Webinar: Moving Forward with Dementia Using Rehabilitation
Dementia Australia webinars are free videos where subject experts discuss topics relating to dementia for a general audience.
In this webinar, Professor Lee-Fay Low from the University of Sydney discusses rehabilitation for people with dementia, including cognitive therapies, occupational therapy, exercise therapy and psychological therapies.
Prof Low is joined by Dementia Advocate Bobby Redman talking about her own experience and providing practical tips.
You will learn:
- the evidence for rehabilitation for people with dementia
- cognitive therapies, occupational therapy, exercise and psychological therapies
- how to find and access rehabilitative intervention services.
Transcript
[Beginning of recorded material]
[Title card: Dementia Australia]
[Title card: Moving forward with dementia using rehabilitation]
[Title card: This presentation was recorded on unceded Gadigal land. I acknowledge the traditional owners, Elders past, present, and emerging]
Professor Low: Hello, I'm Lee-Fay Low. I work as a professor in ageing and health at the University of Sydney. In this webinar, I'm going to share some of the scientific evidence of the benefits of rehabilitation for people with dementia, and talk about how you or the person you look after can get services to support their rehabilitation. I'm not going to start, as many dementia talk starts, with pictures of brains. If I show you a picture of a brain, it's just going to reinforce the idea that we need to just treat the brains of people with dementia. I want us to think about treating people with dementia holistically. So, people with dementia are people. And while changes to their brains may be the source of the disease, their day-to-day problems relate to symptoms of dementia.
We know, from our research, that it's the impact of dementia on daily life that makes dementia challenging for people with dementia. People with dementia find it harder to complete their day-to-day tasks of living, like paying bills, or emailing friends, driving safely, or socialising. Some people with dementia tell us they feel confused because the world is harder to understand, and that navigating the world with a cognitive disability can be exhausting. For some people with dementia, being given the label of having dementia is upsetting. So, let's think about dementia as a disease that causes cognitive disabilities that make it harder to do daily activities.
Rehabilitation can help maintain or compensate for these daily difficulties. I'd like to introduce Bobby Redman, a friend and colleague who actually lives alone with dementia. Bobby has developed her own rehabilitative program, which helps her maintain her function, and supports her through her daily difficulties.
Bobby: I looked at all the research and the things that, first of all, that are designed as risk reduction, but I also think slow down the process. So, I've modified my diet, although, I didn't eat badly, but I have no simple sugars and things like that now. I live alone, and I say my technology is my primary carer.
I started off with my phone, we all now live with smartphones and are getting much more comfortable with them, I've found that my planning went out of the window, so I would have the normal regular alarm goes that it's time to go for an appointment, but I would recognise that it was time to go for my appointment, but I hadn't thought about anything that led up to that, so I might still be in the middle of my breakfast and not had a shower because I hadn't planned how it was going to work. So, I now have my phone set up with step-by-step. My kitchen, I've taken photographs of the insides of all my cupboards, and I have those stuck on the outside. So that helps me to put things in the right place and to find things again.
Lee-Fay: So what is rehabilitation? Some of you are probably wondering why we have Bobby talking about diet, technology, or how she's got her kitchen arranged. You're wondering what relevance this has to rehabilitation. Well, these are all examples of rehabilitation for someone with dementia. Many people think of rehabilitation as physical rehabilitation – so the physical work that happens after an injury or stroke. This is one form of rehabilitation, but rehabilitation is much more, much broader than that.
The World Health Organisation definition of rehabilitation says that rehab helps us manage symptoms and changes associated with illness and disability. This includes prevention of the loss of function, slowing the rate of loss of function, compensation for loss of function, or maintenance of current function. So, we want to do all these for people with dementia – these strategies might include something like exercise which helps maintain brain health, either slowing the rate of loss of function, or maintaining current function, it might include use of taxis or public transport to compensate for not being able to drive anymore, a lost function. It might include technology such as glasses, which is my way of compensating for loss function, my eyesight. Other simple technologies might include calendars, phone reminders. Bobby talked about these as using these technological strategies to help her maintain her current function.
Kate Laver and I compiled a book which brings together the evidence for rehabilitation for people with dementia. Today, I'm going to share some of the key learnings from that book. I'm particularly going to talk about less commonly offered rehabilitative therapies for people with dementia in Australia. These particularly relate to physical activity, cognitive interventions, occupational therapy, and psychological therapies. My first takeaway is be physically active. Exercise might help people with dementia by improving the circulation of blood and oxygen to the brain, it can also help by improving heart and physical health, and by improving mood.
