Webinar: Occupational Therapy
Dementia Australia webinars are free videos where subject experts discuss topics relating to dementia for a general audience.
In this webinar, occupational therapist and professional practice advisor Christina Wyatt explains the role of occupational therapy and the ways occupational therapists can assist someone living with dementia.
- You will learn about:
- occupational therapy services
- how occupational therapy services can support people living with dementia
- how to access occupational therapy.
Transcript
[Beginning of recorded material]
[Title card: Dementia Australia]
[Title card: How occupational therapy can assist you]
Christina: Hello, and thank you for joining this webinar on occupational therapy and dementia. Before we begin today, and in keeping with Occupational Therapy Australia's commitment to reconciliation and respect, I would like to acknowledge the traditional custodians of country throughout Australia and their connections to the land, sea, and community. We pay our respects to their Elders past, present, and emerging, and extend that respect to all Aboriginal and Torres Strait Islander people with us today.
Firstly, let me introduce myself. My name is Christina Wyatt, and I'm an occupational therapist and a professional practise advisor for Occupational Therapy Australia. Occupational Therapy Australia are the national peak professional association for occupational therapists and students in Australia. We are a member based not-for-profit organisation, and we provide support and services to our members, enabling them to work across a diverse range of practise areas, and with a diverse range of people.
Today's webinar is all about how occupational therapy can support someone living with dementia. During this session, I plan to take you through some points about what we know of dementia, introduce the role of occupational therapy to you, discuss the many ways in which occupational therapists work with people living with dementia, and provide some advice about services and resources that can support someone with a dementia diagnosis to receive the right services, including occupational therapy.
So what is dementia? Dementia itself is not a single specific condition. Rather, it's an umbrella term for a large number of conditions that gradually impair brain function. Impairments or changes caused by dementia can include cognition, language, memory, perception, personality, behaviour, and mobility, and other physical impairments. Dementia is now the third leading cause of disease burden in Australia. Up to 472,000 Australians are living with dementia, and more than half of the people in residential aged care have a dementia diagnosis.
There are several risk factors for dementia. Age, for example, is a well-known risk factor for dementia, with the risk doubling every five to six years for people over 65. Having said that, ageing is not a determinant of developing dementia, and in some circumstances, dementia can develop in people under 65, known as younger onset dementia. Age is classified as a non-modifiable risk factor, but there are many other risk factors for dementia that can be minimised known as modifiable risk factors. A recent report presented by The Lancet Commissions identified 12 modifiable risk factors for dementia, with these risk factors accounting for around 40% of worldwide preventable dementia. Key modifiable risk factors include hypertension or high blood pressure, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, social isolation, excessive alcohol consumption, traumatic brain injury, and air pollution.
The main types of dementia include: Alzheimer's disease, a degenerative brain disease caused by nerve cell death resulting in shrinkage of the brain; vascular dementia, a disease that is mainly caused by issues with blood flow to the brain through events such as stroke or bleeding into or around the brain tissue; dementia with Lewy bodies, a disease caused by degeneration and death of nerve cells in the brain due to the presence of abnormal spherical structures that develop inside the nerve cells called Lewy bodies; and frontotemporal dementia, a disease that is caused by progressive damage to the frontal and/or temporal lobes of the brain.
Dementia can also be associated with other conditions such as Parkinson's disease, Huntington's disease, and Down Syndrome. As mentioned earlier, prolonged substance abuse and severe brain injuries are risk factors for dementia and can lead to specific types of dementia. Having multiple types of dementia at once is also common, and is referred to as mixed dementia. Dementia can present differently from person to person, and for some individuals, from day-to-day. Dementia progression and symptoms can vary due to personal characteristics like age and health conditions, type and severity of dementia, with some dementias presenting with particular symptoms, age at diagnosis, and personal circumstances like care and living arrangements or access to health services.
Despite the variations in symptom, presentation, and progression, all cases of dementia will eventually result in cognitive and physical decline. Dementia-related symptoms are often grouped into three stages: mild, moderate, and advanced dementia. Occupational therapists work with people across all stages of dementia to help mitigate the impact symptoms have on daily life. Early intervention is key to maintaining function and independence for as long as possible.
The first stage of dementia is mild dementia. It is defined by subtle changes to cognition or behaviour, but because many people still retain independence in basic activities of daily living, these changes may not be recognised as dementia and are instead attributed to old age. As mentioned earlier, the onset of symptoms may differ or be gradual. These symptoms can include forgetfulness and confusion, irritability and appearing more apathetic, poor judgement and decision making, disinterest in activities, vision or speech problems, behavioural changes, and a decline in higher order or more complex activities of living like finances, planning, and organising self and others.
The next stage is moderate dementia. Symptoms in this stage are more distinct, an impact on key activities of daily living such as driving and preparing meals. In addition to these symptoms and the ones outlined earlier, moderate dementia symptoms may include increased fear and paranoia, increased forgetfulness and confusion, inappropriate or uncharacteristic behaviours, and loss of function.
