This is Part 2 of Leah Bisiani’s Person Centred Care series – Read Part 1 here
Tom Kitwood, the pioneer of Person Centred Care, states that: “The malignant social psychology damages the client as much as the disease process”.
Older people and people living with dementia are often seen as less human, lacking sensation, emotion, and spirit, where in fact they can enjoy a magnificent quality of life.
Let us appreciate instead, the person as a whole, taking into perspective their entire life transitions, rather than viewing them purely related to their dementia.
It makes sense that implementation of interventions supporting existing ability will assist with slowing rapid decline in function and deterioration.
For example, if a person cannot sequence, then they may have significant difficulty when dressing, working out which item goes first and which last, what goes where, and they may feel under extreme pressure due to the unfair expectation put on them.
Effectively this is setting them up for failure, and the resulting confusion, anxiety, and stress may trigger a catastrophic event.
The involvement of recurring disappointments in any life, can be the source of exasperation and distress.
Solutions to agitation triggered by unfair expectations may include, staying with the person, assisting and providing cues simply, one instruction at a time, throughout, thus improve self-esteem and reduce the possible occurrence of feeling inadequate.
Ongoing praise at each and every small success and accomplishment also promotes value and self-respect.
This attitude will not only ensure further achievement, but assist in maintaining independence for longer, values personhood and self-worth, and could signify a turnaround in how that person with dementia feels about themselves as a whole being.
“Our primary aims should be to create an environment in which people living with dementia are provided with a new beginning at this stage of their lifespan”.
Interventions may include:
- Education, guidance, support, and advice to all caregivers
- Promote change in current cultures and philosophies of care, focusing on person centred care and upholding personhood
- Creating enriching environments that reduce triggers to stress related responses and stimulate the senses
- Catering for individual specific needs, choices and preferences
- Validation of the reality of people living with dementia
- Preservation of respect and dignity with a belief that all people are of value, and are unique
- Placing importance on the continuation of life
- Prevention or minimising obvious risk
- Keeping active in body, mind and soul
- Maintenance of current strengths and independence, self-esteem and self-worth
- Conversion of ill-being to well-being with holistic care – spiritual, religious, sexual, physical, social, cultural and emotional
- Focus on building and retaining relationships and effective interaction/communication
- Promotion of continuity of community
- Preserving the individual’s privacy and confidentiality
The 4 pillars of Person Centred Care
- Uniqueness – Regardless of any medical condition, all people are unique, and this must be acknowledged
- Complexity – Humans are complex beings and a myriad of factors influence the way we see and respond to the world around us. Always consider the level/type of dementia, personality, life history, physical health status, social life etc.
- Enabling - It is all too easy for us to focus on the disability and loss associated with cognitive decline and age. We need to recognise the strengths and abilities of all people and ensure opportunities exist for them to be utilised.
- Value – Person centred care is not just about the way we interact with a person but also recognises the personhood of all people
The Person Centred Care Model
- Consistency in caregiver approach and expectations
- Continuity of past life patterns and preferences
- Respect for personal values, beliefs and worth
- Involvement in decision making
- Support in decreasing or eliminating areas that impede quality of life – maximising autonomy, independ