The Role of Occupational Therapy in Dementia Care

1
The Role of Occupational Therapy in Dementia Care

• Speaker Bronagh Flynn
• Senior Occupational Therapist

2
Aim of Presentation

• To Outline an overview of the role of the
  Occupational Therapist when working in dementia
  care in areas of
•        Early onset Dementia
•   Maintaining skills with Dementia
•       Later Stages of Dementia
•  

3
Theories of aging

• Developmental Theories (Human stages of
  development)
• OT intervention often uses the developmental
  approach with techniques of reminiscence and
  validation i.e. can help resolve the
  developmental process of old age.

4
Theories of aging

• Biological Theories
• Social Disengagement Theory   
• Activity Theory
• Social Exchange Theory 

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Theories of Aging

• Activity Theory
• Main alternative to disengagement activity which
  is associated with older people withdrawing from
  groups community affairs. Activity Theory is
  also known as re-   engagement theory. (Lemon et
  al, 1972).

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Theories of Aging

• Social Exchange Theory
• Emphasises that neither disengagement or
  activity theories do not take into consideration
  economic or environmental factors affecting older
  person's roles.

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Role Identity

• Loss of roles causes loss of identity, the value
  of purposeful occupations is important to
  maintain role identity
• (Kielhofner, 2002).

8
Types of Dementia

• 1) Alzheimer's
• 2) Dementia with Lewy bodies
• 3) Vascular (multi-infarct)
•  

9
Common factors Influencing the Treatment in OT

• Aphasia receptive/ expressive impaired language
• Apraxia inability to perform motor function,
  individual understands task
• Agnosia inability to recognise objects in spite
  if intact sensory capabilities
• disturbances in executive functioning.

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The role of the Occupational Therapist

• A holistic approachleisure, personal care and
  occupation in relation to the physical,
  psychological, social, economic spiritual
  aspects of life, (Reed Sanderson, 1992)
  Creek, 2002.
• Maintaining, restoring improving occupational
  performance, promoting health and quality of
  life and easing caregiver's burden (AOTA, 1994)

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Personhood Well-being

• Socio-psychological Approach
• Personhood
• Social Interaction
• (Kitwood Bredin, 1992)

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The OT Philosophy Personhood

• All assessments are individual to clients,
  family carers needs, with active involvement
  from client at appropriate level.
• Planning based on clients desired aims to be
  realistic, individual to each person uniquely.

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• The Occupational therapist must assess the
  cognitive abilities of the client, in addition
  instruction in treatment activities must be
  geared to with consideration of impairments
• People with dementia may be unable to learn new
  skills however old skills and habits remain
  deeply ingrained, and these can be used long into
  the disease.

14

• Structure and predictibility are important
  aspects of the environment in which people with
  dementia live.
• Daily routines that are predictable and
  reflect rhythm of the larger society, with the
  opportunity for activity and a chance to rest,
  keep the person in touch with the world(Willard
  Spackman, 2003)

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Delivery of Client-Centred Practice (personhood)

• Contribution
• Comfort/Change/Calm/Content
• Contact/Companionship
• Choice
• Competence
• Commitment

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Occupational Therapy Assessment used in Dementia

•  Self Assessments 
•  Interview
•  
•  Observation Techniques

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Environmental Needs

• Level of clients needs need to be detemined at
  initial Ax to determine whether persons aim is
  to remain living at home with support or LTC
• Regardless of environment appriopriate sensory
  social stimulation prevention of over
  stimulious.

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Environment

• The occupational therapist helps fashion the
  environment to the persons abilities, interest,
  and comfort level and help maintain their
  dignity.
• Due to the nature of dementia, cognitive
  abilities decrease over time, the environment
  must be adapted accordingly

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Environment

• Even when abilities are simple, it is possible to
  provide occupation
• Grandpas fascination with paper helped him to
  pass the time..
• (Honel, 1988 cited in Willard Spackman, 2003 pg
  839

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OT Assessments Used in Dementia Care

• MEAMS Middlesex Elderly Assessment of Mental
  State
• MMSE Mini Mental State Examination
• CAM Cognitive Assessment of Minnesota

