Person-centred and Non-person-centred Approaches to Dementia

Quality care is very important especially to the people who suffer from diseases like the elderly. There are several geriatric health conditions that affect the lifestyle, day-to-day living, social and emotional, and spiritual aspects of their lives. Seniors who have dementia are entitled to be treated well. There are different approach that healthcare providers must know for them to become effective caregivers. In the same manner, patients expect to receive an appropriate care from their carers.

In this paper, with the best of my knowledge, I will discuss and explain the person-centred and non-person-centred approach to dementia, different techniques, and the impacts of equality, diversity and cultural issues, as well as the effects of legislation and policy on the person-centred approach for people with dementia.

1. Person- centred approach is a philosophy that acknowledges the unique characteristics of each individuals living in a rest home. The employees interact with the patients based on the personality, medical history and their values. Its main objective is to create partnerships between the staff, demented patients and their families which will give the best results and improve the quality of care and life for the unwell persons. This philosophy mainly focuses on the people rather than on the health condition, and on the individual’s abilities and strengths rather than losses. There are eight principles of care involved in this approach, and these are the following:

1. Individuality

People working in the rest home must make sure that they know very well, or at least try to scan the previous records of the patients so as to be aware on the client’s interests, preferences, needs and wants. It is also achieve by gathering information to the relatives, visitors and families of the patient. In this way, proper treatment and handling is executed to each residents. Most of the time, sick individual responds to the caregiver on how they are being manage. It develops smooth relationship between the care recipient and healthcare provider if they get along with each other, the work is much easier to perform than the other way around.

2. Rights

Demented patients still have the right to live the way they wanted to be even if they are suffering from a disease. Oftentimes, these people are being discriminated and treated differently compared to others. Each rest home has provided set of guidelines and rules for the patients. The government also outlined the legal rights of demented individuals. They still have the right to do their own care especially if they are able to manage themselves. Healthcare providers are there just to guide and support them. The right to perform their daily activities and whatever curricular activities they want to do must be given to them. Additional rights are: the right to information, to proper treatment and access to health and other services, to be respected and the right to choose and individuality, fair treatment, complaints, and the right to proper standards.

3. Choice

People who have dementia must not be taken for granted when it comes to making decision. Their condition do not serve as a hindrance in deciding for themselves. They should invariably be asked to what they favour, and still have to be part in decision and plans about their present situation. Simple things such as choosing what to wear, eat, taking medication and even doing activities must always be based on their preferences. Clients are also required to fill out the consent form before admitting to the rest homes or in any service provisions. Most of them signed the DNR (Do Not Resuscitate) form in advance since dementia is a progressive disease that no known cure. Residential care home always emphasize that patients have the freedom to act whatever they want but with the support of healthcare providers and other allied health professionals.

4. Privacy

Dementia linked to cognitive impairment most likely affects the privacy of sick individual as well as the people surround them. Facility’s procedures and policies can influence the privacy of patients. Personal information and health status of the clients must not be tackled without the consent of the concerned person. When it comes to caring them, caregiver must ensure that the door whether in the toilet or room must be closed, even curtains of the window for patients safety and privacy. It is important to knock on the door before entering in to the room, it also shows respect to them.

5. Independence

Most of the rest homes encourage self-reliance to the residents especially if the person still has the capacity to do so, despite of the health status.it is important for them to give the space and assistive equipment specifically inside their bedroom so that they are inspired, and it helps stimulate their self-support. Still, the facility is responsible for their clients, aside from encouragement, they must ensure that safety comes first before anything else.

6. Dignity

It is defined as the quality of being worthy of honour or respect. As the illness advances the individuals start to lose their personal identity or sense of self, which is the reason for them to become more reliant on the people around them. Someone must validate to the patients who they are, and what they are doing. It is essential that demented people are being treated extra special and most especially with respect. Care staff must keep in mind that, despite from the health condition of the clients, they are still valuable human being and are unique. The support of family, relatives, friends, and even health care professionals are important in order to help the patients in retaining feelings of self-worth as well as the sense of identity.

7. Respect

Everyone is entitled to be respected by other people. Regardless of the status in life, attained education, job, and even health condition. Individuals with illness need special attention and cares, and most of all they must be regarded as important persons too. By doing this, they will not feel neglected and not worthy to the society. Expressing concerns, and helping them in remembering what and who they were in the past will make a big difference. Listening and making conversation with them is essential as well, it helps in uplifting their spiritual, cultural, beliefs and values.

