What type of interventions do occupational therapists and occupational therapy assistants use with an individual who has Alzheimer’s disease?
Occupational therapy practitioners 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 AD, depending on the focus of the intervention, the stage of the disease process, and the treatment setting.
Like all occupational therapy evaluations, evaluating a person with AD should begin with an occupational profile of the individual’s valued occupations, roles and routines, and current level of occupational performance. Often, the caregiver is crucial in supplying this information because the person with AD may be unable to provide accurate information or 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. Examples of this approach include the following.
- Identify performance patterns (i.e., habits and routines) that can be maintained and that will prolong independence and assist with adjustment to new living settings, such as a health care facility or an adult child’s home. Consider information stored in the client’s procedural memory, which often remains stable for the longest period of time in someone with AD. Performing well-learned basic activities of daily living, such as combing one’s hair, is an example of using procedural memory. It’s important to determine the client’s hobbies and occupations, which will help with planning the intervention to stimulate client interest and active participation.
- Determine what type of cueing strategies the individual best responds to, and instruct the staff on how and when to use these strategies during various activity demands (e.g., does the client require a one-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 day, then changing that routine may be challenging—the optimal time for engagement in activity may be late afternoon).
Other areas to consider during the evaluation process include accompanying conditions, such as vision or hearing loss. The caregiver (e.g., family or facility staff or both) is also a client, and the occupational therapist should include identifying caregiver concerns about occupational performance and handling difficult behaviors as part of the evaluation.
For a person in the early stages of AD, the occupational therapy intervention may focus more on compensating for the loss of cognitive abilities and recognizing remaining abilities rather than on re-mediating deficit areas. This focus is helpful because new learning may be impaired or absent as the dementia progresses.
For a person in the later stages of the disease, the intervention may focus on adapting the environment, instructing caregivers to promote continued occupational performance, and teaching 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. Staff and family training is crucial, and it 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 his or her 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.
What are some resources available for occupational therapy practitioners working with clients with AD and their caregivers?
Occupational therapy practitioners may find the following AOTA resources on Alzheimer’s disease helpful. Evidenced-based practice literature is also available from the AOTA website at www.aota.org/Practice/Productive-Aging/Evidence-based
AOTA Fact Sheet: Dementia and the Role of Occupational Therapy
AOTA Fact Sheet: Occupational Therapy’s Role in Adult Cognitive Disorders
SPCC: Neurocognitive Disorders: Interventions to Support Occupational Performance - Neurorehabilitation in Occupational Therapy Series, Volume I Edited by Mary A. Corcoran, PhD, OTR/L, FAOTA Series Senior Editor: Gordon Muir Giles, PhD, OTR/L, FAOTA
Occupational Therapy Treatment Goals for the Physically and Cognitively Disabled By C. K. Allen, C. A. Earhart, & T. Blue, 1992. Rockville, MD: AOTA Press.
AOTA Online and CD-ROM Course: Using the Occupational Therapy Practice Guidelines for Adults With Alzheimer's Disease and Related Disorders (ADRD) to Enhance Your Practice Presented by P. Schaber, 2012. Bethesda, MD: American Occupational Therapy Association. Visit http://store.aota.org and enter order #4883.)
Resources for Caregivers
There following AOTA Tip Sheets may be helpful for practitioners working with caregivers of people with AD:
Living with Alzheimer’s Disease
The following AOTA resources on caregiving and AD 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. ($49 for members, $69 for nonmembers. Visit http://store.aota.org and enter order #1232.)
Ways of Living: Adaptive Strategies for Special Needs, 3rd Edition By C. Christiansen & K. Matuska, 2004. Bethesda, MD: AOTA Press. http://myaota.aota.org/shop_aota/prodview.aspx?TYPE=D&PID=982&SKU=1970B
Other books for caregivers include: The 36-Hour Day By N. Mace & P. Rabins, 1999. Johns Hopkins University Press, Baltimore, MD.
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 By V. Bell & D. Troxel, 2003. Baltimore, MD: Health Professions Press.