Occupational Therapy in Mid-Stage Alzheimer's Disease

A study was done to test the quality of life of individuals living with Alzheimer's disease and their caregivers, prior to and after an occupational therapy intervention in mid-stage Alzheimer's.

The study revealed that adherence to occupational therapy recommendations derived from individualized assessment produced significant improvements in quality of life for the person with Alzheimer's disease living in the community and significantly diminished the burden felt by family members caring for them.¹

Common mid-stage Alzheimer's symptoms

There are a variety of symptoms unique to mid-stage Alzheimer's disease, including:²

Problems with cognition: a person can be confused, not know where they are, unable to recall the day of the week or the year they are in. Become forgetful of names of their close family members, have difficulty or an inability to understand and express themselves through speech, and often display difficulties finding the right words when they speak. However, they are still able to respond to instructions.

Behavior: increased anxiety, disruptive with physical and/or verbal aggression. Inappropriate behavior in social situations. Wandering with higher prevalence in the later afternoon or night-time. Increased suspiciousness and paranoia of others, along with frequent social withdrawal from others, hallucinations, and resistance to care.

Problems with daily living skills: decreased motor skills and ability to interpret sensations. Difficulty recognizing items, and poor safety awareness are notable at this stage. These deficits lead to the person requiring assistance for tasks such as grooming and hygiene, feeding, and dressing tasks.

Additionally, at this stage, an individual's ability to perform, instrumental activities of living (IADL's), such as shopping, driving, doing laundry, medication management, and using the telephone are often greatly affected and require much assistance.²

Occupational therapy in mid-stage Alzheimer's

Evaluation

Occupational therapists will perform very specific evaluations on the person to assess their ability to carry out their daily living tasks and navigate in their home environment. The caregiver's input and level of assistance they provide are also an important part of the evaluation process.²

OT for middle-stage Alzheimer's

Occupational therapists can help explore and brainstorm ideas to help keep the person cognitively engaged and stimulated with activities, that they might enjoy doing. An OT can also help caregivers and loved ones with strategies to continue to include the person in family activities, parties, and social outings.^2,3

Additionally, the evaluation of the individual's performance of everyday tasks in their home environment (home-based performance evaluation) is of extreme importance.^2,3

Home modifications

Education of home modifications for caregivers to address potential environmental hazards and prevent injury. Some examples might include: disabling the garbage disposal, removing throw rugs, keeping cleaning supplies and medications out of reach and in locked cabinets, using electrical covers over sockets to prevent injury, use of childproof knobs on the stove, or replacing a glass shower door.^2,3

Caregiver education and adapting communication

OTs can educate caregivers and help to provide potential strategies to help their loved ones function in their environment, with the presence of their cognitive impairments.^2,3

Focus on the caregiver's ability to recognize any triggers that cause or increase stress and agitation in the person. For instance, mirrors can potentially cause increased anxiety. Sometimes when individuals battling Alzheimer's disease see their reflection, they don't recognize themselves. This can increase their anxiety level and feelings of being watched or followed by someone they don't know. Removing or covering mirrors is a simple strategy that could help.^2,3

Educating and assisting caregivers to break down tasks and simplify them for the person. Breaking tasks down into segments helps. It makes the activity easier to for the person to think through.^2,3

Education of caregivers in the use of cues during activities. When used appropriately, verbal, visual, and touch (tactile) cues or hand over hand assistance, as needed, is extremely helpful with an individual in mid-level Alzheimer’s disease. It helps the person to still engage and participate in purposeful activities.^2,3

Home occupational therapy programs

Instruct patient and caregivers in a home OT program with visual and verbal cues as needed. It is very important to incorporate strength, endurance, and range of motion activities into the person's daily life.^2,3

Having a structured schedule of self-care tasks, leisure activities, rest periods, and sleep are very important. Occupational therapists will work with the patient and caretaker to create a schedule and provide it in written or visual form for the person. Keeping the schedule visually simplistic will help to not overwhelm the person.^2,3

OT as part of the treatment team

Occupational therapists can help in so many different ways, in each stage of Alzheimer's disease. This therapeutic intervention can be a benefit for not only the person but for their family and caregivers as well.

If your feel OT could be of benefit to your loved one and your family. Then reach out and have a conversation with your doctor. If your doctor feels that OT could be of benefit, they can refer you and your loved one to occupational therapy.

Most insurances will cover OT services. Contact your individual insurance company regarding your specific plan's coverage. Have you utilized occupational therapy for middle-stage Alzheimer's? Want to talk to other's in the community about occupational therapy? Tell us about your experience in the comments below, or share your story with the community.