8. Autonomy

This simply means self-determination or self-rule. Patients with dementia have the right to make their own decision. Depriving their chance to decide their own destiny or fate will be grounds for the moral right of the clients. An example of this is the paternalistic approach, which define as the intentional restriction of an individual’s liberty. In this theory, it is believed that restricting the person will protect and promote the individual’s interest. That is why person-centred approach is being practiced in most of the residential care homes because its principle is self-determination, in which the patient’s role is more active when it comes to his wellbeing. It requires responsibility for deciding on their own and the ability to handle the consequences of their choices.

2. Non-person-centred approach is different from person-centred approach. The latter deals with patient directly such as staff to client relationship, medication treatment specifically for the person involved and everything that is personalised for a patient. Whilst the previous approach cares for the whole facility, residents, as well as to the employees. The two types of this approach are the following:

1. Institutional perspective

In rest homes or hospital, it is always departmentalise like kitchen, laundry, housekeeping, physiotherapy, chaplain, and other services offered depending on the organisation, all have different functions but have the same goal, which is for the benefit of the residents. For instance, in the kitchen, the chef must ensure that patients are getting the right designation of food, whether puree or on a soft diet, and is following dietician’s nutritional plans. Similarly, housekeeping department should always keep the room, lounge, toilets and the whole facility tidy and inviting for the residents and visitors as well. Laundry staff must sort out properly the clothes of each residents, should be clean and presentable enough to wear. The same with the towels, flannels, beddings etc. it should always be washed and cleaned appropriately.

2. Biomedical perspective

Dementia syndrome is common to the elderly from 65 years old and beyond, and it is a progressive disease that is incurable. Although there are few younger people experiencing this kind of illness. Most of the populace are scared to have this kind of illness, and because of this the government conducts a lot of public awareness and educational programmes regarding this matter. Patients admitted in the hospital or in a rest homes do not always have dementia, there are also other geriatric health conditions like diabetes, kidney problems, stroke or heart diseases, paralysed individuals, and other cases which come to the end point or there body stops responding to the treatment. Even though they are under palliative care, GP’s still prescribe medications for them just to lessen the pain they have. Residential care depends on the doctors’ orders and to the pharmacists who provide the set of medicines for the residents. Nurses are the ones who give medications to the clients certainly. The treatment plan is sometimes altered if the client refuse from it. Physiotherapist are there to help, assist, and support them like in moving, walking, and other related sessions for patient’s own sake. Activity coordinators prepare mental activities to enhance or at least activate the minds of the residents.

3. Several techniques are available to be able to cope with behaviours of the elderly especially demented individuals. Care staff and families must be aware of the different approach. These are the following:

1. Validation Approach

It is a therapy which merely focuses on the emotional feelings of the patient. It is also a way of showing understanding and empathy to the seniors since most of them have experienced unresolved issues in the past which triggers their emotional behaviour. There are sub- techniques in this kind of approach which the care giver must practice to be an effective validation therapist, and these are: Centre Themselves, the staff must put themselves in patient’s shoes. Try to view the client as their own mother or grandparent, relax and think clearly before reacting. Second is try to Reminisce, ask questions about care recipient’s mom or dad, share your personal experience, and let the patient show his loneliness. The third one is to Use Extremes, know if the client misses his mother or grandparent and what are the things that he wants to do again with that loved one. This enables the patient to process the feeling of woe in losing someone. Match and Express the Emotion is necessary to let the patient know that he is not alone about the sadness, care staff are there to help him. Rephrasing and Use Senses are also important since it reassure the patient that somebody understands what he truly feels.

2. Holistic approach

This care addresses the wholeness of a person. It includes the emotional, spiritual, and intellectual of the patients. Its main goal is to enhance the quality of life of a person and still be able to enjoy the remaining years of their life despite of the illness. Utilizing holistic methods is beneficial to both care staff and patients. According to the website keepinmind, there four pillars of holistic approach: Environmental, Communication, Nutritional, and Engaging Activity. Environment can affect the behaviour of a patient. It is important to eliminate negative aspects and keep the place safe in order to achieved holistic care, and minimise the anxiety and agitation of the client. Effective communication play a vital role also since constant talking and convincing the patient is required for them to keep calm. These includes verbal and non-verbal communication skills.

3. Assistive Technology

Nowadays technology is becoming a necessity. It is part of a person and it makes life easier and faster. Even though high technology is often linked to younger generations, there are useful inventions and gadgets specifically designed for the seniors, especially to those disabled, unwell, and dementia patients. These individuals need assistance whilst maintaining their independency and autonomy. Some of the simple tools available are touch lamps, and automatic calendar clock. High technology devices like satellite navigation systems in which it is use to find missing person. In rest homes, sensor mats are placed to those residents who are prone to falls. Automatic beds and specialised foams or mattress are also available for special case patients. Hearing aids allow the client to be aware of the happenings around them and to be able to communicate with their loved ones and employees. Standing and sling hoist equipment are designed for easy transfer of patients. It promotes safety to both healthcare providers as well as to the patients.