Advanced dementia is the final stage of dementia in which health and functional ability decline such that the person becomes more dependent on others for their activities of daily living like dressing, bathing, and toileting. The person may experience severe memory loss, problems with communication, difficulty swallowing, incontinence, decreased mobility, or complete immobility in the final months or weeks of life. Most people in advanced stages of dementia require extensive care, often from permanent residential care settings.
So, who are occupational therapists and how can they help someone live with dementia? Occupational therapists work to maximise a person's active enjoyment in life by identifying barriers to participation, and by building strategies to minimise any risks or impediments to participation. To achieve this, we apply a person-centred and holistic approach to our practise. What does those words mean? Well, it means we consider all the aspects that make up a person, and all the life roles they find meaningful. We then work on strategies to achieve optimal health and well-being through participation in these meaningful occupations of life.
When occupational therapists use the term occupation, we aren't talking about paid work. The term occupation is used to describe all the everyday things we do in our life, all the things we do to be who we are, all the things we do to create a meaningful life, and all the things we do so we can engage with the wider society and culture. These meaningful activities might include the routine daily tasks we do to take care of oneself and others, work or volunteering activities, activities where we engage with others socially, or activities that allow us to participate in hobbies or leisure pursuits.
For people living with dementia, an occupational therapist can support you in maintaining your independence and quality of life for as long as possible. Occupational therapists apply a strength-based approach when working with people with a focus on fostering personal goals, abilities, and motivations. We break down all the meaningful tasks or occupations to fully appreciate what the task involves, and what it requires of someone. We also consider the environment, and how it may support or hinder a person's ability to perform their meaningful occupations. These environments may range from a person's home, through their work, social, or community settings.
How do we do this? Well, as mentioned earlier, occupational therapists take a holistic approach. We do this by fully exploring the person, their environment, and their support systems, and the activities or occupations that are important or meaningful to them. Through these key parameters, we can truly appreciate all the facets that make up an individual. There are many ways occupational therapists can support a person with dementia, and these will often interact and overlap.
I'll now take you through the key areas of a person's life that an occupational therapist might address when working with someone living with dementia. People with dementia might start to struggle to do their daily activities like personal care, meal preparation, or housework. In these circumstances, occupational therapists might adopt a variety of strategies to ensure ongoing safe participation in daily activities.
We might look to retrain a person on how to perform a certain activity to highlight their abilities and to mitigate any risks. We may train carers on how they can assist someone to safely undertake certain tasks. Small aids or equipment may be prescribed to facilitate participation like long handled showering aids, or dressing aids, or toileting aids. We may also modify the environment to make it easier or safer for someone with dementia to participate in these activities of daily living.
As function deteriorates, a person with dementia might need their environment altered to allow. them to safely navigate and use the space, or to support them to participate as safely and independently as possible in their meaningful activities. These changes, as mentioned earlier, are usually done in consideration of the way a person is performing the task, anticipated changes to function that may come with the dementia diagnosis, and carer support requirements. Changes can be small like increased lighting along passageways to facilitate night access to toilets, through to more complex changes like major modifications to spaces like bathrooms.
Changes to a person's memory, ability to make decisions, or coordinate themselves to perform regular daily activities is a common presentation for someone with dementia. People with dementia may also experience behaviour changes as a result of cognitive changes. Occupational therapists can work with the person, and their family or carers, to identify solutions to compensate for the cognitive changes being experienced, and provide strategies to utilise their strengths so they can continue to engage in their meaningful activities.
Strategies, such as calendars, diaries, and building daily routines, can often be very helpful for someone living in the early stages of dementia. More structured supports may be considered in the moderate stages, such as alarms or digitised diaries to remind people of their important daily activities. Signage or colour coding of the environment can also be used to help guide people with moderate dementia through their environment.
People living with dementia may experience physical decline and loss of functional mobility. Functional mobility relates to someone's ability to perform routine movements, such as transfers on or off furniture, or navigation of steps or stairs, and deficits in these areas can negatively impact someone's ability to participate in various meaningful activities.
These changes might be related to the type of dementia someone has been diagnosed with or related to other health conditions they have that are exacerbated by dementia. Much like the strategies covered in daily activities or environment, occupational therapists can assist with prescription of small aids or equipment, environment modifications, falls and balance prevention strategies, or exercise and activity redesign or retraining. Enabling a person to live with dementia to maintain relationships with family, friends, and colleagues, or connections to their community of interest is really important, so is creating opportunities to make new connections if former ones drop away. Occupational therapists often work in the context of meaningful activities to facilitate or enhance connection with others.
Occupational therapists will assist a person's ability to access their community whether that be by driving or by using public transport options, consider their cognitive or language impairments, and how this might impact on their ability to connect with others, and may consider new ways of staying connected like digital or virtual methods, particularly during times like these of pandemic and quarantine.
Recreational and leisure activities are an important part of many people's lives, and the ability to perform these activities impact on our quality of life and well-being. Occupational therapists will often work with people experiencing dementia, and their carers or families to ensure they can maintain their recreational and leisure pursuits. This might include strategies to support access to these activities with and without carer support, ways to continue to participate, including activity modification or aids and equipment, or ways to open up new opportunities for recreational leisure when dementia-related deficits may prevent someone from participating in long-held pursuits.
