Dementia Patients Get Relief From Occupational Therapy
Finding a way to alleviate the tough realities of dementia would bring
relief to about 6.8 million people in the United States (U.S. Office of
Technology Assessment, 2011); of those, 5.3 million have Alzheimer’s,
making it the most common cause of dementia. In 2011, it’s expected
that a half million new cases of Alzheimer’s will be diagnosed (Advance
for Occupational Therapy Practitioners, 2011).
Dementia is not a specific disease, but rather symptoms caused by other
illness or conditions that affect the brain. Contrary to what
many people believe, it is not a normal part of the aging process. It
is a severe loss of cognitive ability, such as thinking, memory, and
reasoning, that interferes with a person's daily functioning. Symptoms
include personality changes, behavioral problems, and memory
problems.
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Find an
Alzheimer’s Clinical Trial
Alzheimer's
Association TrialMatch™ is a free service that makes it easy
for people with the disease, caregivers, families, and physicians to
locate clinical trials based on personal criteria, such as diagnosis,
stage of disease, and geographical location. The web-based patient and clinical
trial matching service is also accessible via a toll-free
telephone number: 800-272-3900.
For people with
Alzheimer's and their caregivers, clinical trials present an
opportunity to play a more active role in treatment – ultimately
contributing to scientific discovery and benefiting future generations.
Research shows people involved in studies tend to do somewhat better
than people in a similar stage of their disease who are not enrolled,
regardless of whether the experimental treatment works.
10 Signs of Alzheimer’s Disease:
- Memory loss that
disrupts daily life
- Challenges in planning
or solving problems
- Difficulty completing
familiar tasks at home, at work, or at leisure
- Confusion with time or
place
- Trouble understanding
visual images and spatial relationships
- New problems with words
in speaking or writing
- Misplacing things and
losing the ability to retrace steps
- Decreased or poor
judgment
- Withdrawal from work or
social activities
- Changes in mood or
personality
Source:
Alzheimer’s Association, 2011.
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Treatments for dementia currently include prescription drugs and/or
housing tailored for individuals with memory issues. While these
options help manage the disease, it’s been discovered that occupational
therapy has positive effects on dementia patients’ ability to perform
daily activities and on their caregivers’ confidence levels, both in
the short- and long-term.
A 2006 study by the British
Medical Journal through Nijmegen University in the
Netherlands followed 135 patients. Each was over age 65, with mild to
moderate dementia, and had a primary caregiver at least one day a week.
Occupational therapists received training specifically for dementia
patients, and then provided therapy to both the patient and the
caregiver twice a week for five weeks, totaling 10 sessions.
Patients were scored on two measures: 1) motor and process skills and
2) deterioration of daily activities. Caregivers were assessed about
their feelings of competence in taking care of the dementia patient.
Twelve weeks after therapy ended, 75% of the patients showed improved
process skills and 82% needed less assistance with activities of daily
living (ADLs) (Medical News Today, 2006). In addition, 58% of
caregivers reported an increase in their own sense of competence as it
related to taking care of the dementia patient (healthandage.com,
2009). These findings clearly indicate the significant benefits of
occupational therapy for dementia-related situations, and the cost
benefits to this approach are under investigation.
According to the Alzheimer’s Association, in 2010,
$172 billion was spent towards Alzheimer’s. Because
occupational therapy appears to lengthen the amount of time an
individual remains self-sufficient and helps a caregiver remain more
confidently in control of the caregiving, it may offer new answers in
several ways for patients, caregivers, doctors, and insurance providers.
Paying for occupational therapy may have to come from one or more
sources, including private pay and Medicare Part B, which covers
occupational therapy only under certain conditions (see www.medicare.gov):
Medicare
helps pay for medically necessary outpatient physical and occupational
therapy and speech-language pathology services when:
- Your doctor or therapist sets
up the plan of treatment, and
- Your doctor periodically
reviews the plan to see how long you will get therapy.
The
amount you need to pay:
- Medicare Part B pays for
Occupational, Physical, and Speech therapy as long as it is medically
necessary.
- Only up to the yearly benefit
limit, which varies from state to state.
- Before the limits, you pay 20%
of the Medicare-approved amount after you have met your yearly
deductible.
- After you have reached the cap
for your state under Medicare Part B, you will be responsible for 100%
of the charge, unless you have other insurance coverage.
In
2011, there may be limits on physical therapy, occupational therapy,
and speech language pathology services. If so, there may be exceptions
to these limits.
What does occupational therapy
look like?
The American Occupational Therapy Association uses this chart as a
guide for implementing occupational therapy for Alzheimer’s
patients. Because Alzheimer’s is a degenerative disease with
gradual deterioration of the brain resulting in a progressive onset in
three stages – early, middle and late, occupational therapy is
implemented in different ways at each stage.
| Table:
Occupational Therapy Intervention for Early, Middle, and Late Stages of
Alzheimer's Disease |
| Stage |
Areas of
Occupation |
Occupational Therapy
Intervention |
| Early Stage |
Work/Volunteer
IADLs
(Instrumental Activities of Daily Living)
Social Participation
|
Create opportunities to
engage in work/volunteer tasks adapted to client capacity.
Modify environmental and activity demands to reduce frustration and
provide caregiver education and training in modifications.
Maintain safe engagement in IADLs with appropriate supports and
resources.
Establish primary and secondary social network with family and
community.
Promote involvement in leisure activities of choice; adapt leisure
activities to client capacity.
|
| Middle Stage |
ADLs
Leisure
Social Participation
Sleep
|
Maximize engagement in
ADLs through compensatory and environmental adaptations.
Train caregivers in tailored activity programs.
Create opportunities for leisure skills identifying adequate
supervision and concerns for safety.
Pursue community-based programs designed for people with cognitive loss.
Prevent sleep disturbances through active engagement in daytime
activities.
|
| Late Stage |
ADLs
Social Participation
Sleep
|
Maintain client factors
to participate in ADLs with caregiver support and training.
Modify approach to social participation to meet the need for human
contact.
Prevent co-morbidities related to decreased movement during sleep/rest.
|
| Source: American Occupational
Therapy Association, Inc., 2010. |
Family-Centered Care Model
For the person with dementia who depends on a family caregiver, a
treatment plan is put together using a family-centered care model based
on collaboration among the occupational therapist, patient, caregiver,
and family members. Family caregivers are involved in
determining the patient’s levels of ADL abilities, exploring the
patient’s strengths and limitations, and setting goals for patient
independence and caregiver support.
Team-Centered
Care Model
In more severe dementia cases, and with a move to a memory care
facility or long-term care institution, a team-centered care model,
which includes the patient’s family, physician, and the staff of the
care facility, is used. The team works together to determine the
patient’s ability levels, select goals, and develop a plan of care that
includes occupational therapy.
Goal
of Occupational Therapy
The challenge of occupational therapy is to create a comfortable
balance between patient safety and maximum independence. The payoff for
the dementia patient is improvement in cognitive and hands-on skills in
doing daily activities that help the patient live more independently
with a better quality life for a longer period. Caregivers who are
trained in occupational therapy benefit with reduced stress and an
increased feeling of proficiency. Occupational therapy is worth
investigating if you or a loved one is affected by dementia.
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