The Role of Occupational Therapy in Dementia
Sheila is a 78-year-old gardener, an avid reader and a retired high school teacher. She has three beautiful daughters and five adorable grandkids. Sheila was diagnosed with Alzheimer’s disease four years ago and has recently moved to a memory care center. She enjoys playing bridge with her friends in the common living room of the facility. Her daughters, who live in the same city, take turns visiting her, and Sheila enjoys spending time with her grandkids. While she was never good with directions, she now needs someone to escort her from her room to the common living room of the facility. Recently, she has been forgetting her daughters’ names, but she still remembers their favorite desserts.
Just like Sheila, 92,000 individuals above the age of 65 years live with dementia in Louisiana. According to the Alzheimer’s Association, one in nine people above the age of 65 has Alzheimer’s disease. A diagnosis of dementia can be troubling and overwhelming for individuals and their caregivers. Fortunately, health-care professionals like neurologists, occupational therapists, psychologists, physical therapists, and speech and language pathologists can help people like Sheila live a healthy and fulfilling life for as long as possible.
What causes dementia?
Dementia is most commonly associated with Alzheimer’s disease; however, Alzheimer’s is only one of the causes of dementia. Other causes include various types of brain trauma, vascular brain disease, Lewy body disease and Parkinson’s disease. While some amount of cognitive decline is normal as we age, impairment that affects the ability to engage in dayto-day activities could be considered a sign of dementia.
How does dementia affect everyday activities?
When we think of dementia, the first thing that comes to mind is loss of memory, but dementia symptoms also include difficulty in orienting to the date and time of the day, making decisions, problem solving, planning, finding words during conversation and feeling depressed, anxious, irritable or frustrated. These cognitive impairments may show up in tasks such as remembering to take medicines, selecting clothes appropriate for weather, communicating with others or ordering food at a restaurant. Another common sign of dementia is an inability to remember how to use common objects such as toothbrushes, faucets or shirt buttons. A person with dementia may view these objects as completely foreign, which then causes a sense of confusion and anxiety. Imagine finding tools in your home that you don’t remember nor can identify.
You might feel threatened or worried about where they came from. Knowing that this occurs can help caregivers understand the behavior of someone with dementia and respond with compassion. Caregivers should also be mindful of the effect of memory loss and confusion on the loved one’s safety. Disorientation often leads to wandering behaviors as the person attempts to find familiar surroundings.
How can occupational therapists help?
Occupational therapists (OTs) are healthcare professionals trained to understand the signs, symptoms and individual needs of persons diagnosed with dementia. Using a holistic perspective, OTs provide tailored strategies and modifications to help with cognitive and behavioral issues of individuals with dementia and their caregivers. The goal of OT is to help individuals with dementia be as independent as possible in their valued daily tasks, so they can have a better quality of life. Some of these tasks include bathing, brushing teeth, eating, driving, travelling, socializing and creating a safe environment to live in.
Sheila’s occupational therapist met with Sheila’s family and caregivers to suggest ways to help her stay oriented and to engage in stimulating activities that Shelia enjoyed. Together they created a memory box to help Sheila manage anxiety. In the memory box was a family photo of Sheila with her daughters and grandchildren labeled with their names, her gardening gloves and a deck of bridge cards with instructions. The OT also created a series of arrows placed on the walls of the assisted living facility to help Sheila find her way from her room to the living area. While dementia is a progressive disorder, there are many ways in which an occupational therapist can help families and their loved ones live more satisfying lives.
Tips for individuals diagnosed with dementia:
1. Use sticky notes, planners and checklists to remember important dates and plans.
2. Socialize as much as you can; communication is a great cognitive exercise.
3. Perform difficult tasks when you are most alert.
4. Use technology to assist you. Alarms, reminders and/or birthday calendars on your phone or computer can help you remember events. Applications for shopping, medicine and grocery deliveries also are helpful for tasks that may be difficult to do in person.
5. Advocate for yourself; people will know how you feel only if you tell them.
Tips for caregivers of individuals with dementia:
1. Maintain daily routines and tasks to help your loved one follow routines.
2. To respect your loved ones, avoid quizzing them about everyday tasks as this can increase confusion. If you do need to ask questions, restrict it to closeended questions as much as possible.
3. Follow the KISS principle: Keep it simple, silly! Use simple sentences and one- to two-step commands when talking to your loved one.
4. Pay attention to your and their body language. It may be stressful to provide care for your loved one but remember that they may sense your stress, too.
5. Do not assume that your loved one will remember important dates and facts. Verbalize names, days, dates events every time you talk to them.
6. Spend time reminiscing about the past. A loved one with dementia may remember more about the past than the present. Instead of asking questions or talking about what happened today or yesterday, try talking about events from their past, such as a childhood memory.
7. Use hobbies and creative interests of your loved ones to keep them engaged and happy.
Where to find OT services?
A referral for occupational therapy can be obtained by talking to a neurologist or primary care physician. OTs provide services in out-patient clinics, via home-health and in hospitals, long-term care and assisted living facilities. LSU Health Shreveport offers occupational therapy services at the School of Allied Health Professions Rehab Faculty Clinic at 1450 Claiborne Ave., Shreveport, LA 71103. You can call 318-813-2970 for more information.
Pooja Jethani, OTD, LOTR, and Christie Raymond, DrOT, LOTR, are clinical assistant professors of occupational therapy at the LSU Health Shreveport School of Allied Health Professions. Robin Steed, PhD, LOTR, is an associate professor of occupational therapy at the LSU Health Shreveport School of Allied Health Professions.