Four categories of interventions are discussed for clients with dementia at home with support by caregivers.
Introduction
While the specific needs of the client should be addressed, there should be considerations for the caregiver(s) who have taken on the primary role of caregiving for clients at home with dementia. Studies have shown that caregivers are at risk for caregiver strain: physical and mental health problems including stress and anxiety, difficulty maintaining their own employment, decrease enjoyment and participation in leisure activities, socialization, and family interactions. Overall, caregivers may have impacted the quality of life compared to other family members who are not involved in caregiving for the client with dementia. Even those who are not directly involved may be impacted due to a ripple effect, e.g. children may get less attention from their parents as they are responsible for caregiving.
Research into non-pharmacological interventions for clients with dementia is evolving and increasing. Systematic reviews describe the potential for occupational therapy to enable clients with dementia to continue to live in their community.
| Population | Older adults |
| Condition | Moderate to late dementia |
| Setting | Home |
| Client(s) | Client with dementia, Caregiver(s) |
OT Non-pharmacological Approaches for Dementia
- Collaborating with caregivers (most caregivers are spouses)
- Participating in meaningful activities
- Simplifying and modifying activities to optimize engagement
- Removing hazards, stressors, and distractions from the environment
Discussion
What may be meaningful depends on the individual client. Should older adults with dementia be allowed to engage in activities that are perceived to be risky? In some countries, older adults continue to participate in activities such as farming, with the supervision of family members. They lead long and healthy lives, often with little other physical or mental health issues. This is also dependent on culture. However, more and more multigenerational families are living apart across different cultures around the world. While this is a case-by-case basis, a doctor may not advise that a client participate in an activity, but perhaps they should continue if it does no harm to themselves or others.
Simplifying and modifying is a common occupational therapy approach. This point goes well with the previous point of meaningful participation because if a task or activity can be simplified, it can allow the client to continue to engage in said activity. Clients may continue to participate in an activity with added supervision, for a shorter duration, or with more involvement and assistant from the caregiver. Of course, if this takes a large commitment from caregivers, who may not be interested in the activity themselves. The alternative for most could likely be an institutionalized setting, where they have no opportunity to participate in any meaningful activities at all. I would not consider ADLs in this category. Most older adults find IADLs, leisure, or productive work meaningful, not ADLs.
While the most obvious hazards should be removed, some hazards may not be as it is inherent to the activity. If an older adult with dementia wants to ride a horse, they can really only ride an animal. The activity can be modified and the client may ride a pony instead. However, there are still risks involved such as falls. Distractions in the immediate environment may or may not be removed, but in a dynamic external environment, this may be less possible. If a client wishes to continue and age in the community, there are fewer options to addressing this. Occupational therapists can find creative ways and problem solve how to achieve this through collaboration with the caregiver as they will be spending the most time with the client.
General considerations should include sundowning, level of exertion, the required amount of cognition (particularly memory), and prevention strategies – particularly for late-stage dementia.
References
Bennett S, Laver K, Voigt-Radloff S, et al. Occupational therapy for people with dementia and their family carers provided at home: a systematic review and meta-analysis. BMJ Open 2019;9:e026308.