Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-23T14:18:22.120Z Has data issue: false hasContentIssue false
  • English
  • Français

Recognising and supporting self in dementia: a new way to facilitate a person-centred approach to dementia care

Published online by Cambridge University Press:  14 August 2009

FIONA KELLY
FIONA KELLY*
Affiliation:
Dementia Services Development Centre, University of Stirling, Stirling, UK.
*
Address for correspondence: Fiona Kelly, Dementia Services Development Centre, University of Stirling, Stirling FK9 4LA, UK. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

This paper reports findings from a three-year study which integrated Kitwood's (1997) person-centred and Sabat's (2001) selfhood approaches in the design, fieldwork and analysis of a multi-method observational study that explored the social worlds of 14 people with dementia in continuing-care. The types of interactions that participants experienced in everyday ward life and during creative sessions were identified by observing, video-recording and engaging with them and by Dementia Care Mapping. The participants' responses to such interactions in terms of their well- or ill-being and expressions of self were identified and documented. The findings indicate that in the wards, staff interactions were often limited and sometimes abusive and that participants experienced ill-being, whereas during creative sessions, interactions were generally facilitatory and celebratory with the participants experiencing wellbeing. By developing the selfhood approach and integrating it with the person-centred approach, I argue that recognising and supporting selfhood (or not) during interactions can lead to qualitatively different staff behaviours, with consequences for the well- or ill-being of people with dementia. There is scope for incorporating this developed selfhood framework into staff training, for it has the potential to transform practice and the experiences of people with dementia in receipt of care.

