person centred care

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Person-centred Dementia Care:
A Vision to be Refined
Healthcare professionals have increasingly been moving away from a task-oriented, professional-driven model of healthcare, towards a more holistic model of care which emphasizes patients’ perspectives and their subjectively defined experiences and needs. In the field of dementia care, this shift has been described most often as a move towards “person-centred care.” Despite a wealth of literature describing the philosophy of personcentred care, we know very little about the current definition and implementation of this philosophy in dementia-care settings. This article will provide an overview of the literature to date.

by Timothy D. Epp, PhD

T

Dr. Epp is an Assistant Professor of
Sociology at Redeemer University
College, and Adjunct Assistant
Professor at the Murray Alzheimer
Research and Education Program,
University of Waterloo,
Waterloo, Ontario.

he concept of the “person” is
at the centre of current debates
on the beginning and end of life,1
the assessment of competency,2,3
and human suffering.4 Promoted as
a shift in the “culture” of care,
holistic dementia care is referred
to most often as “person-centred”
(although terms such as “individualized,” “resident-focused,” and “patient-centred” also are utilized),
and is based on various sources,
including the social psychology of
professor Tom Kitwood.5
Person-centred dementia care
(PCC) has emerged as a response
to an old culture of care6,7 which:
1) reduced dementia to a strictly
biomedical phenomenon;8 2) was
task-driven; 3) relied on control
techniques including chemical and
physical restraints,9 warehousing
and unnecessary medication; and
4) devalued the agency and individuality of persons with dementia. In contrast, PCC is valuedriven, focuses on independence, well-being and empowerment of
individuals and families,10 and

14 • The Canadian Alzheimer Disease Review • April 2003

“enables the person to feel supported, valued and socially confident.”11 Promotion of PCC also is a response to the lack of attention in
dementia research, and to the
agency and subjectivity of persons
with dementia.12

Personhood
According to Kitwood,5 personhood is “a standing or status that is bestowed upon one human
being, by others, in the context of
relationship and social being...
impl[ying] recognition, respect
and trust.” The aim of good
dementia care is “to maintain personhood in the face of the failing of mental powers.”5 Attention to
personhood includes recognition
of “the centrality of relationship,
the uniqueness of persons, [and]
the fact of our embodiment.”5
Dementia care which focuses only
on the disease and its treatment
does not attend to a patient’s personhood, treats the patient as a passive object, and is damaging to
the patient.

PCC is founded on the ethic
that all human beings are of
absolute value and worthy of
respect, no matter their disability,
and on a conviction that people
with dementia can live fulfilling
lives8 (Table 1). Central to PCC is
the principle that an individual’s
life experience, unique personality and network of relationships should be valued and taken into
account by staff in care settings.
This perspective is founded on the
observation that the presentation
of dementia cannot be reduced to
the effects of neuropathologic
damage, but is instead a combination of factors, including personality, biography, physical health, neurologic impairment and social
psychology. In contrast, focusing
on a patient’s losses or deterioration may reinforce negative perceptions and treatment of individuals with dementia, and also may have a significant impact on the
progression of dementia.
Several studies have identified
the importance of self-esteem for
the overall well-being of persons
with Alzheimer’s disease (AD).13,14
PCC involves the establishment
and maintenance of positive, supportive, social environments for persons...
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