The Well-Being Approach to Distress - Trading Dementia Drugs for Water Jugs

With over two decades of experience in residential care homes, Dr. Allen Power has witnessed firsthand the limitations of traditional approaches to managing dementia, particularly the overreliance on antipsychotic drugs and sedatives to address behavioural distress.

Refusing to succumb to pressure to medicate emotional responses that weren’t understood, Dr. Power set out to uncover alternative solutions that honoured the humanity and unique experiences of those under his care.

“I just didn’t like the way that staff would instantly resort to antipsychotic drugs and sedating medications when we encountered behaviour that we didn’t understand,” said Dr Power.

Central to Dr. Power’s paradigm shift was the recognition that dementia represents not just a neurological disorder, but a profound shift in the way individuals perceive and interact with the world around them.

This realisation and many more like it resulted from Dr Power’s growing interest in a philosophy of care called The Eden Alternative™, which is primarily focused on fortifying relationships between care recipients and care staff.

Utilising these teachings to reframe dementia as a “shift in experience” rather than a mere collection of symptoms, Dr Power was granted permission by The Eden Alternative™ to adapt and create his own approach to delivering dementia care using the framework of ‘The Eden Alternative Domains of Well-Being(R)’.

The result of this is a methodology of dementia care that Dr Power calls ‘The Well-Being Approach to Distress.’

This framework invites caregivers to view dementia through a prism of seven domains that require fulfilment to bring happiness to a care recipient. It is easiest understood by visualising each of the seven domains as drinking glasses that range from empty to full depending on a care recipient’s level of satisfaction in each of those domains.

The next step is adopting a care plan for each individual that works to fill the metaphorical glass for each domain. The closer a care provider can get to satisfying each of these domains, the more likely a care recipient is to feel holistically satisfied which then reduces the need to medicate ‘behavioural symptoms.’

The seven domains are as follows:

Identity

Understanding the essence of each individual beyond surface details is pivotal. Dr. Allen Power underscores this: “It’s more than just knowing who their family is… It’s knowing what gives them meaning.”

Aged care staff can tailor routines to match personal rhythms, respecting sleep patterns and daily preferences. Recognising past roles shapes present behaviours; a teacher may seek to educate still and a caregiver may radiate compassion.

Incorporating Professor Erwin Böhm’s approach delves into what actions signify about personal values. By honouring these nuances, caregivers affirm identities and instil purpose.

Connections

Meaningful connections form the bedrock of quality care. Dr. Power advocates for continuity, reducing confusion by limiting different caregivers. Daniella Greenwood’s award-winning consistent staffing model exemplifies this.

Fostering rapport and shared interests, whether in hobbies or spirituality, strengthens bonds. Recognising the significance of familial ties and friendships, caregivers create environments of trust and familiarity. By prioritising connections, caregivers provide solace and companionship, essential for emotional well-being.

Security

Providing a sense of safety and comfort is paramount in dementia care. Dr. Power stresses the significance of routines and respectful interactions.

“Provide a safe and supportive environment that promotes feelings of security and comfort for individuals with dementia,” he advises.

Respecting personal space and boundaries fosters trust. Caregivers tailor approaches to meet individual security needs, ensuring environments promote well-being. By prioritising security, caregivers create sanctuaries of solace and support.

Autonomy

Empowering individuals with dementia fosters a sense of dignity and agency. Dr. Power emphasises involvement in decision-making processes and honouring personal choices. fspri”Provide cues and prompts as needed to enable individuals to contribute to activities in meaningful ways,” he advises.

Providing opportunities for active participation in daily tasks and respecting abilities nurtures independence. Caregivers offer cues and prompts while creating supportive environments that prioritise individual control. By nurturing autonomy, caregivers preserve dignity and self-worth, enhancing overall quality of life.

Meaning

Infusing daily routines with personal significance enriches experiences for individuals with dementia. Dr. Power advocates for incorporating traditions and preferences, creating rituals to imbue activities with purpose.

Caregivers embrace creativity, finding avenues for expression aligned with interests. By challenging staff to make interactions meaningful, each moment becomes an opportunity for connection and fulfilment.

“Emphasise the importance of fostering a sense of purpose and connection through meaningful engagement,” he stresses.

Growth

Supporting personal growth transcends cognitive limitations. Dr. Power encourages exploration and skill development, celebrating every achievement.

“Recognise and celebrate moments of growth and achievement, no matter how small,” he advises. Engaging in artistic expression or learning opportunities stimulates cognitive function. Caregivers nurture imagination and creativity, fostering holistic development. By focusing on growth, caregivers affirm individual potential and promote lifelong learning.

Joy

Creating moments of joy is essential for emotional well-being. Dr. Power highlights the importance of sensory stimulation and positive experiences.

“Encourage sensory stimulation and positive experiences that evoke happiness and contentment,” he emphasises. Cultivating deep relationships and prioritising fulfilling activities fosters lasting happiness. By nurturing environments that prioritise joy, caregivers enrich lives and cultivate emotional resilience.

Put into practice

The implementation of the ‘The Well-Being Approach to Distress.’, inspired by Dr. Allen Power’s insights, has yielded remarkable outcomes, particularly evident in the notable reduction of antipsychotic medication usage across 92 care homes in Arkansas.

This initiative, led by Dr Angela Norman, is driven by a commitment to holistic dementia care that has led to tangible, transformative shifts in resident well-being.

By embracing Dr Power’s methodology, caregivers have adopted a more nuanced understanding of dementia care, emphasising personalised interactions and meaningful engagement.

The tangible benefits of this approach are underscored by the significant decrease in antipsychotic usage across the 92 care homes in Arkansas, dropping to less than 7%. This dramatic reduction stands in stark contrast to the national average of 20%, showcasing the potency of the 7 Glasses methodology in improving resident outcomes.

As Dr. Power’s groundbreaking approach continues to revolutionise dementia care, it’s worth mentioning his influential books that have paved the way for change. His first book, “Dementia Beyond Drugs: Changing the Culture of Care,” published in 2010, challenged conventional practices and emphasised the importance of personalised, holistic care.

Subsequently, “Dementia Beyond Disease: Enhancing Well-Being,” released in the same year, further expanded on the principles of well-being and dignity in dementia care.

These seminal works, including contributions from experts like Daniella Greenwood and from many people living with the diagnosis, have been instrumental in shaping the discourse around dementia care.

Dr. Power’s upcoming book, co-authored with Jennifer Carson and Pat Sprigg, promises to push the envelope even further. Titled with a focus on unlocking and desegregating memory care, it seeks to address fundamental rights issues and advocate for a more humane approach to dementia care.

As Dr. Power’s philosophy continues to evolve and influence caregivers worldwide, his books serve as indispensable resources, providing both philosophical insights and practical guidance for improving the lives of individuals living with dementia.

Through ongoing research, advocacy, and collaboration, Dr. Power’s legacy ensures that the future of dementia care is rooted in compassion, dignity, and respect.