Keywords

dementiaperson-centred/selfhood approachwell/ill-beinglong-term care
Type
Articles
Information
Ageing & Society , Volume 30 , Issue 1 , January 2010 , pp. 103 - 124
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Armstrong-Esther, C. A., Browne, K. D. and McAfee, J. G. 1994. Elderly patients: still clean and sitting quietly. Journal of Advanced Nursing, 19, 2, 264–71.CrossRefGoogle Scholar
Bradford Dementia Group 1997. Dementia Care Mapping Manual. Seventh edition, Bradford Dementia Group, University of Bradford, Bradford, UK.Google Scholar
Bredin, K. and Kitwood, T. 1995. Decline in quality of life for patients with severe dementia following a ward merger. International Journal of Geriatric Psychiatry, 10, 11, 967–73.CrossRefGoogle Scholar
Brooker, D. 2004. What is person-centred care in dementia? Reviews in Clinical Gerontology, 13, 3, 215–22.CrossRefGoogle Scholar
Brooker, D., Foster, N., Banner, A., Payne, M. and Jackson, L. 1998. The efficacy of Dementia Care Mapping as an audit tool: report of a 3-year British NHS evaluation. Aging and Mental Health, 2, 1, 60–70.CrossRefGoogle Scholar
Brooker, D. and Surr, C. 2005. Dementia Care Mapping: Principles and Practice. Bradford Dementia Group, Bradford, UK.Google Scholar
Capstick, A. 2003. The theoretical origins of dementia care mapping. In Innes, A. (ed.), Dementia Care Mapping: Applications Across Cultures. Health Professions Press, Baltimore, Maryland, 11–23.Google Scholar
Cohen-Mansfield, J., Golander, H. and Arnheim, G. 2000. Self-identity in older persons suffering from dementia: preliminary results. Social Science and Medicine, 51, 3, 381–94.CrossRefGoogle ScholarPubMed
Davis, D. 2004. Dementia: sociological and philosophical constructions. Social Science and Medicine, 58, 2, 369–78.CrossRefGoogle ScholarPubMed
Dewing, J. 2002. From ritual to relationship: a person-centred approach to consent in qualitative research with older people who have a dementia. Dementia, 1, 2, 157–71.CrossRefGoogle Scholar
Dewing, J. 2004. Concerns relating to the application of frameworks to promote person-centeredness in nursing with older people. Journal of Clinical Nursing, 13, 3a, 39–44.CrossRefGoogle Scholar
Folstein, M., Folstein, S. and McHugh, P. 1975. Mini-mental state exam: a practical method for grading the cognitive states of patients for the clinician. Journal of Psychiatric Research, 12, 3, 189–98.CrossRefGoogle Scholar
Fontana, A. and Smith, R. 1989. Alzheimer's disease victims: the ‘unbecoming’ of self and the normalization of competence. Sociological Perspectives, 32, 1, 35–46.CrossRefGoogle Scholar
Fossey, J., Lee, L. and Ballard, C. 2002. Dementia Care Mapping as a research tool for measuring quality of life in care settings: psychometric properties. International Journal of Geriatric Psychiatry, 17, 11, 1064–70.CrossRefGoogle ScholarPubMed
Hubbard, G., Cook, A., Tester, S. and Downs, M. 2002. Beyond words: older people with dementia using and interpreting nonverbal behaviour. Journal of Aging Studies, 16, 2, 155–67.CrossRefGoogle Scholar
Innes, A. 2002. The social and political context of formal dementia care provision. Ageing & Society, 22, 4, 483–99.CrossRefGoogle Scholar
Innes, A. and Capstick, A. 2001. Communication and personhood. In Cantley, C. (ed.), A Handbook of Dementia Care. Open University Press, Buckingham, UK, 135–46.Google Scholar
Innes, A., Capstick, A. and Surr, C. 2000. Mapping out the framework. Journal of Dementia Care, 7, 2, 20–1.Google Scholar
Innes, A. and Kelly, F. 2007. Evaluating long stay settings: reflections on the process with particular reference to Dementia Care Mapping. In Innes, A. and McCabe, L. (eds), Evaluation in Dementia Care. Jessica Kingsley Publishers, London, 144–60.Google Scholar
Innes, A. and Surr, C. 2001. Measuring the well-being of people with dementia living in formal care settings: the use of Dementia Care Mapping. Aging and Mental Health, 5, 3, 258–68.CrossRefGoogle ScholarPubMed
Judd, S. 2007. Citizenship and dementia: some inconvenient truths. Journal of Dementia Care, 15, 3, 19–21.Google Scholar
Kelly, F. 2007. Well-being and Expression of Self in Dementia: Interactions in Long-term Wards and Creative Sessions. Unpublished thesis, University of Stirling, Stirling, UK.Google Scholar
Killick, J. and Allan, K. 2001. Communication and the Care of People with Dementia. Open University Press, Buckingham, UK.Google Scholar
Kitwood, T. 1997. Dementia Reconsidered: The Person Comes First. Open University Press, Buckingham, UK.Google Scholar
Kitwood, T. and Bredin, K. 1992. Towards a theory of dementia care: personhood and well-being. Ageing & Society, 12, 3, 269–87.CrossRefGoogle ScholarPubMed
Knapp, M., Comas-Herrera, A., Somani, A. and Banerjee, S. 2007. Dementia: International Comparisons. National Audit Office, London.Google Scholar
Knapp, M. and Prince, M. 2007. Dementia UK: Summary of Key Findings. Alzheimer's Society, London.Google Scholar
Kuhn, D., Ortigara, A. and Kasayka, R. 2000. Dementia Care Mapping: an innovative tool to measure person-centred care. Alzheimer's Care Quarterly, 1, 3, 7–15.Google Scholar
Li, R. and Orleans, M. 2002. Personhood in a world of forgetfulness: an ethnography of the self-process among Alzheimer's patients. Journal of Aging and Identity, 7, 4, 227–44.CrossRefGoogle Scholar
Mead, G. H. 1934. Mind, Self and Society. Chicago University Press, Chicago.Google Scholar
National Audit Office 2007. Improving Services and Support for People with Dementia. Stationery Office, London.Google Scholar
Nolan, M., Grant, G. and Nolan, J. 1995. Busy doing nothing: activity and interaction levels amongst differing populations of elderly patients. Journal of Advanced Nursing, 22, 3, 528–38.CrossRefGoogle ScholarPubMed
Packer, T. 2000. Does person-centred care exist? Journal of Dementia Care, 10, 3, 19–21.Google Scholar
Perrin, T. 1997. Occupational need in severe dementia: a descriptive study. Journal of Advanced Nursing, 25, 5, 934–41.CrossRefGoogle ScholarPubMed
Sabat, S. 2001. The Experience of Alzheimer's Disease: Life Through a Tangled Veil. Blackwell, Oxford.Google Scholar
Sabat, S. 2002. Surviving manifestations of selfhood in Alzheimer's disease. Dementia, 1, 1, 25–36.CrossRefGoogle Scholar
Sabat, S. 2005. Capacity for decision-making in Alzheimer's disease: selfhood, positioning and semiotic people. Australian and New Zealand Journal of Psychiatry, 39, 11/12, 1030–5.CrossRefGoogle ScholarPubMed
Sabat, S. 2006. Mind, meaning and personhood in dementia: the effects of positioning. In Hughes, J., Louw, S. and Sabat, S. (eds), Dementia: Mind, Meaning and the Person. Oxford University Press, Oxford, 287–302.Google Scholar
Sabat, S. and Collins, M. 1999. Intact social, cognitive ability and selfhood: a case study of Alzheimer's disease. American Journal of Alzheimer's Disease, 14, 1, 11–9.CrossRefGoogle Scholar
Sabat, S. and Harré, R. 1992. The construction and deconstruction of self in Alzheimer's disease. Ageing & Society, 12, 4, 443–61.CrossRefGoogle Scholar
Sabat, S., Napolitano, L. and Fath, H. 2004. Barriers to the construction of a valued social identity: a case study of Alzheimer's disease. American Journal of Alzheimer's Disease and Other Dementias, 19, 3, 177–85.CrossRefGoogle Scholar
Snyder, L. 2006. Personhood and interpersonal communication in dementia. In Hughes, J., Louw, S. and Sabat, S. (eds), Dementia: Mind, Meaning and the Person. Oxford University Press, Oxford, 259–>76.Google Scholar
Surr, C. 2004. Self in Dementia. Unpublished PhD thesis, Bradford Dementia Centre, University of Bradford, Bradford, UK.Google Scholar
Sutherland, S. 2008. Independent Review of Free Personal and Nursing Care in Scotland. Scottish Government, Edinburgh.Google Scholar
Wood, D., Bruner, J. and Ross, G. 1976. The role of tutoring in problem-solving. Journal of Child Psychology and Psychiatry, 17, 2, 89–100.CrossRefGoogle ScholarPubMed