Occupational therapists can provide support to those caring for someone experiencing dementia. We have a role in supporting carer well-being and safety. Occupational therapists might provide stress management techniques, or mindfulness training to those carers who need the support, in addition to linking carers with professional services, such as specialist carer support agencies or counselling support. Occupational therapists can also ensure carer safety and well-being by ensuring the environment is set up to facilitate safe delivery of care, and through the training of safe manual handling techniques.
Occupational therapists often work as part of a multidisciplinary approach to dementia. Multidisciplinary teams that support people with dementia often involve other medical and allied health professionals, such as physiotherapists, speech and language therapists, dietitians, podiatrists, nurses, and psychologists. Strategies and interventions recommended by occupational therapists may be designed and delivered following collaboration and consultation with other allied health and medical professionals. Occupational therapists can help connect people with dementia to other health professionals if they haven't yet been, to ensure the holistic needs of the person are being best addressed.
There are a number of different ways people experiencing dementia can access occupational therapy services. The My Aged Care website provides a referral point for older people to access assessment and funding for the allied health services they need, including occupational therapy. The process involves firstly registering, then undertaking an assessment from which referrals for necessary services will be generated. This can include referrals to health professionals like occupational therapists, or to other services like home-based support or respite care.
Allied health services provided in the community are funded in a variety of ways: through federal aged care funding, eligible to those registered with My Aged Care and assessed as needing those services; through a GP chronic disease management plan or mental health plan, and they offer Medicare-subsidised allied health services for physical or mental health needs; and through state government funded programs by community health services. A discussion with your GP will help you determine which services you're eligible for, and we’ll assist you with the necessary steps and referrals to access these services.
Department of Veteran Affairs cardholders may be eligible for occupational therapy services. A referral from your GP, a medical specialist, or your hospital treating doctor is required. A call to the Department of Veteran Affairs is encouraged to confirm that your card entitles you to occupational therapy services. Those with private health insurance may have coverage that funds occupational therapy or facilitates access to health and wellbeing programs that include occupational therapy. Other people may opt to arrange private occupational therapy services with local providers. Occupational therapists are also involved in providing specialist services in programs like movement disorder clinics, behaviour support services, or pain management programs. A GP or medical specialist would be best placed to identify and refer to these specialist services.
It is worth noting that there are a number of services available outside of those described earlier that are specifically for people living with dementia. These services often work alongside, collaborate with, and compliment services provided by an occupational therapist. These include the National Dementia Support Program, a government initiative predominantly delivered by Dementia Australia that offers information, education programs, services and resources aimed at improving awareness and understanding about dementia, so that people living with dementia and their families can make informed decisions about the support services they access.
Dementia Australia is the national peak body for people of all ages living with all forms of dementia and their family and carers, and they offer a number of programs and services. Some worth noting include the National Dementia Australia Helpline, a free service for anyone affected by dementia to seek support and advice, and the Dementia-Friendly Communities program, providing resources, services, and strategies for individuals, communities, and groups to better support people living with dementia in the community.
Dementia Support Australia is a national service held by HammondCare, and they offer expertise in dementia care across three key programs. The Dementia Behaviour Management Advisory Service provides client-focused information, assessment, and advice to both staff and carers supporting people with dementia across community, acute, and residential care settings. The Severe Behaviour Response Team is a 24/7 mobile workforce aimed at providing assessment and tailored recommendations to support people experiencing severe behaviours or psychological symptoms of dementia living in eligible residential care settings. The Needs Based Assessment program identifies those who are eligible to receive the specialist dementia care program. This program offers individualised care to those experiencing severe behavioural psychological symptoms of dementia, who cannot be cared for in a mainstream residential care facility. The program aims to reduce or stabilise the behavioural or psychological symptoms, so that people can move back to less intensive care environments.
Some other services that aren't dementia specific but are worth noting include the "Find an OT" service offered by Occupational Therapy Australia. This service helps people locate a private occupational therapist with specific skills or clinical expertise in their area. As explained earlier, the Department of Veteran Affairs can be a source of funding for occupational therapy input to those who are eligible. The Australian Government Care Gateway is a service designed to support those acting in a carer role. They offer resources and links to services to provide support to carers Australia-wide. As mentioned earlier, the My Aged Care is the key gateway for older Australians to access aged care services and funding nationwide.
Occupational therapists work across and within many of the programs described, so it is important for people living with dementia to understand what they may be eligible for, and who can best support their needs. We welcome any questions that you might have of us as occupational therapists, and you may contact us at our Occupational Therapy Australia service. We look forward to hearing from you and wanting to best support you and your needs. We thank you for your time today, and we hope that you found this webinar useful in understanding how occupational therapy can support people living with dementia.
[Title card: Together we can reshape the impact of dementia]
[Title card: Dementia Australia. 1800 100 500. Dementia.org.au]
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