By Amy Sheridan, Seasons Program Director

In working with people living with dementia, Abraham Maslow’s Hierarchy of Needs serves as a framework for identifying and prioritizing the needs of individuals. It emphasizes that basic physiological needs like food and shelter, safety needs, and needs for love and belonging, self-esteem, and self-actualization must be addressed to promote well-being. However, in dementia, the progression through the hierarchy is reversed, with higher-level needs often addressed first, and the focus shifts to person-centered care that validates emotions, builds trusting relationships, and adapts strategies like vocational reenactment activities to address unmet needs and mitigate behaviors.

How can we apply Maslow’s Hierarchy to Dementia Care

• Reverse the Pyramid: For individuals with dementia, the traditional pyramid is essentially turned upside down. Instead of progressing up, people are moving down, losing memory of experiences, skills and the ability to meet needs independently.
• Address Higher Needs: While basic physiological needs are always important, higher-level needs like connection, dignity, and respect become crucial early on.
• Focus on the whole person: Recognize that individuals with dementia are adults with unique histories, personalities and preferences, even as cognitive functions decline.

Meet Needs though Person-Centered Care:

• -Physiological Needs: Ensure adequate nutrition, hydration, shelter, warmth and regular routines for sleep and daily tasks. Prepare meals that are easy to eat, frequently offer water, implement a bathroom schedule and stay active during the day to help with sleeping at night.
• -Safety Needs: Provide a secure and supportive environment, while also ensuring comfort and avoiding excessive focus on safety at the expense of other needs.
• -Love and Belonging: Foster social contact, build trusting and empathetic relationships, and validate emotions, recognizing the interdependence of people with dementia and their carers.
• -Esteem Needs: Preserve dignity, provide opportunities for positive social interaction and make efforts to awaken a person’s sense of self through activities that tap into their past. Validate their thoughts and actions, do not correct and instead redirect, offer activities that allow your loved one to feel successful, and ask simple questions and communicate clearly.
• -Self-Actualization: Though challenging, identify and engage the person in meaningful activities like vocational reenactment to help maintain their identity and sense of purpose. If the other needs are being met, your loved one will likely feel content, social and secure.

Practical Strategies for Care Partners

• Get to know the individual: understand the person’s history, lived experiences, personality and preferences
• Adapt the environment: Include familiar belongings in the living space to create a sense of comfort and familiarity
• Address behavior as communication: Recognize that behaviors such as pacing or repetitive vocalizations may be an attempt to alleviate boredom, pain or communicate an unmet need
• Regularly evaluate care: Assess if needs are changing and what can be improved upon

Maintaining a level at or near the top of Maslow’s pyramid isn’t easy, nor is it going to happen every day. Doing what you can to stay engaged and aware is important – this will lessen the chance of falling back down the pyramid. Validating one’s feelings and thoughts should be a recurring theme throughout the day. The time for arguing or trying to rationalize has passed. It can quickly become overwhelming to think about all the needs that must be tended to in a day for a person with dementia. There are no two cases just alike and there is no one magic answer.

Seasons Adult Day Health Services can help with achieving the Hierarchy of Needs for those living with dementia. In a comfortable and social environment, your loved one can participate in activities while making new connections! For more information about how Seasons can help your loved one living with cognitive changes to stay as healthy as possible while engaging in therapeutic programming, contact our Family Support Manager, Christin Cardani, at 989-633-3767.