Bobby: I’m trying to exercise more. I've never been much of an exerciser, but I get out there and I try to exercise on a regular basis. My mobility is failing, I fall quite a lot. So, I now see a physiotherapist on a fortnightly basis who gives me a range of exercises that I practise in the fortnight. She's very good, and she prints the exercises out for me so that I've got a worksheet to work from. And then, she adds things to it each time I go, or takes things off and changes it around. And that, I believe, is helping to keep me moving.
Lee-Fay: The research tells us that physical exercise works for people with dementia. Physical exercise has been shown to reduce decline in global cognition and working memory, though there's less evidence for other types of cognitive function. Exercise also reduces behavioural changes in dementia, though these reductions are small. The evidence suggests that aerobic exercise at moderate intensity or more, or total training of over 24 hours in total, has greater effect on global cognition. In practise, people with dementia should try and keep physically active. Ideally, this means regular moderate intensity exercise. This means exercise that gets your heart beating faster, such as swimming, or brisk walking, walking upstairs or walking up a slope, or cycling. There's also growing evidence for the benefits of resistance or strength training for people with dementia – so this might mean using weights, or your own body weight, in order to build muscles. Unfortunately, in Australia, there are few dementia-specific exercise services. Look to local seniors’ exercise groups, walking clubs, or even gyms who are supportive of older people.
If you need help to start exercising safely, if you're worried about falling or your heart as you start to exercise, then see a physiotherapist or exercise physiologist after talking to your GP. You can get subsidised visits to physio or exercise physiology through a GP chronic disease management plan, so talk to your GP about this. If you have a community care package, this can also fund access to allied health, such as the physio, exercise physiology, or even help you get to and pay for an exercise group – so ask your community care case manager about this. You might also be able to access a falls prevention program such as Stepping On. These are commonly offered across the states, and are offered to people at high-risk of falls, or who have already fallen. The next lesson from our research is that people with dementia should be mentally and socially active.
Bobby: I do a whole range of mental stimulation with the computer, word games, and Sudoku, and Wordle, and Word Finder, all the different things. Try to work out for myself where the gaps are, where I'm struggling with things, and find something to do. So, my processing speed is very slow now, so I do things, games that I have to do against the clock to try and make myself think better, and I honestly believe that makes a big difference for me.
Lee-Fay: Bobby talked about her own brain training program. Brain training are tasks designed to target one or more cognitive processes. These might include short-term memory, memory for faces, attention, or speed. Brain training usually involves repeated practise of these tasks, these exercises, and more and more often, these tasks are computerised rather than done using pencil and paper. The research tells us that brain training has small to moderate effects on global cognition after the training, and this is maintained three to 12 months later. It also has a moderate effect on speech and language. What we know about brain training is that if you train one area of the brain, so if you are practising your working memory, this doesn't generalise to other aspects of the brain. So, your working memory will improve but your speed and processing won't improve, unless you specifically train speed and processing as well.
Brain training programs are best done under the supervision of a psychologist or neuropsychologist, who can tailor the program to your specific cognitive disabilities or cognitive needs. In Australia, at the moment, it's hard to find a brain training program offered by a psychologist. Here are some brain training programs that you can pay for and do at home with some evidence. These are CogniFit, Happy Neuron, and Brain HQ. Cognitive stimulation therapy is a group social program of enjoyable activities. These activities have been created to stimulate and target different aspects of memory and thinking, including concentration, attention, orientation. Typically, these programs go for about seven weeks, twice a week.
In cognitive stimulation therapy, you might discuss daily affairs, play games, talk about your life, even do some simple maths. There is consistent evidence in the research that cognitive stimulation therapy has moderate effects on global cognition, memory, day-to-day functions or daily tasks of living, and depression. Again, there are few organisations offering cognitive stimulation therapy here in Australia. You might be able to go to a group social program which might have some benefits, and you can access these via the Commonwealth Home Support program.
Cognitive rehabilitation is an individual program where the person is given training and support to achieve their own daily function goals. So, goals might be being able to read their email and use their email again, strategies to feel confident to go out alone, be able to cook a meal without getting distracted, maintaining the ability to keep dressing yourself, or managing difficulties with swallowing. The few studies that have been done so far on cognitive rehabilitation suggests that, after the training, there are large positive effects for the person being able to reach their goals, and this is corroborated by what the carer says.
