Practitioners Section

Alzheimer's Disease FAQ

1. What type of interventions do occupational therapists and occupational therapy assistants use with an individual who has Alzheimer's disease?

2. What are some resources available for occupational therapists and occupational therapy assistants to use with caregivers of persons with Alzheimer's disease?

Question 1. What type of interventions do occupational therapists and occupational therapy assistants use with an individual who has Alzheimer's disease?

Answer: Occupational therapists and occupational therapy assistants work with individuals who have Alzheimer's disease (AD) and with their families to maximize occupational engagement, promote safety, and enhance quality of life. A variety of skilled techniques may be used when working with an individual who has Alzheimer's disease, depending on the focus of the intervention, the stage of the disease process, and the treatment setting.

Like all occupational therapy assessments, evaluation of the person with AD should begin with an occupational profile of the individual's valued occupations, roles and routines, as well as his or her current level of occupational performance. Often the caregiver is crucial in supplying this information as the person with AD may be unable to provide accurate information, or may be unaware of his or her own deficits. It is essential to identify the remaining abilities of the person with AD rather than to focus solely on what he or she can no longer do. Some examples include:

Identifying performance patterns (i.e., habits and routines) that can be maintained which will prolong independence and assist with adjustment to new living settings such as a health care facility or a daughter's home. Consider information stored in his or her procedural memory, which often remains stable for the longest period of time in someone with AD. Performing well learned basic ADLs, such as combing one's hair, is an example of utilizing procedural memory. It's important to find out what the client's hobbies and occupations are which will help with planning the intervention to stimulate patient interest and active participation.
Determining what type of cueing strategies the individual best responds to, and instructing the staff on how and when to utilize these strategies during various activity demands (e.g., Does the client require a 1-step verbal command or does he or she need tactile cueing in addition to verbal cues? Can the client follow multi-step commands? )
Consider the time of the day that the person is most alert to maximize performance with activities. (e.g., If the client's typical routine pre-illness was working at night and sleeping during the daytime, then changing that routine may be challenging. The optimal time for engagement in activity may be late afternoons.)

Other areas to consider during the assessment process may be accompanying conditions such as visual loss, or hearing loss. The caregiver (e.g., family or facility staff or both) is also a client, and the OT should include identification of caregiver concerns about occupational performance and handling difficult behaviors as part of the evaluation.

For a person in the early stage of AD, occupational therapy intervention may focus more on compensation for the loss of cognitive abilities and recognition of remaining abilities rather than on the remediation of deficit areas. This is helpful since new learning may be impaired or absent as the dementia progresses.

For persons in the later stages of the disease, the intervention focus may become adaptation of the environment and instruction of caregivers to promote continued occupational performance, as well as learning ways to minimize any unwanted behaviors (such as agitation, combativeness during caretaking) or complicating conditions (such as weight loss, or falls). Addressing the safety of the person with AD is paramount.

Regardless of the stage of AD, the intervention should be individualized for the person. One of the most crucial interventions is staff and family training, which is often accompanied by a functional maintenance program. Such a plan is specifically designed for caregivers and indicates what type of intervention an individual can benefit from to function at their best.

The ultimate goal of occupational therapy intervention for someone with AD should be to set up a program to promote independence, utilize retained abilities for as long as possible, ensure safety, and promote the quality of life.

Additional Resources

Occupational therapy practitioners may find the following AOTA resources on Alzheimer's disease helpful. Further information can be found in the AOTA Online Store at store.aota.org.

