Dementia is one of the main causes of disability in later life ahead of some cancers, cardiovascular disease and stroke. Forecasts predict the population of people with dementia in Ireland, of which Alzheimer’s disease is the most common form, will increase to 140,000 by 2041 — a 240% hike of the 2006 figure of 41,447. Dementia is a syndrome characterised by progressive reduction in brain function and is associated with impairment in functional abilities and can also include behavioural and psychological symptoms. There may be memory loss, disorientation, communication difficulties, changes in personality or mood and problems with spatial awareness.
The role of Occupational Therapy
Occupational therapy interventions for those with dementia can involve various approaches which include:
1. Health Promotion
By focusing on maintained strengths of clients and promoting wellness of care providers, practitioners can enrich their lives by promoting maximal performance in preferred activities.
Although the remediation of cognitive skills is not expected, restoration of physical skills (range of motion, strength, and endurance) may still take place even with the backdrop of dementia.
Practitioners can determine what is working well in the daily routine of the person with dementia, and provide supports to ensure that the person’s skills are maintained for as long as possible.
This is perhaps the most frequently used intervention for those with dementia, as it ensures safe and supportive environments through adaptation and compensation.
Who could benefit from Occupational Therapy?
The following table illustrates potential occupational therapy interventions to promote optimal functioning for people with dementia and their families or care providers. These examples are somewhat simplified; during actual intervention occupational therapists complete in-depth evaluations and activity analyses to determine the specific demands of an activity.
Potential Occupational Therapy Intervention
|Person forgets what season it is when choosing clothing.
||Helping the care provider set up limited clothing selection to fit the season, while still addressing client control and self-efficacy
|Person gets disoriented and wanders
||Setting up the environment to enhance daily activity, including mobility within safe confines, and using technology to ensure safety. For example, a fenced courtyard with stop signs at the gates could be all that is needed to keep the person oriented to his or her own yard
|Person forgets that they have been cooking and leaves pots on the hob
||Combination of activity analysis, behavioural analysis and cognitive assessment. Implementation of internal or external cognitive strategies to reduce the impact of memory impairment. Environmental modification and recommendation for safety devices.
||Teaching care providers the concepts of non-defensive responding and orienting techniques, and working on determining the underlying emotion that may have precipitated the client’s behavioural outbursts
|Repetitive non-productive behaviour
||Providing opportunities for engaging in occupational tasks that fulfil the person’s need to be productive and help support relationships with others. For example if the person once enjoyed crossword puzzles, perhaps simplified puzzles or word searches would still be enjoyable.
Able Ageing Specialist Dementia Service
Our service begins with an initial face to face assessment. We gain an account of the client’s journey with dementia and gain an insight into the client as an individual; their personality, their current and previous roles and what is important to them. We investigate whether the client has any goals, are finding anything difficult or have any concerns about his/her current home environment, performance with activities of daily living, or indeed any health concerns such as low mood or anxiety. It is important to gain perspectives of the people who are central in the life of the client and what their wishes are too. The ultimate goal of this initial face to face assessment would be to formulate mutually agreed goals which are relevant to the client, taking into account the concerns of the client’s family or care givers.
The remit for further sessions depends on individual circumstances and will be discussed at the initial assessment stage. Further therapy sessions could include:
This involves an assessment of the individual performing an activity relevant to him/her. This could be an activity that the client has said they are finding difficult or the client’s family or care-givers are concerned about. The observational assessment provides valuable information regarding the client’s mental and physical strengths and problem areas within the context of their daily routine and home environment. As a result of this assessment we may recommend that the activity or environment is adapted to better support participation to increase independence or safety. We can also provide advice around structuring a person’s daily routine to increase participation and wellbeing.
As dementia is a progressive condition, functional or behavioural problems could be indicative of a decline in cognitive function. We can complete a comprehensive assessment of cognition to include attention, memory, information processing, language skills, visuospatial skills, and executive skills such as planning, organisation and insight. This helps to monitor cognition over time and highlight particular cognitive domains which could be particularly impaired. If relevant, a mental state examination can be conducted including assessments of depression or anxiety.
As mentioned, physical problems such as reduced mobility, range of movement, and weakness can occur within the backdrop of dementia. Many individuals have the potential to overcome these physical issues to increase independence in mobility and activities of daily living.
Reminiscence therapy is a biographical intervention where the past is discussed generally or with the use of stimuli such as music or pictures. Evidence suggests that reminiscence therapy for persons with dementia can lead to overall improvements in depression, loneliness, psychological well-being and functional ability and can reduce the strain experienced by care-givers. Improvements in cognitive assessment scores have also been found. Furthermore, studies with individuals with mild to moderate dementia have found physiological improvements in the brain.
Ultimately, we want to support our clients suffering from dementia to remain at home for as long as possible, as we know a change in environment can be potentially debilitating. We also understand that somebody’s safety and wellbeing can be compromised by living at home, even with substantial support. We are experts in supporting the person with dementia and their family to make a decision regarding future care needs and the most appropriate living environment.
Please contact us if you would like to discuss your particular needs.