behavioral and psychological symptoms through non-pharmacological methods, such as engaging activities and environmental adaptations, can lead to a reduced reliance on medications for mood and behavior management.

Practical Strategies for Implementation

Putting person-centred care into practice involves a number of concrete strategies:

1. Create a 'Life Story' Book: Gather details about the person's past, including their hobbies, career, family, and significant life events. This information helps caregivers connect with the person on a deeper, more personal level and tailor activities to their interests.
2. Validate Feelings, Don't Correct: If a person with dementia is confused about time or place, instead of correcting them and causing distress, validate their feelings. For example, if they talk about going to work, you might say, "Tell me more about your job," focusing on the emotions and memories rather than the factual inaccuracy.
3. Adapt the Environment: Make the living space familiar and comforting. This might include using personal mementos, playing preferred music, or using clear, simple signage. A calm, safe environment can significantly reduce agitation and confusion.
4. Offer Meaningful Engagement: Ensure activities are purposeful and aligned with the person's past interests and remaining abilities. This could be anything from gardening to helping with simple household tasks, listening to music, or looking at old photos. For more practical guidance on dementia care, visit the Alzheimer's Society website.

Person-Centred vs. Traditional Dementia Care

Feature	Traditional Care Approach	Person-Centred Care Approach
Focus	Primarily on the diagnosis and managing symptoms.	On the individual's unique identity, history, and preferences.
Care Plan	Often task-oriented and standardized across residents.	Individualized and flexible, adapted to the person's changing needs.
Activities	Scheduled and generic group activities to occupy time.	Meaningful, personalized activities that align with hobbies and skills.
Communication	Often one-way, directive, and focused on practical tasks.	Two-way, empathetic, and aimed at validating feelings and building relationships.
Environment	Functional, institutional, with little personalization.	Homelike, personalized, and designed to promote comfort and safety.
Family Role	Limited to visiting hours and formal meetings.	Active partners, providing essential life story information and feedback.

Challenges and Considerations

While the person-centred approach offers significant benefits, its implementation is not without challenges. One common hurdle is staff training and buy-in. It requires a fundamental shift in mindset from task-based care to relationship-based care, which can take time and resources. Organizational constraints, such as staffing levels and workload, can also make it difficult for caregivers to spend the necessary time building personal relationships and understanding individual needs. Furthermore, as dementia progresses, communication can become more challenging, requiring caregivers to develop and adapt non-verbal communication skills. Overcoming these challenges requires a commitment from all levels of the care organization, from leadership to frontline staff, to create a truly person-centred culture.

The Future of Person-Centred Care

As research continues to shed light on the lived experience of dementia, the shift towards person-centred care is accelerating. Technology is playing an increasingly important role, with innovations like digital memory books and smart environments helping to create more personalized and supportive spaces. The integration of person-centred principles into wider healthcare policy is also gaining traction, ensuring that this approach is not just an ideal but a standard of care. This evolution promises to create more humane and dignified care experiences for the millions affected by dementia, affirming their personhood throughout their journey.

Conclusion

In conclusion, the person-centred care approach in dementia is a transformative shift away from a clinical, disease-focused model. By prioritizing the individual's unique story, emotions, and needs, it empowers caregivers to build meaningful relationships and create a supportive environment that fosters dignity and well-being. Despite implementation challenges, its proven benefits in reducing agitation, improving quality of life, and strengthening relationships make it the gold standard for dementia care. Embracing this philosophy ensures that individuals living with dementia are seen, heard, and respected for who they are.

Frequently Asked Questions

What is the primary difference between person-centred and traditional dementia care?

Traditional care often focuses on managing the symptoms of the disease and following a set schedule. Person-centred care, however, prioritizes the individual's personal history, preferences, and emotions to tailor the care plan to their unique needs.

How does person-centred care benefit individuals with dementia?

This approach leads to several benefits, including reduced agitation and distress, higher quality of life, preserved dignity and self-esteem, and more meaningful social engagement.

What role do family members play in a person-centred care approach?

Family members are integral to this approach. Their knowledge of the individual's life story, hobbies, and preferences is crucial for creating a truly personalized and effective care plan. They are viewed as partners in care.

Can person-centred care help with agitation and other behavioral issues in dementia?

Yes, it can. Many behavioral issues in dementia arise from unmet needs or distress. By focusing on understanding the person's emotions and experiences, caregivers can identify and address the root cause of these behaviors, often reducing or preventing them.

Is person-centred care only for people with mild dementia?

No, the approach is beneficial at all stages of dementia. While communication may change as the disease progresses, the principles of valuing personhood, validating emotions, and providing a supportive environment remain vital throughout the journey.

How can a caregiver learn to practice person-centred care?

Caregivers can undergo specialized training that focuses on communication techniques, empathy, and understanding a person's individual needs. Resources like workshops and dementia-specific care training programs are available to help develop these skills.

Does person-centred care mean abandoning all routine?

Not at all. While the approach emphasizes flexibility, it does not mean discarding all routine. Instead, it involves adapting routines to the individual's needs and preferences, creating a sense of security and familiarity rather than rigid, institutional schedules.