4. Alternative therapies

Some people are open-minded and are willing to try traditional treatments. As what others say, there’s no harm in trying. Treatments include acupuncture, aromatherapy, music therapy, bright light therapy, and herbal medicines. Taking herbal medicines, dietary supplements or even vitamins believed to cause delay or it slower the progress of dementia. Although there is no strong evidence about it but there are few researches say that it has positive effects to the patients. The most common herbs are Ginkgo biloba extract, Yizhi capsule (YZC), Kami-Umtam-To (KUT), and Choto-san. Vitamin E might slow the effects of dementia but taking too much has high risk for patient with heart disease. The same effect with Omega- fatty acids and Coenzyme Q10 but still need further studies and research about it.

5. Reminisce techniques

Every person reminisce, whether healthy or suffering from a disease. It is a useful tool for everyone especially in times of hardship and stressful events in life. People can divert their feelings through this process, it is inspiring and helps a person to keep moving on and continue to live. This technique is effective to dementia patients, it is a way for them to recall who they were decades ago. In addition, reminiscing or life-review promotes socialization too, since it involves communication with other person. Most of the seniors love to tell stories about their previous experiences to the young ones, and those are useful information that can be applied in the future. Their knowledge, wisdom and skills are very important since those are based on real-life event, not just make-up stories.

Moreover, reminisce therapy conveys a lot of benefits for persons with Alzheimer’s. It gives them the sense of belonging, peace and power, existence, importance and value, and gives a positive outlook in life. Furthermore, there are several mediums that can assist in this therapy which is intended to use for different senses as well. Captured memories from the past, paintings, and other valuable objects is utilise for their vision. Old music played in various instruments is used for their sense of hearing, and certain food and smell kits are for their sense of taste well as smell. There are three types of reminisce activities and therapies and these are: Simple, Evaluate, and Occasional reminisce. It is like a level of reminiscing, from their happy and enjoyable to challenging experiences and conflicts, and up to the stressful events and other emotional happenings in life. Involvement and participation of families, friends, relatives, care staff, and other healthcare providers are necessary for this to be an effective therapy.

4. Public health and health promotion

The most common dilemma of patients with dementia or any other geriatric health conditions is discrimination. Oftentimes, families and relatives hesitate to seek professional and government help because they are scared to be treated as different from other normal individuals. Promoting public health and awareness is very important to eliminate such stigma. Lack of information to health problem can due to the misunderstanding that dementia is a normal condition of ageing rather than a progressive disease. It can also because of unrecognised or limited information about the signs and symptoms of dementia. Then, lack of understanding about risk factors associated with the disease. Socioeconomic and cultural variables contribute to shaping knowledge and beliefs about dementia. That is why government funded programmes and other organisational campaigns are important in public awareness. It helps the society to fully accept the illness as well as those who have this condition, and proper management and approach will eventually implemented nationwide. By doing this, discrimination will be totally eliminated, fair treatment and smooth life ahead for affected individuals is feasible.

Attitudes to health and demand for healthcare

The increasing number of people having dementia resulted to high demand of healthcare providers worldwide. Lots of service provisions and other government support services are available to help families in dealing with the disease. Family members send their patients to rest homes and hospitals due to the fact that they cannot handle them at home. They are aware that professional help is necessary to provide the quality care for their unwell seniors. It is important to give the utmost cares when it comes to the patients. Choosing the right facility that suits to the needs of the client must be done. For the care staff, several trainings, programmes and seminars are important to ensure the safety of the stakeholders.

5. In response to the necessities of patients with dementia and other common geriatric health problems, local agencies in New Zealand established rules and regulations for stakeholders, healthcare providers, families, and support organisations as their guidelines. Person-centred approach focuses on the individual which is more applicable and is now followed by any service provisions compared to the traditional one. The principles of care are mainly for the benefits of patients. Their rights as a resident in a rest home are carefully executed, every care and treatment is always based on their preferences. Most of the clients are fully aware about their rights since prior to admission, the management let them sign forms, consent and other important protocols. Basically, the main function of employees is to ensure the safety of the clients, performing cares without offending their right to privacy and independence, support and understand the current situation facing by the patients as well as the families, and most specially giving the best effort for them to enjoy the last chapter of their lives in the world.