Thomas Kitwood's Person-Centered Care for Dementia

A Practical Way to Improve Quality of Life

Thomas Kitwood's Person-Centered Care Can Improve Quality of Life in Dementia
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What Is Person-Centered Care?

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 in which the unique person and their preferences are emphasized, instead of the disease, its expected symptoms and challenges, and the lost abilities of the person. Person-centered care recognizes that dementia is only a diagnosis of the person, and that there is much more to the person than her diagnosis.

A person-centered approach changes how we understand and respond to challenging behaviors in dementia. Person-centered care looks at behaviors as a way for the person with dementia to communicate his needs, and it understands that figuring out what unmet need is causing the behaviors is the key.

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 Does Person-Centered Care Differ from the Traditional Medical Model of Care?

Let's take the example of George:

George is an 89 year-old male with Alzheimer's disease who one week ago was moved to a nursing home because his wife Hilda just couldn't keep caring 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 will be almost solely concerned with how much of his breakfast George ate, getting George to meet his goal of walking 50 feet in the hallway today, and accomplishing his shower today at 9am 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 9pm.

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. One experimental study used trained staff members to implement person-centered care approaches with nursing home residents who had dementia. The results? Inpatient hospitalizations—which sometimes result if challenging behaviors are not able to be safely handled in a care facility—and the use of psychotropic medications—which can be minimally effective and also can have serious side effects—were both significantly reduced.

Another study involving 289 nursing home residents at 15 different sites demonstrated reduced levels of agitation in people with dementia when a person-centered care approach was utilized.

Person-centered care can reduce caregivers' frustrations and save money by reducing hospitalizations and the use of medications, but more importantly, 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 some of these 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 then can 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 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 give us a usable tool to help honor the individual choices of the residents we serve.

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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