What is person-centred care?
Person-centred care, a concept pioneered by Professor Thomas Kitwood, is a philosophical approach to care that emphasizes the uniqueness of each person, rather than defining them by their illness. For individuals with dementia, this means seeing past the diagnosis and focusing on their personal history, values, and preferences. It is a holistic approach that builds on empathetic, respectful relationships, and individualized support. The core idea is to create a nurturing social environment that recognizes and values an individual's 'personhood'—the status and worth bestowed on them by others.
Key elements of person-centred care for dementia
- Knowing the individual: Caregivers take time to learn about a person's life story, hobbies, and routines. This knowledge is used to create care plans that feel familiar and meaningful.
- Flexibility and adaptability: Since every individual's experience with dementia is different and changes over time, a flexible care approach is essential. Caregivers adjust routines and activities based on the person's current needs, mood, and abilities.
- Involving the person in decisions: Wherever possible, individuals with dementia are included in care decisions. This respects their preferences and helps them maintain a sense of control and autonomy.
- Creating a positive environment: The physical and social environment is designed to be calming, supportive, and stimulating. Simple elements like familiar music, personal photos, and tailored activities can evoke positive memories.
- Enhancing communication: Communication extends beyond verbal language to include body language, tone of voice, and eye contact. A key practice is validation, where caregivers acknowledge and support a person's feelings instead of correcting factual inaccuracies.
The importance of focusing on personhood
Professor Kitwood's work highlights that personhood is not lost even as dementia progresses. When caregivers disregard a person's emotions and experiences, it can lead to psychological distress. Person-centred care addresses the social and psychological threats to a person's self-worth, which can otherwise lead to damaging a vulnerable person's self-esteem.
- Emotional and mental well-being: By acknowledging the emotional experiences of individuals, this approach helps alleviate the confusion, anxiety, and frustration that often accompany dementia. Studies have shown that person-centred interventions can significantly reduce depression.
- Strengthening relationships: It fosters deeper, more meaningful connections built on trust and respect between caregivers and the people they support. Family members also benefit from learning how to interact more empathetically, reducing their feelings of helplessness.
- Meaningful engagement: By tailoring activities to an individual's personal interests, person-centred care provides a sense of purpose and joy. Examples include listening to favorite music, tending to plants, or looking at a life story book.
- Preserving dignity and independence: Instead of doing things for a person, caregivers assist them in doing things with them, preserving their dignity and helping them maintain functional abilities for as long as possible. Giving choices, even small ones, empowers the person and builds confidence.
Reducing challenging behaviors
One of the most significant benefits of person-centred care is its effectiveness in managing and preventing challenging behaviors and neuropsychiatric symptoms (NPS), such as agitation and aggression. A meta-analysis of multiple studies found that person-centred care interventions reduced agitation, NPS, and depression in people with dementia.
Traditional approaches to dementia often address these behaviors with psychotropic medication, which can have harmful side effects. Person-centred care provides a non-pharmacological alternative by addressing the unmet needs that often lie beneath these behaviors, such as isolation, boredom, or a fear of an over-stimulating environment. By understanding the root cause of the behavior, caregivers can offer reassurance or redirection, promoting a more positive and peaceful state of mind.
Comparison: Person-Centred vs. Traditional Care
| Aspect | Person-Centred Care | Traditional/Task-Oriented Care |
|---|---|---|
| Focus | The unique individual and their personal history, preferences, and emotions. | The disease, its symptoms, and managing daily tasks. |
| Approach | Holistic, flexible, and adaptive. | Institutional, rigid routines, and one-size-fits-all protocols. |
| Communication | Emphasizes verbal and non-verbal cues, uses validation, and builds trusting relationships. | Often focuses on correcting errors or providing instructions, potentially leading to misunderstandings and frustration. |
| Activities | Tailored to personal interests and abilities, providing meaningful engagement and purpose. | Standardized group activities that may not resonate with all individuals. |
| Environment | Personalized spaces with familiar objects, calming elements, and minimized clutter. | Institutional, impersonal settings with little personal detail. |
| Outcomes | Improved quality of life, reduced agitation and depression, enhanced relationships, and preserved dignity. | Focus on physical needs; less attention to emotional and psychological well-being. |
The role of family and caregivers
Family members play a crucial role in providing valuable insights into a person's life history, preferences, and triggers. Caregivers, both family and professional, are empowered through training to implement person-centred practices, which can increase their job satisfaction and reduce burnout. The commitment to this approach benefits the entire care network, improving the overall care experience for individuals with dementia and their loved ones. The Alzheimer Society of Canada emphasizes that person-centred care requires strong leadership and adequate staff training to ensure compassionate, consistent support.
Conclusion
Person-centred care is fundamentally important for people with dementia because it affirms their identity and preserves their sense of self-worth amidst cognitive decline. By moving away from task-oriented models, it fosters a compassionate environment that is tailored to the individual's unique history and needs. The evidence shows that this approach not only improves quality of life and promotes independence but also effectively reduces common behavioral symptoms like agitation and depression. Ultimately, prioritizing the person over the disease ensures dignity, respect, and a more fulfilling life for those navigating their journey with dementia.
