No family should have to go through the pain, heartache, and struggle of an aging parent developing dementia. Although you may have heard of Alzheimer’s Disease, there are other variations of dementia that an occupational therapist can help to support you and your family with. The sad fact is that many families have dealt with dementia, and it is a growing problem around the globe.
Occupational therapists help those with impaired cognition due to dementia. They work with the family, caregivers, and even those with early stages of dementia to evaluate the impairments, strengths, and needs for support for the dementia patient.
Occupational therapists can help support transitional times for families, caregivers, and those with dementia by ensuring that the patient gets the care and training they need. This article will give you some background and tools to help you work with an occupational therapist if your parents have dementia (AOTA and RCOT).
What Occupational Therapists Do For Dementia Patients
Occupational therapists work alongside the family of older parents with dementia, so it is essential to know what to do so you can help. Trained occupational therapists study curricula of knowledge that allows them to provide direct care for dementia patients or consult those providing long-term care.
The ultimate goal of occupational therapists for their dementia patients is to help them maintain existing lives and function for as long as possible. Occupational therapists play a vital role in supporting dementia patients as a support member of a team in a dementia patient’s long-term care, as a consultant for the long-term care team, or as the primary caregiver themselves,
The Main Roles of Occupational Therapists for a Dementia Patient
Dementia and its various ideations are insidious and painful for family and friends to cope with. Progressions of the disease, such as Alzheimer’s disease, should be supported by occupational therapists.
Occupational therapists play a central role in maintaining the autonomy and function of dementia patients. They will also advise and work with families and other caregivers in various roles that are detailed below.
Maintaining the Skills and Autonomy of Dementia Patients
Helping dementia patients maintain skills, norms, routines, and overall life autonomy is a central function in the occupational therapist’s role. These skills are critical for a dementia patient to maintain as they tend to deteriorate quickly.
To aide dementia patients in retaining and maintaining the skills needed for their independence, occupational therapists will:
- Provide regular routines and healthy habits that the patient should perform regularly.
- Give support of these routines with written or verbal feedback to be updated regularly
- Give check-ins on progress and advise on support systems and techniques for loss of function or limits to routines.
Promote the Physical and Mental Health of Dementia Patients
The occupational therapist helps the team of those supporting a dementia patient with both the patient’s physical and mental well-being. There are many activities, techniques, protocols, and interventions that the occupational therapist may employ or suggest to support mental and/or physical well-being.
As a support role, occupational therapists work closely with those who are live-in aides. The support leads to a relationship built on communication about strengths and weakness and the routines and techniques that the occupational therapists believe should be implemented as support.
To aide dementia patients in maintaining the physical and mental fitness needed for independent living, occupational therapists will:
- Create plans for caregivers and family that focus on maintained strengths
- List and create options for preferred activities that are optimal for mental and physical stimulation
- Work with family on optimizing interaction with those family members with dementia
- Advise a course of action for mental blockage and/or physical lackluster
Support and Coordinate Interventions During Remediation
Most occupational therapists create care plans and execute these plans with progress in the focus and forefront. However, remediation of dementia patients does tend to happen. The unfortunate truth is that families tend to make things worse for dementia patients who remediate.
Occupational therapists can help support caregivers and family members for times of remediation by:
- Identifying specific cognitive and physical remediation of skills
- Identify and help support practitioners with interventions to strengthen activities of daily living and functional mobility
- Provide techniques specific to the individual dementia patient that pertain to many physical attributes such as the strength of upper and lower body, limb and spine range of motion, as well as overall physical and mental endurance
Support Needed Modifications of Care Plans for Dementia Patients
One of the most common things about care for dementia patients is modifying the current plan to accommodate new and unforeseen challenges concerning the condition. Once not needed, the support may be seen as essential and require training for caregivers and family alike.
Even if the patient is not in need of live-in care at this point in their dementia progression, the data used is valuable. The support for needed modifications is an ongoing process that needs revisiting on a monthly and even weekly basis.
Members of the team should always be on the lookout for regression and report them to the occupational therapist so that interventions and supports are put in place quickly.
