6. Module 5 · Person-centred care & life history

Attitude

The person at the centre

Person-centred care (shaped decisively by Tom Kitwood) is the core of modern dementia care. Its basic idea: the person with dementia is and remains a person with dignity, individuality, a life history and needs – they are not to be reduced to their illness or their ‘deficits’. Kitwood coined the term ‘personhood’: the recognition of the human being as a valuable, unique individual who exists in relationship with others. This personhood must be actively maintained and strengthened – through the way we treat the person. At the centre are the psychological needs that Kitwood described: love (at the centre), comfort, attachment/security, occupation/inclusion, identity and belonging. When these needs are met, the person does well; when they are disregarded, the person suffers.

Kitwood also described how personhood can be undermined (through ‘malignant social psychology’ – e.g. infantilisation, ignoring, mockery/accusation, objectification, treachery, outpacing) and how it is strengthened (through appreciation, recognition, enabling, celebration, inclusion). For care, person-centred care means: seeing and treating the person with dementia in their individuality and dignity, meeting their psychological needs and supporting them as a person – not as a ‘case’ or a ‘task’.

What this module is about. What it means to treat a person with dementia as a person, which needs sit at the heart of this approach, and how knowing someone’s life story turns care from routine into something personal.

What you will be able to do afterwards. You can name the psychological needs, spot behaviour that undermines or strengthens personhood, and use a simple life-history sheet to plan one small, personal step.

Think about it first. Mr Okafor (fictitious), 86, used to be a bus driver. In the care home a carer says brightly, while tying a bib around his neck: “Time for our dinner, dear. Let us be a good boy.” He stares at the table and does not eat. What could this carer have done differently? What would you want to know about Mr Okafor before you speak to him? Note your ideas and compare them with Figure 5.2 on the next page.

Learning objectives of this module

  • You understand person-centred care (Kitwood).
  • You know the psychological needs.
  • You strengthen personhood and avoid undermining it.
  • You use the person’s life history for individual support.
  • You can recognise in a short everyday scene which behaviours undermine and which strengthen personhood, and you can suggest a better wording (apply, analyse).
  • You can fill in a simple life-history sheet and derive one concrete offer from it, while respecting what the person and the relatives are willing to share (apply).

Life-history work – knowing the person

A central tool of person-centred care is life-history work (biography work): knowledge of the person’s life course, personality, preferences, habits, values, occupations, hobbies, important relationships and formative experiences. Why is this so important? Because people with dementia increasingly live in their past (Module 2) and because their life history helps you to understand the person, to interpret their behaviour, to recognise their needs and to offer them familiar and meaningful things. Examples: if you know their occupational history (e.g. ‘was a farmer’), you may understand why someone wants to get up early and go ‘to work’, and you can offer meaningful occupation (e.g. gardening). If you know their preferences (favourite music, favourite food, customary rituals), you can bring joy and familiarity. If you know formative experiences (e.g. wartime experiences), you understand certain fears and can avoid them/take them into account. If you know their relationships, you understand the longing for particular people. The life history – usually obtained from relatives and documented – is thus a treasure for individual, person-centred support.

Person-centred care therefore means seeing and supporting every person with dementia in their uniqueness – not ‘people with dementia’ as a group, but this particular person with their history, their preferences and their needs. This requires interest in the person, life-history work and a willingness to tailor care individually. The reward is great: a person who is seen as a person, understood through their life history and whose needs are met experiences more dignity, wellbeing, security and contentment – and shows less challenging behaviour. Person-centred care is thus not only an ethical attitude but also professionally effective. It is the foundation of all dementia care and links all the other modules (communication, behaviour, everyday life, environment) into a coherent whole: doing justice to the person with dementia as a person.

The needs at the heart of the approach

Figure 5.1 shows the psychological needs in the shape of a flower, with love in the middle. The picture helps you remember an important idea: the needs are connected. A person who is held (comfort) feels safer (attachment), dares to join in (inclusion), has something to do (occupation) and remains someone (identity). If one petal is missing, the others suffer too. Many writers describe Kitwood’s list with these five petals around love. The course text above adds belonging, which is closely related to inclusion, and the table on the next page lists the needs in the same grouped way.

Psychological needs of people with dementia as a flowerPsychological needs, with love at the centreLoveComfortwarmth, gentle touchAttachmentfamiliar faces, securityInclusionpart of the groupOccupationmeaningful tasksIdentityknown as who I amIf one need is neglected, the others weaken too. Read it as a reflection tool, not a checklist.
Figure 5.1: Kitwood’s psychological needs in the shape of a flower (general professional model). Source: own illustration.

Figure 5.1 is a reflection tool and not a checklist. Ask yourself of a particular person: which petal is strong today and which is weak? A resident who sits alone in a corner may be missing inclusion. One who wanders and pulls at doors may be missing attachment or occupation. The answer often points to a very small, practical step: a hand on the shoulder, a seat at the table, a task that matters.