Psychological Design

Salutogenic Approaches to Dementia Care


Salutogenesis is a theory of health focused on strengthening the forces that support life and engagement, rather than on preventing or treating disease. In doing so, salutogenesis propels a person’s ontological sense of self (their sense of coherence  – SOC) towards full engagement with life and away from infrmity and death. ‘Good health’ and ‘a strong sense of coherence (SOC)’ are thus powerfully correlated; helping people feel strong and resilient to life events, pathogens, and other challenges. This approach contrasts to health disciplines (‘white-coat medicine’) that seek to draw people back from physical and mental failure to the point where the pathogens and insults have been neutralised.

Salutogenesis theory is useful in developing ecopsychosocial (Zeisel et  al., 2016), non-pharmacological aged and dementia care interventions because it incorporates not only factors that lead to infrmity but also ones that lead towards better health. Salutogenesis provides practical tools to understand and affect this passage, managing cognitive and other age-related declines by maximising all available resources. Unlike white-coat medicine, the focus is not on eliminating a disease (although this approach is still compatible); instead, salutogenesis improves resilience and a person’s capacity to engage in life more completely, fortifying the ability to cope with the challenges that are a normal part of life’s passage – even the challenges associated with ageing and dementia

SRRs focus on supporting a person’s endogenous adaptive capacity in three domains: intellectual (comprehensibility), physical (manageability) and affective (meaningfulness). Salutogenic theory holds that while disease is unquestionably caused by pathogens, specifc stressors, genetics, and so on, good health is not merely the absence of these things. In the face of life’s challenges (including disease), health is maintained by a strong SOC, which in turn is drawn from the generalised composite of all resistance resources (the GRRs). A strong SOC is expressed as hope, optimism, and buoyancy in the face of adversity. When a person can no longer manage or even understand life’s challenges, their SOC becomes depleted, the GRRs needed to maintain their vitality and reason to live are insuffcient for the job, and disease and infrmity follow.

While salutogenic theory explains and predicts resilience in the face of assaults on body and mind, the question remains, ‘How does a salutogenic framework explain resilience in the face of the natural and inevitable course of ageing  – especially once cognitive, emotional, and physical decline has already set in?’ And what about when a person faces the stressful inevitability of death (Butler, 1975)? With age, a salutogenic approach focuses on improving a person’s SRRs to continually strengthening their SOC by targeting tailored interventions in each of the three person-centric salutogenic domains (comprehensibility, manageability and meaningfulness).

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