Social work principles integrated with the Progressively Lowered Stress Threshold (PLST) model create new inspiration for understanding distressed behaviour among people with dementia in Hong Kong. Social work emphasizes the individuality and uniqueness of every human, whose experiences, perceptions and feelings should be respected. This research aimed to explore the self-perception of people with dementia and the interpretation of their surroundings to understand the rationale behind the distressed behaviour based on the PLST model. In-depth interviews and participatory observations during interviews in the residential care homes of Hong Kong were conducted. Following the theoretical framework blending interpretivism and the sociocultural perspective on dementia, the interpretation of data did not focus solely on what was expressed explicitly but also upon how the experiences, perceptions and interpretations of people with dementia had affected their self-perception and distressed behaviour.

Beyond the six principles of care from the traditional PLST model, the research finding in Hong Kong identified the new principles with the adaption of the local context. The seventh principle, known as DemenTitude ®, got the review and approval by one of the original authors, Prof Kathleen Buckwalter, in understanding more distressed behaviour among people with dementia. The new principle involves four key elements as follows: (i) Understand the self-perception and subjective views of people with dementia to synchronize the feeling and impact of dementia; (ii) Avoid using words that stigmatize the person with dementia; (iii) Avoid excess disability and psychosocial restraint & (iv) Assist the person with dementia to create a comfortable relationship with their surroundings and to experience meaningful engagement. Truly listening to the voice of people with dementia and how to minimize different natures of distress with cultural sensitivity is essential to promote a good quality of dementia care in Hong Kong. With the updated finding from the local context and the voice of people with dementia beyond behavioural and psychological symptoms of dementia (BPSD), the paradigm shift should be advocated from the medical model to person-centred care and even further develop a proper caring attitude with the perspective of social work professions, called as DemenTitude®.