Occupational therapists need to be familiar with the dementia patient and the entire team as well as strategies already in place for support so that they can:
- Provide interventions alongside supports that are either working or failing
- Use interactions to support transition periods
- Personal interactions and supports such as verbal cues and other social supports as training for the team of caregivers and family
How Family Members Can Work with Occupational Therapists for Dementia
Occupational therapists have the primary goal of helping dementia patients learn routines, strengthen skills, and support a team around them to live and function in their own homes for as long as possible.
Maintaining independence should be the goal for the family of support, as well. Suppose you are a family member working with an occupational therapist for your parent with dementia. In that case, this should be your primary focus.
Letting the professionals do all of the environmental evaluation and adaptation is just not feasible. Suppose you want to be a central figure in support of your parents with dementia. In that case, you need knowledge of what an occupational therapist does, along with the stages and progressions of dementia.
Look for Signs of Dementia
As a close family member and support team member for your aging parent with dementia, you must observe and relay any worsening signs of dementia to the occupational therapist. Even if you have the feeling that forgetfulness and confusion are daily occurrences, there are certain behaviors and cognitive functions that you should take note of and report to the OT.
- Pacing: Pacing and other behaviors that seem repetitive without purpose can be a clear indication of worsening dementia. These repetitive movements and actions, coupled with confusion and anxiety, are especially troubling.
- Wandering: An essential characteristic of dementia is the loss of sense of direction and getting lost. Wandering and disorientation, especially in what should be a familiar environment, are signs of worsening dementia.
- Wrong Clothing for Weather: Seasonal clothing that matches the weather outside is challenging to choose independently. This cognitive deficiency may be coupled with forgetfulness, anxiety, and wandering or pacing.
- Communication Worsens: If you notice communication patterns that differ from the normal in your parents with dementia, or they become prone to frequent outbursts along with long periods of silence, these could be signs of worsening dementia.
Occupational Therapist Solutions for Signs of Dementia
By observing your parents’ frequent signs of dementia and reporting them to the health care provider and occupational therapist, the team will be better able to support them. An occupational therapist will assist and advise on setting up the environment for your parent with dementia to limit these diseases’ regressive signs.
- Pacing: An occupational therapist will design routines, tasks, and activities that engage the mind and body of your parent with dementia. These activities could include things that they already enjoy, such as board or word games, or simple repetitive tasks that give a feeling of accomplishment.
- Wandering: An occupational therapist will help the team set up an environment for your parent with dementia to live in with safe confines and maximum mobility while using technology, like surveillance and tracking, to ensure they remain safe and secure.
- Wrong clothing for winter: Occupational therapists will suggest and track simple techniques and routines for your parent’s memory with dementia. For example, limiting the clothes selection to minimize confusion and training you with helpful verbal cues for your parents.
- Communication worsens: Occupational therapists will train you to use non-verbal cues for your parents to support their communication. Also, the OT will continue supporting you by teaching ideas and techniques for maintaining non-defensive caring techniques. (My OtSpot)
Those Most at Risk of Dementia
When it comes to those at risk of developing dementia, mum and da are in danger the older they become. Parents who are aging tend to be most at risk after the age of 55 and get more and more susceptible to the ravages of time with each passing decade.
The three populations most at risk of developing dementia and possibly even Alzheimer’s Disease are:
- Elderly People
- Those with a family history of dementia
- Those with Down’s Syndrome (Mayo Clinic)
Occupational Therapists Cannot Diagnose Dementia
If you suspect your mum or da or anyone else has dementia, especially if they are a part of one of the at risk groups detailed above, an occupational therapist is trained and will support a diagnosis of a dementia patient.
However, an occupational therapist will only provide support of techniques, strategies, and routines to keep the patient with dementia functioning fully and independently. An occupational therapist cannot make an initial diagnosis of dementia for anyone (AOTA).
Occupational Therapists May Be Able to Prescribe Medicines
The scope of an occupational therapist is usually for assistive technologies, such as walking devices and bathroom adaptations. However, in certain situations occupational therapists can prescribe and administer medications to their patients.
The specific times and situations where an occupational therapist can prescribe and even administer medication are:
- Patient Specific Direction (PSD): If an authorized prescriber has prescribed a patient with medicine, an occupational therapist can deliver and administer the medication
- Patient Group Direction (PGD): If the patient is part of a Patient Group Direction, that means they have signed a legal document that allows a health provider like an occupational therapist to prescribe and administers medications to them
- Supplementary Prescribing: If a patient is referred from a primary care physician, a supplementary care physician, such as an occupational therapist, can prescribe and administer medication until the next review by the primary care physician (Royal College of Occupational Therapists)
Occupational Therapists are Rarely Live-In Aides
Some later stages of dementia and Alzheimer’s Disease require live-in aides. Helping a dementia patient with all activities is essential for their health and safety.
