Person Centred Care:
Respecting as Adults
Person-centred care respects people as adults.
One of the most common myths about dementia is that people become like children. The risk of this myth is that we may talk down to the person living with dementia, underestimate them, and rob them of their dignity and identity as an adult by thinking of them as a child, however kindly.
Alma’s Story
One of the people I work with, Margaret, really likes to be kept busy. She had spent much of her life running a successful household and working.
We asked Margaret if she would like to help fold laundry items. When we saw how much she enjoyed helping with this, we provided her with her own name badge, gloves like our other staff wear, and asked her to do this work in our laundry area rather than in our main room.
Margaret really enjoyed the social contact and chat with staff when she joined in.
What Do We See in Alma’s Story?
Alma is thinking of Margaret as a grown-up with a lifetime of experiences.
Alma sees Margaret as a responsible, capable grown-up.
Alma is maintaining Margaret’s self-esteem and self-identity. When we are so busy giving ourselves, it’s easy to forget that giving and having a purpose are also important to the people we support.
Tip 1: Look Beyond Limitations
Why might we slip into treating people living with dementia as children? It is often because we are thinking about limitations. We are helping people with things that adults often do themselves. We see responses that seem less appropriate or considered than we would normally expect. These aspects of the person remind us of a child, but we are not seeing the whole person. Person-centred care looks beyond diagnoses and limitations to see the whole unique individual.
If we think of a behaviour as childlike, we can respond to the person as if they were a child. Then the person may respond to being treated as a child! For example“
– Time for your shower Jimmy” (I’m the grownup and I get to say when you shower). Jimmy point-blank refuses to have a shower and says to go away
– “For goodness sake Beth. That was just silly” (I’m the grown-up telling you off, you’re the naughty child). Beth becomes upset and angry
In Alma’s story, Alma didn’t just see the limitations of what Margaret couldn’t do on her own anymore. Alma saw beyond this to a person with a lifetime of experiences, strengths, interests, roles, and responsibilities.
Tip 2: Think About Communication
We can communicate simply and clearly without sounding like we are talking to a child or a baby (sometimes called ‘elderspeak’).
Sometimes we slip into using endearments like ‘love’ or ‘sweetie’. For some people, this can feel like we are talking down to them and taking away their identity. Using their preferred name is much safer!
We can be careful about the terms we use, for example, avoiding words like ‘nappies’ or “baby food’, even in a joking way.
We can check whether we are using an exaggerated way of speaking.
We can give simple choices.
We can make sure that the person living with dementia is always included in the conversation and not talked about.
Wait, Does Treating Someone as an Adult Mean We Should Stop Activities if they seem childlike?
We can take our cues from the person living with dementia – if they are delighted by a soft toy or intrigued by finger painting, then we celebrate the positive. It’s not up to us to judge.
Tip 3: Look for Ways To Show Dignity and Respect
There are many ways you can show respect and maintain dignity as an adult in your everyday interactions with people living with dementia. For example, when you:
Ask their opinions and give choices.
Really listen to them
Honour their preferences for the things that they like or don’t like in food, clothes, or activities
Talk to them as a fellow person, not just about the task to be done task
Acknowledge their individuality
Ask for their help.
Provide privacy for toileting or bathing
Compliment them
Invite rather than command
Enable them to keep doing what they can do
We can deliberately set out to do more of this so that, every day, we send the message that we genuinely see them as a human being of worth and as the person they are. As we do this, we respect the person’s rights, and we help maintain their self-identity and self-esteem.
Would You Like To Find Out More About Validation and Looking at the World From the Perspective of Respecting the Person Living With Dementia as an Adult?
You can read Jane Verity’s discussion of the myth that people living with dementia are childlike here
You can read an article about what is considered a dignifying aspect of care and how this overlaps with person-centred care here.
You can watch a short video by a daughter of someone with dementia/vlogger about why it’s a risk to treat people living with dementia as children here.