2.4 Person Centred Approach

Aim

To manage the relationship with the person living with dementia, developing a relationship of trust and a good relational climate, starting from their habits and desires (person centred care).

Learning outcomes

At the end of this topic, you will:

• Be able to work alongside the patient’s personality by focusing on the resources and defense mechanisms of the person, ensuring that their wishes are paramount
• Appreciate the person with dementia as a unique and equal person despite the dementia
• Try to understand what is best for the person with dementia from that person’s point of view.
• Protect the person’s self-determination.

Introduction

Reference is made in particular to the method of Tom Kitwood in the eighties, who affirmed a more psychosocial approach to the health of people in general and to people with dementia in particular.

• For the carer and the person with dementia, the pleasure of eating, the pleasure of moving and daily activities together with the person with dementia.
• Food and eating play an important role in maintaining quality of life, providing pleasure, as well as their important role in maintaining health.

2.4.1 Relationship

The caregiver cannot do anything about the personality of a person with dementia, but he/she can take into account his/her background, resources and limitations. Biography and life story are a good starting point for any action and relationship.

The topic focuses on the person-centered approach. Reference is made in particular to the method of Tom Kitwood in the eighties, who affirmed a more psychosocial approach to the health of people in general and to people with dementia in particular. This approach is based on “I-you” relationship and allows you to see the person with dementia as a person equal to the others, with his/her feelings, rights, desires and a life story, which is however present and important to be considered as before the person had dementia.

The bio-psycho-social model is a strategy of approach to the person, which attributes the outcome of the disease, as well as of health, to the intricate and variable interaction of biological factors (genetic, biochemical, etc.), psychological factors (mood, personality, behaviour, etc.) and social factors (cultural, family, socio-economic, etc.). According to the theory of the bio-psycho-social approach, it is important to focus attention on the residual abilities of the fragile person while continuing to recognise them as a social being in need to continue living their life and having relationships despite the progress of the disease.

2.4.2  Behaviour

When behavioural disorders are present, try to ask yourself:

• What does the person want to communicate to us with this implemented behaviour?
• What does this behaviour mean if we observe it with respect to the person’s experience?
• Behind every behaviour there are multiple causes. For example, an episode of aggression can have an organic, environmental or relational cause.
• The person with dementia also has needs, wants and expectations and should be aware of this when providing care. For example, when we propose to the person to do something, the answer may be: “I don’t feel like it, I’m tired”.
• These are defence mechanisms used by the person to protect themselves from engaging in activities they may not know how to do. We can notice them if we learn to put ourselves in the other’s shoes. When faced with a request, there is the anxiety of failing. This is why we should propose simple activities and in the form of collaboration “can you help me?” “should we do this together?”

2.4.3  Activities are important and should be pleasurable

Food and eating play an important role in maintaining quality of life; they are pleasurable as well as playing their important role in maintaining health.

Eating is very significant throughout a person’s lifetime, even when it seems to us that the person is not functioning at all; eating is one of the last functions that are preserved. People with dementia experience difficulties in nutrition and eating, which pose a substantial challenge for caregivers. These difficulties appear even in the early stages of the disease, but become worse as it progresses. More often than not, coping with eating difficulties causes great frustration for the primary caregivers and requires reorganisation around meals throughout the day. In view of this, the need arose to provide an answer and solutions for family and caregivers to deal in a dignified manner with the eating difficulties that characterise the various stages of dementia.

There are several activities can be done:

Chair exercises. There are online videos available that will take you and your loved one through a seated exercise class. They involve moving each part of the body. From a seated position some of the exercises are marching, twisting the upper torso, raising the arms above the head, raising the opposite leg and arm. Chair exercise is a safe way exercise for those who have balance or back issues.

Swimming. For those who enjoyed swimming before dementia, water aerobics may be a great option for those in the early stages of their illness.

Dance. This is a very social option which can take many forms. It can be as simple as swooping your loved one up and dancing to a favourite song. It can be an online class or a grand improvisation that can even be done from a chair. Dancing can change one’s mood and help agility and balance.

Synopsis

Key points:

1. As people we depend on mutual recognition, respect and trust. These needs do not go away because you have dementia, but it becomes more difficult to express and satisfy them. It is up to the caregiver to be aware of the importance of basic needs. The person with dementia cannot do it alone so the job of a good caregiver is to acquire psychological skills such as unconditional acceptance and empathy, warmth and closeness. I’s important to know who you are and your past.
2. Person-centered care is a prerequisite for developing an adequate care culture based on the bio-psycho-social model. Specific attention should be done on behavioural disorders from a person-centred perspective and on the pleasure of feeding, moving and doing daily activities.