The Roots of Person-Centred Dementia Care
Before the widespread adoption of the person-centred model, dementia care often followed a medical, deficit-focused approach. Care typically centered on managing symptoms and individuals were sometimes institutionalized without adequate support for their identity or emotional needs. Tom Kitwood, collaborating with Kathleen Bredin, significantly challenged this perspective, coining the term "malignant social psychology" to describe the negative social interactions that can harm individuals with dementia. He proposed that many observed behavioral and psychological issues were not solely due to the disease but were exacerbated by the social environment and how the person was treated.
Kitwood's framework was influenced by Carl Rogers' client-centered therapy, adapted for people living with dementia. A key tenet of Kitwood's approach is that a person's identity, or "personhood," can be maintained through respectful relationships. According to Kitwood, personhood is a status bestowed upon one human being by another within a relationship and social context. His impactful 1997 book, Dementia Reconsidered: The Person Comes First, was pivotal in establishing this new care philosophy.
Key Components of Kitwood's Model
Kitwood highlighted the importance of meeting core psychological needs to support personhood. These needs include love, comfort, identity, inclusion, occupation, and attachment. Dementia Care Mapping (DCM), an observational tool developed by Kitwood, is designed to evaluate and enhance care quality by focusing on the experiences of people with dementia.
A Comparison of Care Approaches
The person-centred model contrasts with traditional approaches. Key differences include the primary focus (the disease vs. the whole person), care delivery (task-oriented vs. relationship-oriented), interpretation of behavior (problematic symptoms vs. unmet needs), environment (clinical vs. homelike), autonomy (minimal vs. maximized choice), role of family (limited vs. integral partners), and the goal of care (managing symptoms vs. maintaining personhood and quality of life).
The Evolution and Influence of Person-Centred Care
Kitwood's person-centred approach is a cornerstone of modern dementia care and has been globally implemented and further developed. The VIPS model (Valuing the person, treating people as Individuals, understanding their Perspective, and creating a positive Social environment) by Dawn Brooker offers practical guidance. Initiatives like The Eden Alternative also align by focusing on supportive living environments. Challenges like staffing and time limitations persist, but the approach offers benefits like reduced agitation and improved quality of life. It also strengthens caregiver connections.
Conclusion
Psychologist Tom Kitwood, with Kathleen Bredin and influenced by Carl Rogers, primarily developed the person-centred approach to dementia care. This work shifted understanding beyond a medical view to one considering biological, psychological, and social factors. By focusing on the personhood and dignity of individuals with dementia, Kitwood established an influential care framework. Though challenges in full implementation exist, the person-centred model's impact lies in valuing the individual at the core of care. You can find more information about Kitwood's work and related concepts on {Link: academic.oup.com https://academic.oup.com/mtp/article/41/2/198/7221285}.