Traditionally, an occupational therapist is a support position for the primary caregiver who is the live-in aide. However, an occupational therapist can be a live-in aide if they are trained in nursing.
Since the job of the occupational therapist is to identify weaknesses and strengths in the patient with dementia and then develop a routine of support, their expertise is better made as a supporting role. This role is in support of the primary caregiver who is a live-in aide. Together, the team identifies and cares for the patient with dementia with more earnestness (AOTA).
Insurance Covers Occupational Therapy
Most insurance in the US will cover the cost of an occupational therapist, at least for part of the bill. If you have physical therapy, your plan probably covers occupational therapy. However, you want assurances about the limitations of your plan before you start getting the advice and support of an occupational therapist. However if you live in the UK, you may need to discuss this with your insurance company first.
Exclusions and limitations may occur during coverage. These exclusions and limitations are not covered so you will pay out of pocket for them. If you deem them unnecessary for the support of the patient with dementia, you can forgo these treatments and supports.
Asking questions about your insurance is important. Since you are responsible for the bill on things that are not covered, it is essential that these questions are asked before service is conducted. The questions you want to ask your health care insurance provider are:
- Does my plan provide bill coverage for occupational therapy?
- Is the dementia patient covered for occupational therapy in a hospital setting? Or only at home care? Or office care?
- What is the maximum number of visits covered each month ou8nder my insurance plan?
- What are the exclusions and limitations of my insurance coverage for the dementia patient?
- What are my expected out of pocket costs? (Children’s Clinical)
How an Occupational Therapist Can Help at Each Stage of Dementia
Even at the preclinical stage of dementia, consulting an occupational therapist is helpful for both the family members providing support and the parent with functional problems.
The most difficult part of preclinical and early stage dementia is the resistance from the patient. However, with proper help and support from clinical therapists, you can better support mum and da.
When dementia is in the early days, it is difficult to diagnose. An occupational therapist can give some feedback about issues that the family is noticing and coach the family for signs to look for in further dementia progression.
Occupational therapists are also able to coach family members on the types of routines and activities that will promote health cognitive function. Healthy cognitive stimulation and function can lead to a delayed regression to further stages of dementia.
Also, an occupational therapist’s understanding of how changes in the brain affect changes in things like cognition and mobility may be a good resource at identifying the transition into early stage dementia.
Even though there are many parallels between dementia and delirium, occupational therapists can diagnose and help to set up systems for the primary caregiver as well as the family to help to keep the person with dementia in their home.
Maintaining autonomy is possible for a parent with dementia with the guidance and support of an occupational therapist. An occupational therapist offers knowledge of brain physiology and progression of the disease so that interventions are used to maintain brain function.
In the early stage, brain function and mobility will be limited but only at times. It is during these times that interventions and routines should be used. At this point in the care for dementia, the occupational therapist will work directly with the patient.
However, it may be essential to have a close family member like an adult child to do frequent checks and report progress or regression to the occupational therapist and primary caregiver.
The Mild regression into middle stage dementia is evident daily. The family must depend on care for the individual with dementia. It is only through set routines and life parameters to limit confusion that the person can successfully interact and function.
Hopefully, by this point in the diagnosis of dementia, an occupational therapist is a significant part of the care team. By integrating early on in the development of dementia, specific routines and techniques will benefit your parent with dementia when implemented. By the middle stage of dementia, these techniques and routines are modified to meet the higher demands of regression.
Since the forgetting of personal history highlights middle-stage dementia, essential family members may need coaching to help a struggling dementia family member. You can help your mum or daughter by listening and learning the verbal and non-verbal cues from the occupational therapist to relieve dementia stress and confusion.
Once your mum or da reaches the late stage of dementia, they need 24-hour care for all life functions. Your parent with dementia will rarely initiate interactions with you. An occupational therapist can help your parents and you through this difficult time.