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OT Assessments in Dementia

• ACLS Allen Cognitive Level Scale
• Rivermead Perceptual Battery Assessment
• Rivermead Behaviour Memory Assessment
• FIM Functional Independence Measure

22
OT Assessments in Dementia

• Self Assessment of Leisure Interests
• Geriatric Depression Scale
• DRS Dementia Rating Scale
• Sensory Assessment
• Upper limb Assessment Hand function

23
OT Assessments in Dementia

• Seating Postural Needs Assessment
• Occupational Therapy Home Evaluation
• Home Assessments, Community Assessments
• (orientation/use of transport), Adaptations
  equipment for safe discharges can be used along
  with standardised assessments

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OT Intervention

• Maintaining, restoring, or improving functional
  capacity
• Promoting partipation in occupations that are
  satisfying and that optimise health and well
  being
• Easing the burdens of care giving

25
Occupational Therapy Treatment Care Planning

• Reminiscence
• Reality Orientation
• Validation Therapy
• Sensory Stimulation (use of snozelon if access
  available)

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Occupational Therapy Treatment Care Planning

• Behavioural Therapy
• Group Treatments
• Individual Treatments
• Environmental Adaptations (Home/LTC Unit)

27
Occupational Therapy Treatments Care Planning

• Anxiety Management
• Postural Seating care management
• Social Profiles/Life Story
• Attachment in Relationships (past present)
  Browne Shlosberg, 2005

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Occupational Theapy Treatments Care Planning

• U/L Splinting needs
• Individual needs very important, cognitive status
  in understanding communication needs to be
  addressed when maintaining u/l or splinting care

29
Maintenance Skills

• Evaluations of Intervention treatments
• Compensatory Techniques, developing routines,
  when appropriate to learn/maintain skills
• Memory Cards/Communication

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Reminiscience

• To encourage informal conversation between staff
  clients ( needs to be informal, not assessment
  to be affective)
• Reminiscence for fun (important to know
  participants life events, interests dislikes,
  films, tunes, music etc)

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Reminiscence

• Experience will influence the reminiscence
  session, different reminiscence techniques,
  require different levels of skills.
• Some of the purposes of reminiscence are
• To encourage spontaneous conversation between
  other clients

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Reminiscence

• Reminiscence for social emotional stimulation
• Reminiscence of engaging the cognitively damaged
  person

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Reminiscence

• Individual reminiscence work
• Reminiscence for group cohesion
• Reminiscence can be used to help improve
  communication between the person with dementia
  and their families/carer's
• (Bender et al, 1996).
•  

34
Reality Orientation

• Techniques of reinforcing orientation to place,
  time, date most effective when used by
  unit/team approach care with appropriateness of
  what is been re-enforced is needed i.e positive
  memories (Linda Finlay,1997).

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Validation Therapy

• Giving validation of feelings expressed by
  disorientated older person dignity. Used with
  person's who can no longer benefit from reality
  orientation.
• OT needs to empathises with client can help
  reduce problematic behaviours or internal
  conflict (Creek, 2002).

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Communication with Client Team

• The role of the OT to impart knowledge skills
  to help older person carry out tasks to their
  maximum potential how help should be given
  (Creek J, 2002)

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The Importance of good communication

• To know what clients needs are
• To speak a language the client can understand
• To be able to relay the most up to date needs to
  family
• To adapt treatments as aprioprate to clients
  changing needs
• To stimulate maintain clients abilities

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Results/Findings from OT Assessments

• Can tasks /occupations be achieved?
• Can tasks/occupations be achieved with
  modifications?
• How task is completed?
• Is task part completed/ part assisted?
• Prompts/cueing/type needed?

