We’re not actually providing Person Centered Dementia Care.
Every company, community, and dementia professional I work with says they use a Person Centered approach. While we are, for the most part, adhering to the principles above, we’re making a major mistake. By making this mistake, we take longer to come to solutions, families may experience more distress, and we are missing important tools to improve the quality of life and care of the person with dementia and their care partners.
What is person centered care?
The Alzheimer’s Society breaks it down quite well:
- Treating the person with dignity and respect
- Understanding their history, lifestyle, culture and preferences, including their likes, dislikes, hobbies and interests
- Looking at situations from the point of view of the person with dementia
- Providing opportunities for the person to have conversations and relationships with other people
- Ensuring the person has the chance to try new things or take part in activities they enjoy.
Every company, community, and dementia professional I work with says they use a Person Centered approach. While we are, for the most part, adhering to the principles above, we’re making one major mistake. This is a mistake I made for many years, until one day it finally clicked: We do not consider the individual’s personality and therefore, we often mistake one’s personality as a symptom of dementia. There are 3 questions I ask that help to prevent this mistake.
Question 1: “Briefly tell me your top three concerns/challenges”
Its important to understand what they perceive to be challenges because something we think isn’t a “big deal” may be a big deal to their family or we may be able to provide education to help them understand why some perceived challenges can managed easily. Prior to assessing a new client, the family revealed a challenge is that he becomes aggressive when their personal space is encroached upon. For example, if they are at a party and someone bumps into them, the client may raise his arm and shout, “Watch it!”
Question 2: “How would friends, family, colleagues, neighbors etc. describe the client in their young/middle adult life.”
This is important to give clues to their personality and how others had perceived them. Was the client perceived as “laid back,” “uptight,” “short tempered,” “funny,” “social,” “introverted,” etc. For this client, he would often be described as friendly, kind, but short-tempered, he didn’t like clutter or surprises, and was sensitive to his environment.
Question 3: “Explain how the client handled challenge, both large and small in young or middle adulthood. Examples of challenges may include: divorce, car accidents, death of a loved one, misunderstandings, etc.”
This reveals their previous ability and techniques used to cope with challenges and stress. According to his family, when he was in a stressful situation he could often handle it, however, his daughter described a time when he stepped on one a toy she left out. He reacted by yelling out, kicking the toy, and throwing it away.
Whats next?
When we break it down, we can see that his reaction to someone bumping him is not necessarily a symptom of dementia but rather part of his personality. If we attempt to treat this behavior with medication, it may not be effective. So this helps us start to develop other techniques based on the results of the cognitive assessment.
Do you think you’ve been appropriately separating personality traits from symptoms of dementia?