top of page

Occupational Therapy's Role

when working with

     Older Adults with Alzheimer's        disease and related dementias

OT's Approach to Treatment

When comparing the Alzheimer's disease and related dementias (ADRD) population with the general population, approach to treatment is very similar.

 

There is a focus on occupation, while all areas of occupation can be included in treatment, it is often dependent upon the cognition of the client.

 

The main occupational areas of focus are: 

  • Activities of Daily Living (ADLs)

  • Instrumental Activities of Daily Living (IADLs)

  • Health Management 

  • Social Participation

​

Methods for treament often include: 

  • Health promotion

  • Remediation

  • Maintenance

  • Modification of occupations 

  • Environmental modifications

  • Assistive technology 

              (Giles, 2017; Smallfield, 2017)

OT and Cognition

Types of Cognition:

Cognition involves information-processing, such as attention, memory and executive functions (Giles, 2017). There is also functional cognition, which is the use of cognition to engage in an occupation (Giles, 2017). 

​

OT Education on Cognition

Occupational therapy practitioners are qualified to provide intervnetions focused on cognition, as the impact of cognition on occupational performance (American Occupational Therapy Association [AOTA], 2013). In addition to general education on cognition, OT practitioners are also educated on cognitive dysfunction and appropriate interventions to provide to promote overall performance in occupations (AOTA, 2013).

​

OT Process

This is done through:

  1. Evaluation of performance

  2. Incorporation of model/frame of reference to guide interventions

  3. Intervention:

    1. Global strategy learning​

    2. Awareness approaches

    3. Domain-specific strategy training

    4. Cognitive retraining within a functional activity

    5. Specific-task training

    6. Environmental modifications

    7. Use of Assistive Technology

    8. Caregiver education/training

    9. Interprofessional and multidisciplinary collaboration

         (AOTA, 2013; National Collaborating Centre for Mental Health, 2007))

Management of Side Effects and "Behaviors"

ADRD has several side effects, including "behaviors". These behavioral changes are coined "neuropsychiatric behaviors" which often include aggression, agitation, depression, anxiety, apathy, and more (Fraker et al., 2014; Marx et al., 2019, p. 1). Additionally, there can be instances of disorientation, wandering, repetitive and/or non-productive behaviors (Smallfield, 2017). 

​

OT's Role in Management of "Behaviors"

A recent study found that the adjustment and modification to meaningful activities both increased engagement in occupations, as well as decreased incidences of neuropsychistric behaviords (Marx et al., 2019).

 

Most notably, the methods the program (Marx et al., 2019) utilized

were common approaches during OT treaments including using a: 

  • Client-centered approach 

  • Activity analysis 

  • Modifying the task/occupation

  • How the individual completes the occupation within their environment

​

A common intervention currently utilized to manage neuropsychiatric behaviors involve the yse of psychotropic medications. These medications are not the most effective intervention method available and often impact the individual in other ways, which could potentially lead to a hospitalization or nursing home placement (Fraker et al., 2014). The side effects caused by the psychotropic medications can include metabolic disorders and cerebral vascular accidents (Li et al., 2017). OT is an option for a non-pharmacological intervention as there is an emphasis on finding a just-right challenge unique for each individual to promote function and engagement (Fraker et al., 2014).

​

OT and Depression within ADRD

In addition, depression is a common neuropsychiatric behavior that occurs during the disease process. Several studies demonstrating the benefits of OT and reminiscence therapy on depressive symptoms for older adults with ADRD (Asiret & Kapucu, 2015; Chin, 2007; Grøndahl et al., 2017; Lök et al., 2019; Zuiderveen et al., 2016). One method in which depression was decreased, was providing by a safe and comforting space in which the individual felt safe to share their memories and past experience with others (Grøndahl et al., 2017). Additionally, life satisfaction increased when methods to develop coping mechanisms and to promote occupational participation were provided in a SNF (Wren, 2016).

References

American Occupational Therapy Association [AOTA], (2013). Cognition, cognitive rehabilitation, and occupational performance. American Journal of Occupational Therapy, 67(6, Supplement): S9-S31. https://doi.org/10.5014/ajot.2013.67S9

Asiret, G. D. & Kapucu, S. (2015). The effect of reminiscence therapy on cognition, depression, and activities of daily living for patients with Alzheimer disease. Journal of Geriatric Psychiatry and Neurology, 29(1), 31-37. https://doi.org/10.1177/0891988715598233

Chin, A. M. H. (2007). Clinical effects of reminiscence therapy in older adults: A meta-analysis of controlled trials. Hong Kong Journal of Occupational Therapy, 17(1), 10-22.

Giles, G. M. (2017). The role of occupational therapy in adult cognitive disorders. American Occupational Therapy Association. https://www.aota.org/About-Occupational-Therapy/Professionals/PA/Facts/Adult-Cognitive-Disorders.aspx

Fraker, J., Kales, H. C., Blazek, M., Kavanagh, J., & Gitlin, L. N. (2014). The role of the occupational therapist in the management of neuropschiatric symptoms of dementia in clinical settings. Occupational Therapy in Health Care, 28(1): 4-20. https://doi.org/10.3109/07380577.2013.867468

Grøndahl, V. A., Persenius, M., Bååth, C. & Helgesen, A. K. (2017). The use of life stories and its influence on persons with dementia, their relatives and staff: A systematic mixed studies review. BMC Nursing, 16(28). https://doi.org/10.1186/s12912-017-0223-5

Li, M. Lyu, J., Zhang, Y., Gao, M., Li, W., & Ma, X. (2017). The clinical efficacy of reminiscence therapy in patients with mild-to-moderate Alzheimer disease. Medicine (Baltimore), 96(51). https://doi.org/10.1097/MD.0000000000009381 

Lök, N, Bademli, K., & Selçuk-Tosun, A. (2018). The effect of reminiscence therapy on cognitive functions, depression, and quality of life in Alzheimer patients: Randomized controlled trial. International Journal of Geriatric Psychiatry, 34(1). https://doi.org/10.1002/gps.4980

National Collaborating Centre for Mental Health (2007). A NICE-SCIE guideline on supporting people with dementia and their carers in health and social care: National clinical practice guideline number 42. The British Psychological Society and Gaskell

Smallfield, S. (2017). Dementia and the role of occupational therapy. American Occupational Therapy Association. https://www.aota.org/About-Occupational-Therapy/Professionals/PA/Facts/Dementia.aspx.

Wren, R. (2016). Effect of life review on quality of life for older adults living in nursing homes. Physical and Occupational Therapy in Geriatrics, 34(4), 186–204. https://doi.org/10.1080/02703181.2016.1268236

Zuiderveen, A., Ivey, C., Dordan, S., & Leiras, C. (2016). Encouraging occupation: A systematic review of the use of life review and reminiscence therapy for the treatment of depressive symptoms in older adults. Occupational Therapy in Mental Health, 32(3). https://doi.org/10.1080/0164212X.2016.1145090

bottom of page