So, here are my takeaways for staying cognitively and socially active – exercise different parts of your brain, and try to do this every day. This might include playing different types of thinking games such as a crossword or bingo. It also probably includes socialising and talking to different people, which again, stimulates different parts of your brains. Travel, getting out to new places is another great way of stimulating different bits of your brain as well. And lastly, people say, "I do lots of crosswords. Is this good for me?" And I always say, "Well, if you do crosswords, it just stimulates one bit of your brain. So that bit of your brain's going to get really good at doing crosswords, but you need to exercise your whole brain if you want to strengthen all of it." Now, I want to encourage you to think about getting occupational therapy.
Occupational therapists are allied health professionals – so trained health professionals – who help people maintain, or even improve, in activities of daily life. This means doing things around the house, but also out and about in the community. And occupational therapy is all about making sure that you have an engaged and meaningful life. The research is strong for occupational therapy. It shows that occupational therapy for people with dementia improves overall daily function, so ability to do daily tasks. Also reduces behavioural changes in dementia, and improves quality of life. Carers involved in occupational therapy studies with people with dementia say that they've spent less hours helping the person with dementia, they're less distressed or upset by behavioural changes in dementia, and they have improved quality of life.
Bobby: I had an OT come to do an assessment, but unfortunately, she was really much more knowledgeable in the areas of mobility and physical stuff, rather than cognitive stuff, so she really wasn't able to offer me anything.
Lee-Fay: As Bobby told us, sometimes, in Australia, it's hard to find an OT, or occupational therapist, who has experience in supporting people of dementia. Try and get one with experience in dementia. There are a few ways you can get funding for occupational therapy for dementia in Australia. You can ask your GP and get it partially funded through a GP chronic management plan. If you go to hospital, you might be able to get occupational therapy as part of your transitional care plan. Occupational therapy can also be funded through your home care package, might be subsidised by your private health insurance, and you can sometimes find OTs through community rehab services. Go to the Occupational Therapy Australia website to find OTs with a specialisation in ageing, and you might also be interested in checking out the COPE Australia website – COPE is an OT program specifically for people with dementia.
The last type of rehabilitative service I'm going to talk about are psychological therapies. I like to think about them as talking therapies, the way you talk about your feelings, the issues you're having, and try to come to some solutions, or resolutions as to those feelings and difficulties. There are many types of psychological therapies. This includes CBT, or cognitive behavioural therapy, which you've probably heard of in relation to mental health, but also applies to people with dementia. Might include problem-focused therapies where we specifically try to solve problems during therapy, and more generic counselling.
The research tells us that cognitive behavioural therapy reduces depression and anxiety symptoms in people with dementia who started off with these symptoms. The research also tells us that the more broad family of psychological therapies improves depression symptoms for people with dementia. If you're interested in getting psychological therapies for dementia, your first port of call is probably Dementia Australia. They offer counselling, including post-diagnostic support counselling for people with dementia and carers. If you have dementia and also mental health issues, ask your GP about a mental health plan. Under the mental health plan, you get subsidised visits to see a psychologist about your mental health issues. If you are a person with dementia who's interested in learning from other people with dementia, then you should get in touch with Dementia Alliance International. This is an organisation run by people with dementia, for people with dementia, and they run peer support groups online.
In this webinar, I gave you an overview of some of the rehabilitative strategies which are helpful for people with dementia. If you want to know more information, please go to our website, Forward With Dementia. This is a guide to living with dementia. Our website has three sections, one specifically for people with dementia, one for carers, and one for healthcare professionals. Our website has a specific section on supporting wellbeing of people with dementia, and a focus on rehabilitative strategies. You can go there for more of the scientific information about the evidence for rehab strategies, as well as more tips on how to advocate for yourself to get these rehab strategies. Unfortunately, they're not routinely offered in practise yet.
Bobby: None of this information has come from professionals. It's really been my own research and my own work that has identified what I need to do. My background as a psychologist, my professional knowledge has helped me put together strategies to get me through. My biggest worry really is for all these people that don't know these things, because it's now coming six years since my diagnosis, and I believe I'm doing okay, thanks to a lot of stuff that I've got in place.
Lee-Fay: As My final message is that I've met many wonderful people with dementia and their carers, and those people with dementia, like Bobby, have put in their own rehab programs and are living well with dementia. So, I hope this webinar helps you, a little bit, to figure out what your rehab strategy could be. And for more information, of course, please go to our Forward With Dementia website.
[Title card: www.forwardwithdementia.org.au]
[Title card: Together we can reshape the impact of dementia]
[Title card: Dementia Australia. 1800 100 500. Dementia.org.au]
[END of recorded material]
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