In our latest installment in the Caregiver Resource Series we spoke to Occupational Therapist, Catherine Verrier Piersol with Thomas Jefferson University in Philadelphia. According to the Bureau of Labor Statistics, Occupational Therapists "treat injured, ill, or disabled patients through the therapeutic use of everyday activities. They help these patients develop, recover, and improve the skills needed for daily living and working."
For this particular article, Catherine chose to focus on how Occupational Therapists can help to improve the quality of life for people who have been diagnosed with dementia or Alzheimer's Disease.
Catherine Verrier Piersol, PhD, OTR/L
Family caregivers are so important and vital to the care of people with dementia. Caring for a person with dementia can be extremely challenging and can result in caregiver stress and depression. Occupational therapists work with caregivers to teach them specific skills and to help them cope with the challenges of caregiving. Occupational therapists also provide services to individuals with dementia to promote safe participate in daily activities.
Why Occupational Therapy?
Occupational therapists complete a comprehensive standardized assessment to identify what the individual with dementia can do. So often families are just told what their family member can no longer do--like go shopping, be alone at home, and manage the checkbook. The focus of occupational therapy for people with dementia is to use compensatory approaches that help the person participate in everyday tasks based on their preserved abilities.
Some individuals actually have “new learning” capabilities. People with cognitive impairment due to dementia can show functional change thru task repetition and practice. We provide our clients with effective visual and verbal cues to prompt the memory system and facilitate relearning familiar, meaningful, procedural skills.
Good News for Caregivers
Occupational therapists share these evaluation findings with caregivers and help them understand what their family member is still capable of doing and identify the strategies that work best.
Caregivers are the “hidden patient” and many need help managing their distress and challenges. Caregivers may struggle with the progressively complex changes that lead to the complete care of their family member with dementia. In addition, caregivers may be challenged by certain disruptive behaviors – for example, their relative may resist daily care, wander outside the home, or be verbally aggressive. Occupational therapists can recommend a number of adaptations to accommodate the effects of the disease and to improve safety and participation and offer culturally appropriate and customized treatment designed to increase activity engagement and reduced problem behaviors common in dementia.
One of the most important strategies is teaching caregivers how to simplify how they communicate. Dementia can cause the person to have difficulty in communicating and understanding what people are saying. The disease is responsible for these difficulties. Typically, the person with dementia is not able to change the way he or she communicates or processes information. However, the caregiver can use simple strategies to help make it easier for both caregiver and person with dementia.
Here are some examples:
- Use a calm voice and speak slowly – the person with dementia may need more time to process and understand what is being said.
- Rather than using a lot of words or long sentences, provide 1 or 2 step instructions – like “Stand up”, “Walk with me”, or “Sit down”
- Within reason, go along with the person with dementia and avoid arguing - trying to explain reality will frustrate both caregiver and person with dementia.
- Try not to tell the person with dementia in advance about an appointment or family event. Telling in advance may cause him or her to keep asking about when the event is happening.
- Finally, it is a good rule of thumb to use words of encouragement like “Everything is okay” or “Good job”. This help to keep your loved one calm and secure.
Modifications Can Make A Difference
Modifying the physical environment and making it safe is another important focus of occupational therapy. The occupational therapist identifies home modifications that will promote safety and performance. For example, a motion detector for someone who wanders or grab bars and tub seat to reduce fear during the bathing routine. Other adaptations in the home include removing hazardous materials such as sharp objects or poisonous fluids and storing them in a secure location.
If you're still worried about the possibility of a senior wandering off even after making these modifications, however, Medical Guardian's newest product line, the Family Guardian, is the perfect solution. After placing three, unobtrusive safety sensors throughout the home, you can use the Family Guardian Monitoring app as an early detection method since you will receive instant notifications right to your email or smartphone whenever the main door is opened.
Simplifying the way you set up activities or daily routines is another strategy occupational therapists can teach caregivers. If the person with dementia has difficulty putting clothes on in an orderly fashion or gets stuck and forgets what to do, caregivers are taught how to “pre-packaged” or arrange clothing on the bed so that it is easier for the family member to sequence the dressing activity. Or the caregiver may add visual cueing such as hanging up a picture that shows each step of getting dressed.
Providing meaningful activities can be a very effective strategy in managing boredom, restlessness and other troublesome behavior. Based on previous interests, roles, and the cognitive function of the person with dementia, occupational therapists can set up activities with the caregiver that their family member can do.
Occupational therapists are in a unique position to help families understand the disease process, set up predictable and simplified routines, and provide training in effective communication, task, environment and activity strategies to promote participation.
Additional resources:
Living with Alzheimer’s Disease: http://www.aota.org/-/media/Corporate/Files/AboutOT/consumers/Adults/Alzheimers/Alzheimers tip sheet (2).pdf
Dementia and the Role of Occupational Therapy: http://www.aota.org/-/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/MH/Facts/Dementia.pdf
Cathy Piersol, PhD, OTR/L is director of Jefferson Elder Care at Thomas Jefferson University in Philadelphia, PA, USA.
