 Edelman (2000) describes biopsychosocial approach to health as an interplay between the following aspects of our life.

◦ Biological – which includes all aspects of the body such as the brain and nervous system; ◦ Psychological – which includes all aspects of individual experience and behaviour such as cognition and emotions; ◦ Social – which includes all aspects of society, such as family, the local community, public services and physical environment.

◦ Integrity promoting care (Brane et al, 1989) ◦ Individualised care (Rader, 1995) ◦ The ‘best friends’ approach (Bell and Troxel, 1997) ◦ The relationship approach (Zgola, 1999) ◦ Person-focused care (Cheston and Bender, 2000) ◦ Emotion-orientated care (Finnema, 2000)

 Brooker presented an updated model of person- centred care. ◦ V - A value base that asserts the absolute value of all human lives regardless of age or cognitive ability. ◦ I - An individualised approach, recognising uniqueness ◦ P - Understanding the world from the perspective of the service user. ◦ S – Providing a social environment that supports psychological needs

 Valuing people is not just for special occasions.  It means giving people with dementia equal access to specialist care an equal consideration for their social, emotional and physical needs.  It means avoiding all the ways in which people who are cognitively disabled and devalued in society.  It also means acting in ways that compensate for the difficulties of living with dementia.

 How do you show your clients that they are valued?  Is it easier to value some people than others?  Are there some features of your service that might give clients with dementia the feeling that they are not valued?  How do you find out whether clients feel valued or not?

 What does it mean to treat each person as an individual? And what prevents us from doing this?  If you think about your own experiences of not being treated as an individual but as one of a crowd, sometimes we find this tolerable, and other times if makes us angry, hurt, irritated or despondent.  Most of us can endure being treated as one of the mass on a temporary basis but how would we feel if not being treated as an individual pervaded every aspect of our daily life?

 Think about a time when you have been faced with a totally new situation, how did this feel?  Think of the experience of a person with dementia who might be faced with a new and challenging situation such as a new care setting or service.  This principle recognises that whilst we all have shared experiences of what it is like to live in a social world, each of us also has his or her own ‘version of reality’, or ‘frame of reference’.

 Drawing on our own experiences, using our imagination and thinking creatively are important aspects of working with people who have dementia.  Trying to interpret what each person with dementia might be communication through his or her words and actions is vital if we are to propose responses that are genuinely person-centred.

 When a client says of does something that you don’t understand, do you consider explanations based on his or her life history, physical health, or psychological well-being?  Are there attempts in your workplace to respond to behavioural signs that a person is unhappy. In p ain, or angry about the way they are being treated?  Is the care regime changed to suit the individual?

 Think about the extent to which the clients of your service are treated as individuals  What prevents you from treating clients as individual?

 It is important we create a supportive social environment if needs are to be met and well-being maintained.  An understanding of life history is crucial when planning improvements to a person's social environment. This can help us see how to make alterations to better meet their needs for security and attachment, stimulation and occupation, social inclusion, comfort and identity. (Kitwood, 1997)

 This principle is about creating a social environment for each person that will enable them to maintain well being.  People with dementia are no different from the rest of us – relationships play a vital role in meeting their needs.  The losses of late life and life circumstances (which may have altered due to dementia) in combination with each person’s specific difficulties often disrupt vital relationships.

 Consider how well your clients needs are met by her (or his) social environment. For example, does the environment meet needs for ◦ friendships/relationships of trust ◦ conversation, intimacy and companionship ◦ a sense of belonging and having recognised social roles ◦ help with practical matters ◦ pleasant living circumstances ◦ a sense of hope and agency – of being able to ‘make things happen’?

 Bell V and Troxel D (1997) The best friends approach to Alzheimer’s care. Baltimore: Health Professions Press.  Brane G, Karlsson I, Kihlgren M and Norberg A (1989) Integrity-promoting care of demented nursing home patients: Psychological and biochemical changes. International Journal of Geriatric Psychiatry, 4 (3) pp  Brooker D (2007) Person-centred dementia care: making services better. London: Jessica Kingsley Publishers.

 Cheston R and Bender M (2000) Understanding dementia: The man with the worried eyes. London: Jessica Kingsley  Edelman RJ (2000) Psychosocial aspects of the health care process. Essex: Prentice Hall.  Finnema E (2000) Emotion-orientated care in dementia: A psychosocial approach. Amsterdam: Vrife Universiteit.  Kitwood T (1997) Dementia reconsidered : The person comes first. Buckingham: Open University Press.

 Radar J (1995) Individualised dementia care: Creative compassionate approaches. New York: Springer Publications  Zgola JM (1999) Care that works: A relationship approach to persons with dementia. Baltimore, MD: Johns Hopkins University Press.