39
Goals of OT

• Emphasize remaining strengths
• Maintain physical and mental activity for as long
  as possible
• Decrease caregiver stress
• Keep the person in the least restrictive setting
  possible

40
Goal Planning With Older Person

• Promoting occupation, health well-being taking
  into consideration progressive nature of illness
  (Pedretti, 2001)
• PADL skills important in early onset Dementia
• Purposeful e.g. Basic living skills gives
  control, ownership motivation
• Leisure sensory social stimulation (Willard
  Spackman, 2003)

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Restrictions on OT Input on Persons with dementia

• Acute Hospital Settings
• Lack of family support systems
• LTC Units

42
Importance of Remaining at Home as Long As
Possible

• Attachments with family/home/ for well-being
  personal identity
• (Browne Shlosberg, 2006)

43
The Role of OT Education Communication

• Educating Family/Carers in person's with
  Dementia
• Support for the care giver is a must.
  Collaboration with and training of the caregiver
  is essential in the management of persons with
  dementia.

44
Education Communication

• Caregivers need effective strategies for dealing
  with behaviour disturbances and disruptions in
  mood .

45

• The use of environmental adaptations, therapeutic
  interpersonal approaches, referral to other
  disciplines and resource sharing helps in
  collaborating with the patients family and
  handling disruptive behaviour.

46
OT Role in Education Communication

• To focus on what the person can do rather than
  what they cannot.
• Person's with dementia will have a short
  attention span and will be find it hard to
  remember instructions.

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OT Role in Family Education Communication

• To encourage doing ADL's together, sharing
  purposeful occupations - such as folding clothes
  or drying dishes, can give person with dementia
  feelings of value, responsibility, and help with
  self-esteem, while maintaining current level of
  skills.

48
OT Role in Education Communication

• To educate family/carers that the tone of voice
  used can imply criticism as well as the actual
  words, or feelings of being supervised could
  emphasis the loss of skills to the person with
  dementia this could lead to unwanted aggressive
  behaviours.
• Non -verbal gestures demonstrating/guiding
  through body language/ action (when the dementia
  is more advanced).

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Research Value of Occupation in severe dementia

• The principle finding of the research was that
  although sensory-motor activities offer a
  stress-free means of occupation for persons at
  this level of cognitive impairment, participation
  in those occupations, and degree of well-being,
  is largely determined by caregiver presence
  (Perrin, 1998 BJOT, pg 516)

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Conclusion

• Goals in working with elderly clients is
  improvement in quality of life (Ronnberg, 1998).

51
References

• American Occupational Therapy Association (1994)
  Statement Occupational therapy services for
  person's with Alzheimer's disease and other
  Dementias. American Journal Of Occupational
  Therapy, 48, 1029-1031
• Bledelle E.B, Cohn. E.S, Schull B.A.B(2003) 10th
  ed. Willard Spackmans Occupational Therapy,
  Lippincott Williams Wilkins
• Browne J. Shloberg E. (2006) Attachment theory,
  Ageing and dementia A review of literature.
  Ageing and Mental Health, March 2006 10(2)
  134-142

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References

• Creek J. (2002) 3rd ed. Occupational Therapy and
  Mental Health Churchill Livingstone, Edinburugh.
• Kielhofner G (2002) 3rd ed. Model of Human
  Occupation Theory and Application Williams
  Wilkinson, London.
• Kitwood T. Bredin K. (1992) Towards a theory of
  dementia care personhood and wellbeing Ageing
  and Society. 12 269-287

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References

• Lemon et al (1972) An exploration of the activity
  theory of ageing activity types and life
  satisfaction among in-movers to a retirement
  community. Journal of Gerontology 27
• Plastaw A.N. (2006) Is Big Brother Watching You?
  Responding to Tagging and Tracking in Dementia
  Care British Journal of Occupational Therapy
  69(11) 525 527.
• Pedretti L. W Early M.B.(2001) 5th ed.
  Occupational Therapy Practice Skills for Physical
  Dysfunction Mosby St Lous
• Reed K.L. Sanderson S.N. (1992) 2nd ed.
  Concepts of Occupational Therapy Williams
  Wilkins, Baltimore.

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References

• Ronnberg L. (1998) Quality of Life in
  nursing-home residents an intervention study of
  the effect of mental stimulation through an
  audio-visual programme. Age and Ageing, 27
  393-397
• Turner et al. (2001) 4th ed. Occupational Therapy
  and Physical Dysfunction, Principles, Skills and
  Practice Churchill Livingstone, New York.
•