By coaching you and other caregivers through non-verbal cues, your parent with dementia will still get interaction. Interaction and mental or physical stimuli are crucial for maintaining the brain’s health for as long as possible.
Occupational therapists can also address the limits of physical exertion for mum or da and develop a routine of activity. Suppose you help facilitate this routine for physical and mental stimulation. In that case, your parents with dementia have a better chance of living with cognitive function for an extended period (National Collaborating Centre for Mental Health 2007, Fox Rehab).
Why Engagement is Crucial for Dementia Patients
After reading this article, you may be wondering if you have it in you to be part of the team caring for your parents with dementia. An occupational therapist will help you and your caregivers with the information and techniques you need to transition and keep your parents engaged in life.
Engagement is critical for dementia patients, and children of parents with dementia are the best source of this stimulation. Engagement is organic and natural for someone with dementia. Organic engagement is necessary for the rehabilitation and maintenance of cognition in an older dementia patient. Not only does cognitive stimulation with friends, family, and caregivers provide them with stability, purpose, and a routine, but it also maintains connection and fosters hope. An occupational therapist will make sure that this routine is created and put in place.
The benefits of engagement and meaningful activity for dementia patients is numerous and includes:
- Making patients feel useful
- Providing caring and meaningful nurturing
- Creates more significant social contact in times of isolation that can cause depression
- Helps patients to remain independent by strengthening cognitive ability
- Provides practice with decision making and choices needed for independent living
- Learn more about struggles that may not be visible on the surface
Some occupational therapists recommend some techniques for engagement, including getting to know more about a person’s story, engagement with motor functions, and cognitive activities or games.
Know a Person’s Story
You probably already know how your parents met. However, sitting with mum or da and talking with them about their past helps them access the history that might be slipping away.
By asking questions about childhood, adolescence, and other times in your parent with dementia’s life, you can better help them strengthen cognition and hold on to memories.
An occupational therapist will train you in the verbal and non-verbal cues for having these conversations. It is also essential to note any regression to the occupational therapist to formulate a plan of action and support.
Some questions that might support purposeful interaction with a person’s life story are:
- What did they do for work?
- What is a favorite hobby?
- What are some things that make them happy?
These questions and more are open-ended and do not rely on historical knowledge. This kind of soft interaction is excellent for cognitive stimulation without creating frustration.
Motor Function Engagement
Playing and socializing with your body is another great technique that will stimulate cognitive and motor functions with dementia. Your parents’ occupational therapist will give you certain activities to follow. However, the basic idea behind motor function engagement is that play is stimulating and supportive for dementia patients.
Using play as therapy and teaching or reinforcing skills is part of the Montessori school of thought. Under Montessori philosophy, purposeful engagement for dementia patients looks like exploration and environmental cues.
These environmental cues and increased exploration help the person with dementia still contribute to their community and society.
Cognitive Activities or Games
The use of cognitive activities and games as a stimulus to support and reinforce skills and independence for dementia patients follows right along with the Montessori philosophy of purposeful engagement.
The idea that plays with other individuals strengthens bonds and sharpens cognitive ability is nothing new. Playing with an older parent with dementia is also a realm of therapy accessible for you. As a child of a parent with dementia, getting involved with therapy is easier when play is the primary therapy source.
Your role in this realm of support is fun, casual, and lasting. The idea is that fun connections are maintained, fortifying the social, emotional, and psychological bonds to the world the patient with dementia knows (AUSMED).
The types of games and activities that you could play and engage with are limitless and include:
- Card games
- Word games
- Social games like BINGO
- Trivia on TV
Although dementia in a parent is difficult for all families, an occupational therapist helps with knowledge of brain patterns, cognitive functions, and routines to limit regression. As long as you work with your occupational therapist, your skills as part of a caregiving team are better.
Make sure to ask questions and observe as well as support your parent with dementia. Utilizing an occupational therapist and their advice on routines and strategies gives you more tools in supporting mum and da even if their dementia worsens.
The information contained above is provided for information purposes only. The contents of this Blog article are not intended to amount to advice, and you should not rely on any of the contents of this Blog article. Professional advice should be obtained before taking or refraining from taking any action as a result of the contents of this Blog article. OccupationaltherapyBlog disclaims all liability and responsibility arising from any reliance placed on any of the contents of this Blog article.