The ACE Philosophy and Dementia Capable Caregiving

by Catherine Harris PhD, RNCS

The physical and emotional difficulties in caring for a person with Alzheimer’s disease (AD) cannot be underestimated. However, the research literature, recognized experts, and the National Alzheimer’s Association (AA) support key and basic principles of caregiving that will minimize the behavior problems associated with AD. When activities of daily living (ADLs) are conducted with these principles in mind, the risk of a catastrophic reaction, combativeness, or sundowning are greatly reduced. The principles include the Cornerstones of the ACE Philosophy (AA) and the Foundations of Caregiving (University of Arizona, Tucson).

The acronym ACE stands for the Alzheimer Association’s Alzheimer Care Enrichment philosophy. This philosophy states that people are unique and bring to the caregiving situation different life experiences, values, abilities, preferences, relationships and needs. This uniqueness shapes the experience of Alzheimer’s disease for the person and those who interact with them. In addition, the manifestation of Alzheimer’s disease is a multifaceted disease and manifests itself differently for each individual. Care for the person occurs within the context of their relationship with the caregiver, the relationship of the caregiver with the family, their relationship with other persons with dementia and the relationship within and between families. These premises mandate individualized care.

Cornerstones of the ACE philosophy include the following:

  • The care provided to persons with Alzheimer’s disease must be individualized, reflecting the person’s concerns, life history, meaning, relationships, emotions, thoughts, current needs, strengths, and preferences.
  • Care of the person with AD must demonstrate compassion and concern for the individual; Care of the person with AD must be directed at enriching the life of the individual through meaning activities and relationships; and Promoting autonomy for the person with AD remains essential through all stages of the disease.

Underlying these cornerstones are basic beliefs that direct the care of persons with AD. For example, it is believed that all behavior has meaning and instructs caregivers of underlying experiences or needs that may not be easily expressed in words. Truly individualized care requires a paradigm shift from control of behavior to one more attuned to allowing and supporting the person to be his or her unique self. Changes in functional ability are both part of the disease process and the result of excess disability, demanding that caregivers continuously assess, adjust, and personalize caregiving routines. Meeting the person in their reality is more effective and compassionate then expecting them to enter our reality. Finally, one of the greatest challenges is balancing safety and autonomy, allowing the person to be “at risk” in reasonable, predictable ways. This is an important way of communicating respect for the person.

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