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, independence and participation
- Relate to the person rather than the illness
The Care Environment
- Provision of an environment and experience that is enriching and meaningful
- Recognise the importance of working in partnership with family and friends of the person
- Commitment to personalised care
- Leadership by senior carers that promotes ownership of the core principles of person centred care
- Knowledgeable and consistent carers who are encouraged to be positive, creative and flexible
- Well-designed/homelike environment – avoid clutter – do not change
Creating ill being from well-being
- Rule out and resolve immediately depression/delirium
- Concise and accurate assessment/interview and specific individualised care planning
- Management of other comorbidities – eg. Pain, breathlessness, blood ppressure
- Reduce chemical restraint/use of sedatives/polypharmacy
- Abolish physical restraint
- Homelike safe environment
- Establish relationships/rapport/communication based on the person’s abilities
- Treat with respect, and dignity
- Sensory stimulation whilst ensuring over/under stimulation does not occur
- Provide praise to boost self-esteem and remove unfair expectations based on capability
- Create positive situations to experience success and feel needed, valuable and worthwhile
- Include in day to day living, but simplify activity towards need
- Rest periods/recuperation time – especially as progression of dementia occurs
- Use validation, reminiscence, memory aids
- Maintain a sense of humour – laughter is truly the best medicine – SMILE!
- Affection and touch – massage, hold hands, a cuddle, a kiss on the cheek
- Physical activity and exercise catered to needs
Examples of daily activities that are meaningful or purposeful, and not just a diversion, so as to continue life as the person knows it:
- Domestic life: baking, preparing morning tea, setting tables, wiping tables, washing dishes, folding washing.
- Outdoor life: walking, raking leaves, sweeping, gardening, feeding pets, small repair jobs, outdoor men’s sheds.
- Social life: shopping, outings, visiting a park, going to the beach, movies, attending a concert, games, exercise.
- Artistic life: painting, drawing, crafts, knitting, decorating, making cards, flower arranging, singing, instruments.
- Personal life: facials, hand massages, manicures, looking at photos, pets, radio stations.
- Individual life: activity board projects, sorting objects, reading, games, writing letters or cards.
- Work life: working at a desk, using a computer, ledger books, counting money, other tasks related to past
- Physical life: Tai Chi (or tai chair), yoga, strength training, dance, walking groups, swimming, standing and seated exercises.
“At a time when an older person is experiencing the most dramatic changes in their life, they cannot be placed in a situation where who they are, and have been, becomes secondary to the priorities and demands of where they are, or who is caring for them. Becoming older, living with dementia and/or having conditions that debilitate, does not mean losing oneself or one’s humanity. If needs are not met effectively, then that person is likely to deteriotarate, thus withdraw into their own personal, lonely reaity. However if neeeds are met then a person is able to embrace life and their personhood once more, and again retain that distinct and integral place they hold in the world”.
“The person is considered to be the best judge of whether or not his/her needs are being met”.