The Bradford Dementia Group at the University of Bradford was formed in 1992 by Thomas Kitwood. Kitwood firmly believed that viewing people with dementia in purely medical terms, could lead them into being seen as objects and as having no subjectivity or personhood. In order to counteract this, he developed a number of specific ideas relating to person-centred care and developed a number of positive approaches that could be taken toward people with dementia. If you are interested in reading more about this, it is discussed in his book Dementia Reconsidered: The Person Comes First (Rethinking Ageing).
What Kitwood did in his model was to show that when caring for, and supporting people with dementia, we must remember six psychological needs: love, comfort, identity, occupation, inclusion, and attachment.
These are needs that we all have but when we care for someone who is living with dementia, we need to ensure that we take extra time to fulfil these needs. When ministering to someone living with dementia it can be good to look at what these needs represent to us and think how we can apply them to the person and carer we are ministering to and supporting.
It can also be useful to share this information with the primary carer who is very often a husband, wife or family member who has found themselves in this role, feeling at times desperately out of their depth, trying to pick things up as they go along.
So lets take a look at each of these needs.
Everybody needs to be loved and to love someone; being loved and accepted is part of our need for survival, from when we are born. Love can range, from loving a person, an activity, a favourite meal/food, to loving God and feeling self-love. Providing that love, even when it is difficult, is essential. In Kitwood’s model love sits in the very centre.
Comfort is about our physical need. We feel comfortable when we are warm, dry and clean, have a full stomach and are not feeling thirsty. Comfort could also mean we have quiet when we want or need it, we are free to move around, are free of pain, and have a sense closeness, being able to bond with others.
We all have our own personal identity and this is important; from the clothes we wear, how our hair looks, the food we like to the music and tv we like. These all help us and others identify with who we are. Just because someone has developed dementia this personal identity doesn’t go away.
This isn’t about the work we did but remaining occupied. It is being occupied and needed that helps us feel we have worth and purpose in life. From being involved in daily activities, to engaging in planned activities. It is important for the person to be able to occupy themselves with meaningful things. If they have always been in the church kitchen, cleaned, been a sides person, sung in the choir or served tea and coffee this is part of their identity and value. To take this away can have a very negative impact. It is so important to try and find ways to support them to continue in these roles for as long as they want to.
Inclusion is about being a part of something. In church that is that they are part of the body of Christ, His church. In simple terms if they are left out then it makes them feel bad. People living with dementia may lose track of conversation easily, may find services hard to follow, may seem to have shorter attention spans but they are still a person, still a member of the body of Christ and we must keep them included and engaged.
Our connections in life are crucial for our wellbeing and this continues in dementia. Everyone wants to feel connected to something, or someone; often a combination of both. We also have a need to form wider attachments in our community, or in groups. The church is part of this. Often whole friendship groups are in church, happy memories, fun times and support networks. Keep those connections going for them.
We must not forget that the person living with dementia is still a person.
Their personality may appear changed, their memory may be impacted, they may have some physical impairments, but they are still who they have always been at their core. We need to see this and treat them with the love, respect and the care that they deserve.
Keeping the above needs in mind when we are ministering and planning pastoral care can go a long way towards showing the love of God to the person living with dementia.