I'm going to be talking about the concept of personhood, and how that relates to

developing plans of care that promote well-being in individuals with dementia.

Dementia, as you know, is the ultimate thief.

It begins with deficits to short-term memory, eventually moving into

impairing an individual's ability to communicate their needs to us.

And then ultimately moving on and causing deficits in their ability

to function such that they're totally dependent on us for their care.

There are multiple losses that occur over this process, beginning with cognitive

losses and then moving into emotional, social, physical losses,

and the way that they are respected in the community because of these losses.

The individual's also impacted by other past traumas,

disadvantages that they've overcome, and the social dislocation that occurs

as part of the dementia care system, unfortunately.

Often individuals are asked to leave their home environment,

move into other supportive care environments, and

it's these ultimate insults over time that make dementia really an ultimate thief.

Personhood is an important concept to think about in relation

to these multiple loses.

And they should help us be mindful of the need to focus on the sense of

personhood of each individual.

However, the concept of personhood has been very widely debated,

primarily in the philosophical literatures and also in the literature

in thinking about laws around the rights and responsibilities of persons.

And so you look back historically over the literature,

you can see this long debate about the concept of personhood,

particularly among philosophers and ethicists.

As society began to cope with more and

more individuals with dementia residing in and

among in our society, a new level of debate actually occurred.

Some philosophers argued that personhood required the possession of certain

capabilities and capacities, such as the ability to think and reason logically.

Other ethicists and philosophers argue that personhood only requires simply being

a human being, that is the only requirement to this concept of personhood.

And it's that second definition, that simply being a human being is what

we'll focus on in our discussion today about the concept of personhood.

We owe this definition to the work of Tom Kitwood, who defined personhood

as the standing or status that's bestowed upon one human being,

by others, in the context of relationship and social being.

And that it implies recognition, respect, and trust.

Think about the way that individuals with dementia are cared for.

Are they fully recognized?

Are they respected?

Is their opinion trusted?

Especially as individuals lose the ability to communicate their needs with us,

often the utterances and the behaviors that they manifest are ignored and

not understood as an important way of their communicating their needs to us.

And so the personhood model's been particularly useful in helping

us understand why individuals express the symptoms that they're expressing.

And it's because that they have needs that are unmet, and

that we need to respect because we respect them as a person.

Here's the list of domains that Tom Kitwood identified.

The first is the need for comfort, for warmth and compassion,

in the care that we provide.

The second is occupation.

Not just paid employment, but

the need to be involved in meaningful engaging activities.

The third is the need of identity.

The need to feel that they have a sense of continuity with the past, and

that they have meaning, and that their life has meaning, and

that they are respected as individuals.

There's also the need for inclusion.

Feeling that they belong in a social group, and that they are socially accepted

or that their presence has meaning and they're attached to this social group.

And ultimately that there's a need for love,

to be unconditionally accepted regardless of who they are and their past.

Positive person work is the framework that Dr.

Kitwood developed to help us come up with tools and

pragmatic ways of applying the personhood framework into models of care.

And we're going to be talking about different examples of this

when we talk about models of care.

But if we think about the concept of unmet needs in comfort,

for example, we can use holding, relaxation,

timalation, and these domains to inform a palliative approach.

And we'll be talking about a palliative model of care next week

with the understanding that it's a comforting care, way of providing for

individuals, particularly those at end-stage disease.

We'll also talk about the application of meaningful activities

as a very important model of care, and we'll talk about that next week.

And here we'll talk about the need for meaningful engagement or the need for

occupation, and the ways that we go about that through things like play and

negotiation.

So all of these domains are useful in providing a framework,

a very practical way of using the concept of personhood in informing models of care.

And it'll really transcend all of the work that we're going to be talking about

next week.

So in conclusion, this is a very brief overview, and a brief introduction

to the idea of personhood as a central idea in person-centered care.

We use the term person-centered care rather lightly to infer an idea that

the patient is at the center of the care that we provide.

Here we're hoping that we're enhancing your understanding

of what we mean by person-centered care.

That it really is inherent in this idea of personhood.

Hope that this beginning discussion is useful to you.

We'll be providing you with other resources and

links if you're interested in learning more about this model.

There are rich resources available to you

online if you want to learn more about this concept of personhood.

Thank you.

Personhood

Living with Dementia: Impact on Individuals, Caregivers, Communities and Societies

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