Thomas Kitwood's Person-Centered Care for Dementia

A Practical Way to Improve Quality of Life

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The development of the person-centered care approach is widely attributed to professor Thomas Kitwood in the late 1980s at the University of Bradford in the United Kingdom. Person-centered care is a way of providing care to people by focusing on the person's uniqueness and preferences, instead of the disease, its expected symptoms and challenges, and the person's lost abilities. Person-centered care recognizes that dementia is only a diagnosis and that there is much more to the person than just a diagnosis.

A person-centered approach changes how we understand and respond to challenging behaviors and is helpful for those with dementia. Person-centered care looks at behaviors as a way for the person with dementia to communicate his/her needs, and determines behaviors that may occur due to unmet needs of the person.

Person-centered care also encourages and empowers the caregiver to understand the person with dementia as having personal beliefs, remaining abilities, life experiences and relationships that are important to them and contribute to who they are as a person.

On a moment-by-moment basis, person-centered care strives to see the world through the eyes of the particular person with dementia.

How Person-Centered Care Differs From the Traditional Medical Model of Care

To undertand how person-centered care differs from traditional medical care, let's take the example of George:

George is an 89-year-old man with Alzheimer's disease who one week ago was moved to a nursing home because his wife Hilda could no longer care for him at home. Hilda visits George every day and although she wishes she could have kept him at home, she knows that George needed more care than she could give him.

Medical Approach

A strictly medical approach for George would be almost solely concerned with how much of his breakfast he ate, getting George to meet his daily goal of walking 50 feet in the hallway, and accomplishing his shower at 9 am because it's his assigned day. When he tries to sit down after walking only 10 feet, a caregiver using the medical approach asks for a second caregiver to help on the other side of George and they stand George back up again and begin to move him forward, despite his pleas of being too tired. George then becomes frustrated and pushes the caregivers away.

Despite George's resistance, these duties and tasks are checked off the to-do list.

Person-Centered Approach

A person-centered, more holistic approach, might look more like this:

Rather than approaching George with a list in our heads, person-centered care looks at the person first, and the goals and tasks second.

Instead of serving the same breakfast to everyone, a person-centered approach would find out from George or Hilda what George's usual breakfast was before he moved to the nursing home. A person-centered caregiver would also encourage the 50 feet of walking, but if George is tired and resistant when she tries to walk with him, she will try again later in the day. The person-centered caregiver might also have learned that George much prefers taking a bath instead of a shower and that his routine was a hot bath before bedtime; therefore, his bath time will have been shifted to 9 pm.

Not surprisingly, the day goes quite well for both George and his caregiver when it is based on his preferences. 

Benefits of Person-Centered Care

Person-centered care has been shown by multiple research studies to be effective in reducing challenging behaviors in people with dementia.

A 2017 review of 19 studies which included 3,985 participants was undertaken to determine the effectiveness of person-centered care for people with dementia. The results? Agitation, emotional symptoms, and depression were reduced and quality of life was improved by practicing person-centered care in long-term care facilities.

Person-centered care can reduce caregivers' frustrations and it provides a better quality of life for persons with dementia and their loved ones.

It's also very likely how you and I would want to be treated.

One Practical Method to Communicate Resident Preferences

Research conducted through Miami University in Ohio outlines a practical way to identify and communicate person-centered preferences. Researchers developed a tool called Preferences for Every Day Living Inventory (PELI); there is a version for those living in the community and for those living in a facility. The PELI helps identify and rank the importance of personal preferences.

Once we know what's important to someone, the next challenge is to communicate these preferences to those around the individual who is receiving care. The recommendation from the PELI team is to use a five-by-seven laminated card to clearly communicate the preferences of the person, including some fundamental information about his or her background, family, personality, work, and the types of activities enjoyed. This card can then travel with the person, such as on their walker or wheelchair, enabling others around her to quickly know some key information about this person. 

Be certain to exclude HIPAA (Health Insurance Portability and Accountability Act) information—that is, information that would violate the privacy and security of health information. 

This certainly isn't the only way to communicate personal preferences, but it does provide a usable tool to help honor the individual choices of those being cared for.

A Word From Verywell

Person-centered care is a fundamental concept in providing quality care for those living with, and without, dementia. As caregivers, it's important that we surrender our "to-do" list in favor of honoring the relationship with the person, as well as his or her choices and preferences.  

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Article Sources

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