Blog: Person-centred care and Tom Kitwood’s legacy

By Matthew Croucher. Published on 23/6/2020

Dr Matthew Croucher reviews the new edition of Tom Kitwood's influential book "Dementia Reconsidered.  The Person Comes First".

I first read Tom Kitwood’s book, “Dementia Reconsidered.  The Person Comes First.” nearly twenty years ago.  It had a huge impact on me and I have re-read it and loaned it out many times since.  In fact, if you have my copy, that’s OK because I’ve just bought the updated version:
Dementia Reconsidered, Revisited.  The Person Still Comes First
By Tom Kitwood, Edited by Dawn Brooker.  Open University Press.  London.  2019.  
This is the single most important book I have read during my training and career in terms of sending my practice in a richer, more fully developed direction.  I think you should read it too.

Kitwood argues passionately, cogently, and sometimes crankily for a philosophy of care in which the person comes first, their needs are the priority, and their perspective is the most important one to view their situation through.  He is a prophet calling you, me, and the whole system of care to account.  As such, some of his words are uncomfortable, some are inspiring, and some galvanising.  Some go too far, some are certainly unfair, and some are just plain wrong.  But when the prevailing medicalised system of care that I am a part of is so far out to one end of a spectrum of disease-focus versus person-focus, strident voices are needed to wake us all up.  Thank you, Tom!


This book was written just a year before his untimely death: it is the best summary of where Kitwood reached with the research and practical experience that underpinned his work.  This revised version takes each very readable chapter from the original book and adds a commentary from people living with dementia or dementia care workers, to update the thinking and reflect on where we have got to.  Sometimes it is critical of the content but finds the spirit behind his intentions still strong.  At other times the commentators bemoan how little progress has been made.  But mostly, it is exciting to read about how the core ideas have been extended and deepened as part of a broader person-centred care movement that has grown in ways Kitwood might not have been able to imagine.


The concept of “re-mentia” in contrast to the hope-less prevailing medical model of dementia was the key idea that shifted me two decades ago.  In many ways, the on-going work of my career since then has been learning how to really put each person I meet who is living with dementia at the centre of my viewpoint.  Re-reading the book this month, it is the discussion about cultures of care and how they can change that most grabs my attention.


This book is a very good place to start if you couldn’t really answer the question: “What is person-centred dementia care and how is it fundamentally different from the best of what modern nursing and medicine have to offer people living with dementia?”  It is also an excellent place to come back to if, like me, you could do with a repeat blast from Kitwood’s clarion trumpet.


It won’t be a completely comfortable read, but it will charge you up again to re-enter the fray with renewed enthusiasm.

 

Matthew Croucher 
Dr Matthew Croucher is the chair of the New Zealand Dementia Foundation. Matthew is a senior psychiatrist of old age and academic working for the Canterbury District Health Board.

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