The Development of a Holisitic Dementia Caregiver Program. Karen S. Howell, PhD, OTR/L, FAOTA Kayla Collins, MOT

Transcription

1 The Development of a Holisitic Dementia Caregiver Program Karen S. Howell, PhD, OTR/L, FAOTA Kayla Collins, MOT

2 Session Objectives Participants will: understand the BASICS framework as the theoretical underpinnings for client/caregiver program development, be able to describe methods to teach caregivers to help the person with AD in regards to communication, ADLs, fitness and activity enhancement, know how to offer caregivers support that prevents his/her burnout or depression in regards to validation, spirituality and stress reduction techniques

3 The Role of Occupational Therapy with the Client with AD and the Caregiver Design intervention plans that create opportunities for role enhancement Maximize quality of life Maintain occupational performance or modify activity demands Balance client safety with maximal independence Prevent deterioration in performance capability

4 BASICS MODEL for Dementia Interventions and Environments Six needs identified that allow the intervention to have more chance for success A holistic model Interventions should provide opportunities for participants to demonstrate competence Keeping persons with dementia engaged in community service and role enhancement

5 Need Addressed Outcome Addressed Intervention Example B - Biological Promotes Sense of Security and Safety Stretching and Flexibility Activities, Tai Chi, Balance Activities, Swimming, Treadmill, Stationery Bike, Walking, Aerobic Activities A Activities Daily Living Promotes Sense of Independence and Control Over Immediate Environment ADL Training, Memory Aids, Assistive Technology, Caregiver Training, Environmental Modifications S Societal Fosters a Sense of Unique Identity and Self-worth; Meaningful Client Centered Participation Role Enhancement Activities, Volunteer Work, Client Centered Engagement in Occupations

6 Need Addressed Outcome Addressed Intervention Example I Interpersonal Provides an Opportunity for Social Role Expression Caregiver Training, Reminiscence Groups, Scrapbooking C Creative Encourages Use of Spared Talents/Skills; Identifies Activities that Provide Optimal Stimulation Music, Dance, Art, Client Centered Engagement in Leisure Pursuits, Schnoezelen Baskets S Symbolic Encourages Hopefulness and Self-fulfillment Despite Loss of Self Due to Dementia Worship Services, Relaxation Techniques, Role Enhancement, Reminiscence Groups, Validation Activities

7 Need Addressed Outcome Addressed Intervention Example B Biological To emphasize the need for caregivers to manage stress To describe the characteristics of the AD process. To update caregivers on dementia treatment research A Activities of Daily Living To provide caregivers with strategies to enhance the independence of their clients with dementia Disease update worksheet Role of nutrition Stress relieving activities for the caregiver How to encourage independence in ADL s Sleep enhancement S Social Role Enhancement Enhance perception of caregiver roles Explore client roles Implement method for increasing a positive work environment Validation of caregiver importance Praise box Role enhancement for caregiver & client

8 Need Addressed Outcome Addressed Intervention Example I Interpersonal Improve participants communication skills with clients & families Self assessment on communication 4 R s of communication Communication strategies for caregivers C Creative Encourage use of creative activities with clients S Spiritual Recognize & participate in spiritual components of wellness Making a therapeutic activity kit for specific clients Memory books Multi-sensory environment Yoga participation Aromatherapy Personal ritual making

9 Occupational Therapist s Role Early Stage Alzheimer s Intervention Approach Create or promote Establish or restore Maintain Modify Prevent Early Stage Alzheimer s Create opportunities to enhance daily involvement in community activities Restore functional independence using client and caregiver training and assistive technologies Build on past skills and habits to maintain present function Adjust occupational demands, and increase environmental supports Provide prevention education in targeted areas (e.g., falls, geographic orientation, medication management, financial oversight, options for community mobility)

10 Occupational Therapist s Role Mild or Moderate Stage Alzheimer s Intervention Approach Create or promote Establish or restore Maintain Modify Prevent Mild Stage Alzheimer s Promote involvement through specialized memory loss programs Provide training in daily living skills, establishing consistency in performance patterns Develop functional maintenance programs for optimal engagement Simplify daily tasks, modify cues, break down sequence to ability level Encourage activity engagement by initiating task and offering step-bystep guidance to minimize daytime sleep

11 Occupational Therapist s Role Late Stage Alzheimer s Intervention Approach Create or Promote Establish or Restore Maintain Modify Prevent Late Stage Alzheimer s Involve client in adapted activities designed for changing abilities Provide habituation training for communication systems and basic feeding, grooming, and dressing Maintain physical, social, and occupational engagement at the optimal level Guide with external supports to enhance participation in portions of the task Stimulate activity in physical, social, and functional areas through sensory inputs

12 Activity for Caregivers for Biological Stage Fact and Fiction Game Stages of AD and What s new in research Caregiver Strategies for Fitness

13 Activities of Daily ADL s and Modifications Guided Touch Role Play Sleep Enhancement

14 Social Participation And Role Enhancement Validation of the Importance of the Caregiver Role Praise Box Discussion of Client Roles and Ways to Maintain or Adapt

15 Interpersonal Interventions Emotional Regulation, Communication Strategies, Role Play 4 R s reassess, rechannel, reassure, reconsider Repetitive behaviors Hallucinations

16 Creative Interventions Activity baskets, Snoezelen rooms, Music therapy

17 Caregiver Activity for Symbolic/Spiritual Domain Stress Inventory Stress Reduction Techniques Yoga Participation Aromatherapy

18 References Berenyi, Julie, et al Using occupations to improve quality of life, health and wellness, and client and caregiver satisfaction for people with Alzheimer's disease and related dementias. AJOT: American Journal of Occupational Therapy 65. Chee, Y., Gitlin, L. N. & Dennis, M. P. & Hauck, W. W. (2007). Predictors of caregiver adherence to a skill-building intervention among dementia caregivers. Journal of Gerontology Medical Sciences, 62(6), Coon, D., & Evans, B. (2009). Empirically based treatments for family caregiver distress: What works and where do we go from here? Geriatric Nursing, 30(6), Gitlin, L. N., Belle, S. H., Burgio, L., Czaja, S., Mahoney, D., Gallagher-Thompson, D., Burns, R., Hauck, W. W., Schulz, R. & Ory, M. (2003). Effect of multi-component interventions on caregiver burden and depression: The REACH multi-site initiative at six months follow-up. Psychology and Aging, 18(3), Mahendra, N., & Arkin, S. (2003). Effects of four years of exercise, language, and social interventions of Alzheimer discourse. J Commun Disord, 36(5), Schecker, M., Pirnay-Dummer, P., Schmidtke, K., Hentrich-Hesse, T., & Borchardt, D. (2013). Cognitive Interventions in Mild Alzheimer's Disease: A Therapy-Evaluation Study on the Interaction of Medication and Cognitive Treatment. Dementia and Cognitive Disorders EXTRA, 3(1),