4 Person centred care

Tom Kitwood was a psychologist and a pioneer in the field of dementia care. He was a senior lecturer at Bradford University in the 1980s where he researched and wrote about ‘person centred’ dementia care. His aim was to understand, as far as is possible, what care is like from the person with dementia’s point of view.

His book ‘Dementia Reconsidered’ written in 1997 brought together much of his work and is still widely used today. He was very keen to challenge the way that people with dementia are treated and to move away from viewing dementia from purely a medical viewpoint.

He identified a number of psychological and social factors which people need to have met in order to maintain well-being. These are illustrated in the diagram below.

Psychological and social factors which people need to have met in order to maintain well-being

Psychological and social factors which people need to have met in order to maintain well-being

To practice person centred care it is necessary to focus on these needs by using responses and approaches that help to:

Uphold the person’s identity
For example:

  • Respecting the person by addressing them by the name they wish to be called
  • Seeking out opportunities to explore the life history of the person through talking to friends and family members.

Engage the person in occupation
For example:

  • Supporting and encouraging the person to engage in meaningful tasks at whatever level the person is able and comfortable to do.

Provide comfort
For example:

  • Demonstrating warmth and acceptance of the person when talking with them.

Enable attachment
For example:

  • Recognising the important feelings a person may have for past or present relationships.
  • Being sensitive to recognise the person’s sense of reality.

Include the person in what is happening
For example:

  • Enabling a person to be involved both physically and psychologically.

Upholding these needs will have an effect on the person’s well being. Not having these needs met will potentially lead to ill being, that is feelings of distress and discomfort.

Person centred care in practice – key difficulties and suggested responses

Responding to the person with dementia when the person is confused by past memories.

Person centred care in practice

Person centred care in practice

If a person with dementia is drawing from memories from the past the person might say such things as:

  • ‘Where is my mother?’
  • ‘I need to go home to get the tea’

When this happens:
Consider if it is possible to orientate the person to reality

Can the person be reassured about where they are in the ‘here and now’?
If ‘Yes’, then provide reassurance and prompts/cues to help the person keep in touch with this information.
i.e: visual cues such as pictures/symbols/written words on notices/cards

If however the person is distressed when confronted with the facts of the situation and this distress is difficult for the person to manage then
It might be helpful at these times to consider a number of different approaches such as,

Validating the person’s feelings. For example:
‘Are you feeling lost without your mum?’
‘You seem very sad not finding your mother’.
‘You seem to really miss your mum’.

Explore past memories

Explore past memories

Explore past memories that the person is experiencing
‘What was your mother like?’
‘Can you tell me about your mother?’

Provide reassurance and comfort
‘It seems very upsetting for you to be still looking for your mother, I’m sure things are ok’.
‘I can see you are upset and worried but it will be all right’.
‘I know you are worried but things are taken care of’.

Further learning
For more information on the Bradford Dementia Group, see http://www.brad.ac.uk/health/career-areas/bradford-dementia-group/ or join the Bradford Dementia Group on Facebook to keep up to date with news and events http://en-gb.facebook.com/pages/Bradford-Dementia-Group/159919097355319

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