Safety needs
In Maslow’s hierarchy of needs you will have seen how safety needs are the next important level of needs which we seek to have met. To feel secure and safe within the various aspects of our lives is important so we feel able to function and can be in a relaxed state.

This can be about feeling safe within our relationships or financially, as well as more immediate safety concerns of being in danger. When feeling threatened a person will seek safety and security in whatever way is possible.

Tom Kitwood holds specific ideas relating to person-centred care and developed positive approaches to people with dementia which are discussed in his book ‘Dementia Reconsidered’. He challenged the medical model and identified a new approach to supporting people with dementia by focussing on ‘personhood’.

In recent years there has been increased recognition of how the attitudes and actions of other people, combined with their neglect, actively disempower those who have some kind of ‘difference’ and overlook their attempts at action and deny them a voice (Makin 1995). This is termed the ‘social model of disability’.

This began to be recognised to be occurring in a similar way with people with dementia. Kitwood (1990) took these ideas forward within research, making notes on episodes he observed in care settings and classifying them. The harmful and deeply damaging episodes he classified as ‘Malignant Social Psychology’.

Here are some examples of Malignant Social Psychology:

• Disempowerment A lack of recognition of a person’s abilities and opportunities are not given to allow a person to do what they can do.
• Objectification Treating a person as if they were an ‘object’ rather than as a person.
• Invalidation Not recognising the way a person might be feeling in response to what is happening.
• Infantilisation Communicating with a person as if they were a young child.

For further information on the approach: see the ‘Dementia Care Mapping’ section in chapter 16. Observation tools.

Impact of interpersonal interactions
What happens within an interaction has an enormous effect on how a person feels. Key messages are being communicated which can result in powerful feelings. For example if you feel a person is ‘talking down’ or ‘talking over’ you this can often result in feeling angry, upset, hurt, frustrated, humiliated or in many other strong feelings.

If this should happen regularly it can significantly affect a person’s mood and well being.

Social contact and stimulation
Looking at Maslow’s hierarchy of needs it is recognised that once the lower need is satisfied, a person focuses on satisfying the higher needs of love and belonging, self esteem and self actualization.

Kitwood (1997) also suggested this includes a need to be accepted as part of a wider group of people and having bonds with others. Being involved and contributing to a community whether that is family, friends, work or social situations heightens well being.

Observational studies of persons with severe cognitive impairment demonstrate that people with dementia, in common with all people, need social contact to feel they are loved and have stimulation within their life. However they often cannot recognise, express or resolve these needs independently and the environment does not always recognise or provide for these needs.

Further learning
For research on need for social interactions within institutional care (Hubbard et al 2003).
https://dspace.stir.ac.uk/bitstream/1893/278/1/meaningful-social-interactions.pdf

Research on unmet needs, quality of life and support networks of people with dementia living at home (Miranda-Castillo et al 2010).
http://www.hqlo.com/content/pdf/1477-7525-8-132.pdf

Living in the wider community
Many people with dementia are living in the community either with family or alone. Maintaining social and family relationships becomes increasingly difficult, and the quality of life for people with dementia is dependent on other people’s ability to understand the condition.

The education of wider society,families/carers is therefore vital in providing the necessary understanding and information about the disease in order to enable supportive approaches.

People with dementia who are living alone may have a different experience from people living with family or friends. Without people who are close enough to recognise changes and/or difficulties, the person might not receive a diagnosis until much later in the illness when risks are identified by neighbours or the wider community.

‘Living well with dementia – a National Dementia Strategy’ was published in February 2009 and was followed by Quality Outcomes for people with dementia: building on the work of the National Dementia Strategy (2010). These documents set out a vision for transforming dementia services highlighting the need to raise public awareness, amongst other key priority areas:

• Good quality early diagnosis and intervention for all.
• Improved quality of care in general hospitals.
• Living well with dementia in care homes.
• Reduced use of antipsychotic medication.

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