Person- and relationship-centred care in dementia

Abstract

Person-centred care is gaining more ground in dementia care and has evolved to become a synonym for good dementia care practice. The UK’s National Institute for Health and Care Excellence (NICE) clinical guidelines highlight that person-centred care reflects good practice in dementia care, with many principles of person-centred care reflected in its guidelines (NICE, 2006). The term ‘person-centred’ care, although used in other health areas before, in dementia is relatively new. The term has its roots in the work of Carl Rogers and his ‘client-centred’ psychotherapy. According to Rogers, the aim is to create a setting so that the client can come up with their own resolution of their problems, rather than the therapist providing advice (Rogers, 1961; Lane, 2000). The term ‘person-centred counselling’ in fact replaced the ‘client-centred’ term, with the view of recognising that the person who seeks counselling is an expert on themselves, whereas the actual therapist is the facilitator who seeks the patient’s self-actualisation (Brooker, 2004). However, it was not until the work of Kitwood that the ‘person-centred’ term found its way into dementia care (Kitwood, 1988; Kitwood, 1997). He supported the idea of shifting from the traditional approach of dementia care, which focused on the deficits of the person, to a model of care that values the personhood of the dementia patient. Kitwood emphasised that the term ‘person-centred’ care should be used with the view of highlighting communication and relationships during the process of dementia care (Kitwood, 1997). Dementia care mapping has been developed to assess the quality of care in dementia and is largely based on the person-centred care hence promoting patients’ personhood and a holistic approach to their care. Carers of dementia patients, who follow a person-centred care approach, bring out the best in the people living with dementia. This also applies to those care homes that often have their mission statement based around this approach and therefore aim to provide good dementia care. In this regard, it is worth emphasising that there are three key principles of good dementia care (Cheston, 1998; Kitwood, 1997): regular and structured activity; activity at interpersonal, recreational and therapeutic level; reinforcing patients’ sense of worth and value.