Supporting Those with Dementia - an Occupational Therapy Perspective
Shir is in her second year of an MSc Occupational Therapy (Pre-Registration) course at Oxford Brookes University. From a very young age, Shir has always dreamed of studying occupational therapy. Her grandmother was among the first to graduate from occupational therapy in the country where she was born and watching the impact that she had on the lives of others was incredibly inspirational for Shir.
Shir completed her undergraduate honours degree in Canada, studying Kinesiology and Health Sciences, the study of human movement and health. Through this program, Shir learned the value of rehabilitation and evidence-based practice. Shir is so grateful to have acquired this indispensable knowledge and is eager to continue to learn to integrate this into her practice of occupational therapy.
For those who attended the multidisciplinary webinar earlier this week, you will have had the opportunity to recognise the diverse ways in which various healthcare professionals contribute to the diagnosis, treatment, and support of those with dementia.
For anyone who did not have the chance to attend, we are excited to be sharing with you the role of occupational therapists (OTs) in working with individuals with a dementia diagnosis, capturing both an overview of the current literature and policies, as well as personal experiences of OTs working in this specialty.
Dementia is a syndrome (a group of related symptoms) which occurs as a result of brain function decline. There are many different types of dementia, each as a result of different causes (National Health Service, 2020). One of the most well known types of dementia, Alzheimer’s, is just one classification. There are also others including vascular dementia, Lewy Body dementia, frontotemporal dementia, and mixed (National Health Service, 2020).
Dementia can result in difficulties with memory loss, thinking speed, mental sharpness, language, speaking, understanding, judgement, movement, mood, and an overall difficulty in completing daily activities (National Health Service, 2020).
This is where occupational therapists get involved. Occupational therapists support people to take part in activities that matter to them (National Health Service Inform, 2022). They do so by addressing complex environmental, social, and health circumstances to support individuals in overcoming the barriers they face (National Health Service Inform, 2022).
Within dementia diagnosis, treatment, and support, occupational therapists play a critical role. Due to decreased physical and cognitive activity levels, people with dementia often experience significant declines in their independence. As such, occupational therapists can provide support within numerous different capacities:
Health Promotion and Advocacy: By focusing on maintained strengths of clients and promoting wellness of carers, occupational therapists can enrich their lives by promoting maximal performance in preferred activities. This is done from the date of diagnosis right up until the end. Occupational therapists provide people with the tools and knowledge to make decisions about their future and their care. Occupational therapists also provide a lot of support for families in helping them cope with the diagnosis and the pending changes, as well as the difficult behaviours that may emerge as a person’s cognitive decline becomes more significant. Some examples of what occupational therapists may do are:
Develop support groups for carers in order to address caregiver burden;
Engage in social prescribing in order to ensure that an individual is able to engage with their community;
Provide support for future planning, including supporting the selection and processing of Power of Attorneys and end of life decisions;
Refer patients to non-profit organisations or NHS services which provide support for those with a new diagnosis
Remediation: Although the remediation of cognitive skills is not expected, occupational therapists incorporate routine cognitive exercise into their interventions to improve the performance of activities of daily living and functional mobility, and to help the individual to use aids to be more independent. Examples may include:
Developing and facilitating individual and group cognitive training approach sessions;
Developing alternative activity of daily living skills, such as teaching people how to heat ready-made meals or other daily living activities;
Re-develop physical strength and stability through daily exercises and activities
Maintenance: Occupational therapists can provide support for the habits and routines that are working well for the person with dementia, and that can be maintained to prolong independence. Examples can include:
Helping people identify their strengths and abilities and reminding them to continue to engage in these activities;
Helping family members identify useful strategies early in the dementia prognosis in order to establish routine
Modification: This is perhaps the most frequently used intervention for those with dementia, as it ensures safe and supportive environments through adaptation and compensation, assistive technology, including verbal cueing, personal assistance, and/or social support. Some basic examples may include:
Modifying the home environment to ensure maximum mobility is possible by fostering downstairs living if stairs are difficult or ensuring that corridors are designed for mobility devices;
Providing assistive technology to help remind people to take their medication, eat and drink, attend appointments, etc;
Providing adaptive kitchen equipment to mitigate cognitive and physical changes such as kettle tippers, special cutlery, high contrast dining ware, etc.;
Provide medication dispensers;
Providing GPS or home security devices to help ensure that a person at risk of wandering is able to safely be relocated
Prevention: Occupational therapists can work with individuals to prevent the occurrence of comorbidities which may emerge as a result of inactivity and loss of independence. Some examples include:
This can include the prevention of pressure sores from inactivity through movement advice and pressure prevention seating and posture management;
The prevention of heart or lung disease by providing individuals with support to improve mobility and physical activity;
The prevention of financial or family difficulties by offering caregiver support and facilitating access to social services
Within the NHS, occupational therapists play a key role within Older Adult Community Mental Health Teams (OA CMHT). In Oxford for example, occupational therapists make up the majority of the OA CMHT, supporting patients who are referred to the service due to cognitive decline. Through this service, occupational therapists support the diagnosis of dementia through memory clinic facilitation, provide referrals to social services or other helpful teams, and provide support for families. In addition, older adults may be referred to occupational therapists in the team if they experience significant changes in their physical, cognitive, or mental health and need additional support to engage in their desired activities.
While these are just a few examples of the role of occupational therapists within dementia care, it is evident that occupational therapists are well placed to support people experiencing cognitive changes and challenges.
References
National Health Service. (2020, June 25). About dementia. NHS. Retrieved February 14, 2023, from https://www.nhs.uk/conditions/dementia/about/
National Health Service Inform. (2022, October 3). Occupational therapy - Tests & treatments. NHS Inform. Retrieved February 14, 2023, from https://www.nhsinform.scot/tests-and-treatments/counselling-and-therapies/occupational-therapy
