Occupational Therapy Services for Elderly with Severe Dementia

Abstract

The elderly with severe dementia tend to decline physical ability as well as mental ability. Due to functional declining, the elderly with dementia is getting more dependent on caregivers. On the last stage of dementia, functional declining has negative effects on quality of life not only in the elderly with dementia but also in caregivers. Occupational therapy services are aimed to improve the quality of life for the rest of their lives in people with severe dementia and their caregivers. This chapter explores two main therapeutic approaches for person with severe dementia: (1) interventions to improve physical ability and (2) interventions to reduce behavioral and emotional problems.

I am happy because I come to do these activities with my friends.

A client participated in occupational therapy program for dementia

Appendices

The Case Study: Effects of Occupational Therapy Intervention with Mr. Kim

Keywords

Occupational therapy, severe dementia, quality of life

Introduction

The theme of this case study concerns intervention effects of occupational therapy for a person with severe dementia.

The student’s tasks include the following:

• Finding information about condition and progression of severe dementia

• Making intervention plan for assessments and activities applied with severe dementia patient

• Synthesizing the information into a report

As a starting point, the students should use the following references to gather background information:

Boller F, Verny M, Hugonot-Diener L, Saxton J (2002) Clinical features and assessment of severe dementia. A review1. Eur J Neurol 9(2):125–136

Burge E, Kuhne N, Berchtold A, Maupetit C, von Gunten A (2012) Impact of physical activity on activity of daily living in moderate to severe dementia: a critical review. Eur Rev Aging Physical Activity 9(1):27–39

Chang E (2006) Palliative care dementia interface: enhancing community capacity project (Doctoral dissertation, University of Western Sydney)

Folstein MF, Folstein SE, Mc Hugh PR (1975) Mini-mental state: a practical method for grading the cognitive state of patients and for the clinician. J Psychiatric Res 12(3):189–198

Herrmann N, Gauthier S, Lysy PG (2007) Clinical practice guidelines for severe Alzheimer’s disease. Alzheimer Dementia 3(4):385–397

Kim SY, Yoo EY, Jung MY, Park SH, Park JH (2012) A systematic review of the effects of occupational therapy for persons with dementia: a meta-analysis of randomized controlled trials. NeuroRehabilitation 31:107–115

Lee HS, Kim DK, Ko HJ, Ku HM, Kwon EJ, Kim JH (2003) The standardization of geriatric quality of life scale. Kor J Clin Psychol 22(4):859–881

Schmitt FA, Wichems CH (2006) A systematic review of assessment and treatment of moderate to severe Alzheimer’s disease. Prim Care Companion J Clin Psychiatry 8(3):158

Steinberg M, Leoutsakos JMS, Podewils LJ, Lyketsos CG (2009) Evaluation of a home-based exercise program in the treatment of Alzheimer’s disease: The maximizing independence in dementia (MIND) study. Int J Geriatr Psychiatry 24(7):680–685

Wimo A, Prince MJ (2010) World Alzheimer Report 2010: the global economic impact of dementia. Alzheimer’s Disease International, London

Overview of the Content

The major goals of the OT intervention are (1) to reduce behavioral and emotional problem and (2) to improve the quality of life.

Learning objectives

By the end of this chapter, the learner will be able to:

• Understand the symptoms and the specific problem behaviors of a person with severe dementia in report.

• Be able to use a literature review on the case study in the person with severe dementia.

• Be able to apply treatment about severe dementia patient related to case study and similar clinical situations.

The Background History of Clinical Case Study

Personal Information

Mr. Kim is 78 years old. He lives with his wife in farm village. He had worked on the farm over the past 30 years. He has an active, positive character and is a “crowd-pleaser” in health center.

Medical Information

The results of initial cognitive assessment showed a score of 5 on the GDS (Schmitt and Wichems 2006). In results of the initial depression and quality of life assessment , he received 1 of 15 maximum score on Geriatric Depression Scale Korea (GDS-K) version (Kee 1996) short form and 78 of 100 maximum score on geriatric quality of life (GQL; Lee et al. 2003). These results demonstrated that he had severe cognitive impairment but was on positive status of emotion and quality of life.

Occupational therapy interventions were provided once a week for 10 weeks in the health center . Thetreatment session was of 2 h and included cognitive training related to memory and activity program such as making a cup using rubber clay (e.g., see Fig. 29.3), cooking Korean traditional food, designing autumn poster, playing YutNori (Korean traditional board game; e.g., see Fig. 29.4), and Theraband exercise. During cognitive therapy using the workbook, Mr. Kim generally conducted well about visual perception task, but he had lacked concentration while receiving visual memory task. As the session progressed, he had failure of his memory but maintenance of visual perception. When he participated in physical and cognitive activity programs, he had great interest and active participation, but he had some problems related to cognitive and emotional aspects.

Fig. 29.3

Making a cup using rubber clay

Fig. 29.4

Playing Korea traditional board game

For example, when making a cup using rubber clay, he had difficulty with making right a cup shape. Eventually, he made two hands of a cup. The next day, he played YutNori with other people. YutNori is a Korean traditional four-stick game, and it is usually played in traditional holidays. The game is played with two or more teams in turns. Each team has four markers and plays with board, which has 29 blocks. The game is won by the team who bring all their markers home first. When he played YutNori with people with mild to moderate dementia, he also had difficulties getting along with them because he was confused about the procedures and rules of the game.

When ten sessions were completed, we carried out a posttest. The results were 6 on GDS, 3 (cutoff score) on GDS-K, and 91 on GQL. These results showed that cognitive function decreased, but he had positive effects on improved emotional status and quality of life . In conclusion, this case study demonstrated that occupational therapy intervention has positive effects on emotion and quality of life for person with severe dementia .

The Student’s Report

The following guiding questions have been identified in developing possible solutions for Mr. Kim:

How well do Mr. Kim’s present occupational performance abilities suit to the activities he perform (as described above)?

Is it possible to modify the applied activates to better suit Mr. Kim’s present occupational performance ability?

Which are the short- and long-term goals for Mr. Kim?