Occupational Therapy Treatment Goals for the Physically and Cognitively Disabled
By C.K. Allen, C.A. Earhart, and T. Blue, 1992. Rockville, MD: AOTA Press. (Order #1963, $49 for members, $69 for nonmembers)

Geriatric Issues in Occupational Therapy: A Compendium of Leading Research
Edited by Mary Corcoran, 2003. Bethesda, MD: AOTA Press. (Order #1108, $39 for members, $59 for nonmembers)

AOTA Online Course: Fundamentals of Occupational Therapy for Individuals With Dementia
By Mary A. Corcoran, Bethesda, MD: American Occupational Therapy Association. (Order #OLD07, $198 for members, $280 for nonmembers)

AOTA Online Course: Advanced Occupational Therapy for Individuals with Dementia
By Mary Corcoran, Bethesda, MD: American Occupational Therapy Association. (Order #OLD06, $198 for members, $280 for nonmembers)

AOTA Self-Paced Clinical Courses: Neurorehabilitation Self-Paced Clinical Course Series: CORE and all Diagnosis-Specific (Dementia-Related Diseases, Stroke, and Traumatic Brain Injury)

Core Concepts in Neurorehabilitation
By Gordon Muir Giles (Order #3019-CG, $130 for members, $184 for nonmembers)
Neurorehabilitation for Traumatic Brain Injury
By Kathleen Golisz (Order #3020-CG, $185 for members, $263 for nonmembers)
Neurorehabilitation for Stroke
By Margaret Newsham Beckley (Order #3021-CG, $185 for members, $263 for nonmembers)
Neurorehabilitation for Dementia-Related Diseases
By Mary A. Corcoran (Order #3022-CG, $185 for members, $263 for nonmembers)

Further information on this topic may be obtained from the following Web sites:

Alzheimer's Association
http://www.alz.org/

National Alliance for Caregiving
http://www.caregiving.org/

Alzheimer's Disease Education and Referral Center
www.nia.gov/alzheimers

Alzheimer's Research Foundation
http://www.alzheimers-research.org/

National Hospice and Palliative Care Organization
nhpco.org

American Academy of Hospice and Palliative Medicine
www.aahpm.org/

The American Association of Retired Persons
www.aarp.org/

Center for Healthy Aging
http://www.healthyagingprograms.com/

The Kaiser Family Foundation Educational Site
http://www.kaiseredu.org/

Question 2: What are some resources available for occupational therapists and occupational therapy assistants to use with caregivers of persons with Alzheimer's disease?

Answer: There are several information sheets that occupational therapists may find helpful for caregivers of people who have Alzheimer's disease. These are Consumer Tips for Living, and can be found in AOTA's Consumer section.

Living with Alzheimer's Disease has general information about Alzheimer's disease and ways that occupational therapy practitioners can support clients who have it. Basic support and safety strategies for families and friends are also highlighted.

Caring for the Adult's Caregiver discusses how occupational therapy practitioners can help caregivers of adults. It discusses strategies to help promote well-being in the caregiver, encourages recognition of the caregiver's needs, and provides information on supportive services.

The following AOTA resources on caregiving and Alzheimer's disease can be purchased in the AOTA Online Store (store.aota.org).

Occupational Therapy and Dementia Care: The Home Environmental Skill-Building Program for Individuals and Families
By L. Gitlin & M. Corcoran, 2005. Bethesda, MD: AOTA Press. (Order #1232-CG, $49 for members, $69 for nonmembers)

AOTA Online Course: Occupational Therapy for Family, Professional, and Para-Professional Caregivers of Individuals with Dementia
M. Corcoran, 2003. Bethesda, MD: AOTA Press. (Order #OLD05-CG, $198 for members, $280 for nonmembers)

Ways of Living: Adaptive Strategies for Special Needs, 3rd edition
By C. Christiansen & K. Matuska, 2004. Bethesda, MD: AOTA Press. (Order #1970A-CG, $59 for members, $83 for nonmembers)

The following resources for caregiving and Alzheimer's disease can be purchased through your local bookstore.

The 36-Hour Day
By N. Mace & P. Rabins, 1999. Warner Books Inc.
The Alzheimer's Sourcebook for Caregivers—A practical guide for getting through the day
By F. Gray-Davidson, 1999. Los Angeles: Lowell House.
The Best Friends Approach to Alzheimer's Care
V. Bell & D. Troxel, 2003. Health Professions Press, Inc.