Occupational Therapy Engaging the person with dementia Introduction Engagement in activities helps to structure time meaningfully and provide a sense of purpose, usefulness and accomplishment. In persons with dementia (PWDs), engaging in activities can also help to reduce behavior such as wandering and agitation. Planning activities for PWDs Plan activities that focus on the quality of interaction rather than the physical end product. This involves considering the following factors:
Interests
Meaningful to the PWD Establish a familiar routine
Be flexible and patient
Provide support and encouragement Allow variety and choice Provide simple, step-by-step instruction
Assist in difficult parts of a task
Place
Encourage involvement in daily life
Approach
Strengths and limitations
Activity
Person
Likes and dislikes
Safety – equipment and materials Comfortable and familiar environment Minimal distractions
Enhancing participation in activities of daily living The goal is to provide safe care that preserves the PWDs’ sense of dignity and self-esteem while maximizing their independence and quality of life. Dressing Respect the person’s dressing style Simplify and limit dressing choices according to the person’s ability to choose Ensure sufficient time for dressing before leaving home Hand out clothing in the order to be put on with simple instructions Substitute zippers, buttons and snaps with velcro
Showering
Toileting
Retrofit the bathroom with features to enhance safety, e.g. shower chair, non-slip mats, grab bars Place supplies within easy reach Determine the best time of the day for showering Provide sufficient time and simple, step-by-step instruction so the PWD can wash themselves with minimal assistance Ensure the water temperature is not too hot or cold
Provide reminders to visit toilet regularly Use labels and signs to make it easy to find the toilet
Communication Communication skills of PWDs decline as the disease progresses. They experience difficulty in expressing their thoughts and emotions, and may eventually lose the ability to understand or communicate with another person. Communicating with a PWD • Always believe communication is possible - do not make assumptions about the person’s ability to communicate as the disease affects each person differently. • Speak clearly. Use short, simple words and focus on one idea at a time. • Be a good listener – take time to listen and allow plenty of time for understanding and response to questions. • Avoid arguing or correcting the PWD – listen carefully and repeat what was said to clarify. • Encourage non-verbal communication
Ask the PWD to point or gesture if what was said is unclear.
Give visual cues together with step-by-step instructions.
Use touch to attract the person’s attention and to convey feelings of warmth and affection.
Maintain eye contact to show that you care about what the PWD is saying.
Role of occupational therapists in dementia care Occupational Therapists aim to improve the quality of life for persons with dementia by optimising their ability to engage in activities. Education, training and support services are also provided for caregivers and families. Services • Cognitive evaluation and activity prescription Assessment of a person’s level of cognition in order to identify appropriate activities for meaningful engagement. Adaptation of daily activities to maximise independence. • Environmental modification Identification of appropriate sensory and social stimulation in the environment to support function and minimise undesirable behaviours. Home modification for safe activity performance • Caregiver education, training and support Communication skills Physical handling skills to assist in activities of daily living Activity selection and modification
Disclaimer: Exercises illustrated and instructed in this handout are strictly for designated patient based on the assessment and instruction of the therapist. If you have any doubts, please contact your therapist.
Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group. Admiralty Medical Centre • (65) 6807 8000 • www.admiraltymedicalcentre.com.sg Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg The information is correct at the time of printing and subject to revision without further notice.
REHAB.PE.OT.006.0320