Effectiveness of Interventions Designed to Modify the Activity Demands of the Occupations of Self-Care and Leisure for People With Alzheimer’s Disease and Related Dementias

An Investigation of the Wishes, Needs, Opportunities and Challenges of Accessing Meaningful Activities for People Living with Mild to Moderate Dementia

Many people are keen to be actively involved in social life and activities, but even at an early stage, dementia can have a negative impact on social participation and access to leisure activities. As part of the IDoService project, this study has investigated people's needs and wishes, barriers and facilitators to identify opportunities for improving access to meaningful activities. Individual and focus group interviews were conducted with 5 people living with mild to moderate dementia, 2 familial and 2 professional care partners, as well as 12 people working in the field of dementia and/or community activities. Thematic analysis has highlighted the benefits of participating in meaningful activities, such as empowerment and pride, social contacts, and feeling useful to others. A number of barriers to participation relating to individual and environmental factors were reported. Even where participants praised dementia-friendly activities and facilities, they advocated activities inclusive for all and mentioned that some people might be reluctant to participate in dementia-labelled activities because they may not be suitable for their needs. These results indicate the need for developing tailored opportunities for people with mild to moderate dementia and provide valuable insights for researchers, service providers, policymakers and charities wanting to improve access.

Clinical reasoning of occupational therapists in selecting activities together with older adults with dementia to postpone further development of cognitive decline

BACKGROUND

Research suggests that participation in activities has the potential to prevent or delay the development of later-life cognitive decline and dementia. This area is unexplored within occupational therapy.

AIM

To explore and describe the clinical reasoning of occupational therapists in selecting activities together with older adults with dementia to participate in, with the goal to postpone further development of cognitive decline in a sample from the German part of Switzerland.

METHODS

A constructivist grounded theory approach was used. Six in-depth, semi-structured interviews with occupational therapists working in geriatric units in the German part of Switzerland were conducted.

RESULTS

Three main categories were identified: (i) from the discovery of 'who the older adult is' to the discovery of 'meaningful activities', (ii) reflecting on occupational therapists' individuality, and (iii) matching the activity to older adults' skills. A core category was developed: Pursuing active participation through meaningful and chosen activities.

CONCLUSIONS

The study suggests that to pursue enabling active participation in activities among older adults with dementia, and promoting the quality of participation, occupational therapists must consider the identified elements that are important in selecting the activities which might be used to postpone cognitive decline in each individual.

Occupational Therapy Utilization in Veterans With Dementia: A Retrospective Review of Root Cause Analyses of Falls Leading to Adverse Events

INTRODUCTION

Falls in persons with dementia are associated with increased mortality. Occupational therapy (OT) is a rehabilitation discipline, which has, among its goals, the promotion of safety and fall prevention in older adults and those with dementia. The purpose of this study was to evaluate root cause analysis (RCA) data to identify causes of falls with adverse events in patients with dementia who were referred to or receiving OT services within the Veterans Health Administration (VHA).

METHODS

This study used retrospective review of RCAs within the National Center for Patient Safety database for the VHA. The RCA database was searched using these terms: falls with adverse events, dementia, and OT. Descriptive statistical analysis of demographic information, location, occurrence of orthopedic fracture, and mortality was used. All root causes were qualitatively categorized using thematic analysis of determined causes.

RESULTS

Eighty RCAs were included in analysis. Mean age of veterans included was 80 years; 96% were male; 76% resulted in hip fracture; and 20% died as a result of the fall. Occupational therapy evaluations occurred within 7 days of admission to VHA and falls most frequently occurred within 4 days of OT evaluation. Most common causes included inappropriate or lack of equipment (21%), need for falls/rehabilitation assessment (20%), compliance/training to fall protocol of all staff (19%), and behavior/medical status (17%).

CONCLUSIONS

Earlier identification for OT evaluation need may improve access to services, and use of proper equipment to decrease frequency of falls may improve patient safety for older adults with dementia.

Comprehensive Management of Daily Living Activities, behavioral and Psychological Symptoms, and Cognitive Function in Patients with Alzheimer's Disease: A Chinese Consensus on the Comprehensive Management of Alzheimer's Disease

Alzheimer's disease (AD) is the most common cognitive disorder in the elderly. Its main clinical manifestations are cognitive decline (C), behavioral and psychological symptoms (B), and a decline in the activities of daily living (A), also known as ABC symptoms. Early identification and evaluation of ABC symptoms are helpful for establishing the accurate diagnosis, comprehensive treatment, and prognosis of AD. To guide Chinese clinical practice for optimization of the comprehensive management of AD, in 2018, The Academy of Cognitive Disorder of China gathered 22 neurologists and gerontologists in China to build a consensus on the comprehensive management of AD. Based on a review of the evidence, the consensus summarizes the pathogenesis, pathological changes, clinical manifestations, evaluation, diagnosis, drug and non-drug treatment, and patient care for AD. Focus group discussion was used to establish a flowchart of comprehensive ABC management for AD patients. The new consensus provides a feasible AD management process for clinicians.

Home-Based Occupational Therapy for Adults With Dementia and Their Informal Caregivers: A Systematic Review

IMPORTANCE

People with dementia require tailored interventions to support participation and performance in their desired occupations, and informal caregivers need interventions that reduce caregiving burden to enable them to continue with their roles.

OBJECTIVE

This systematic review investigated whether home-based occupational therapy interventions for adults with dementia and their informal caregivers optimized care recipients' performance of daily occupations and reduced caregiving burden and improved caregivers' sense of competence.

DATA SOURCES

Eight databases were searched from 1946 to November 2019 using MeSH terms, keywords, and subject headings as appropriate for each database. Inclusion criteria were quantitative studies investigating the effects of home-based therapy provided by a qualified occupational therapist for adults with dementia and their informal caregivers.

STUDY SELECTION AND DATA COLLECTION

Study selection, data collection, and methodological quality assessments using the Critical Appraisal Skills Programme criteria tool were performed independently by two reviewers. Data analysis involved a two-stage process.

FINDINGS

From 1,229 articles identified through searches, 970 titles and abstracts were screened for eligibility after removal of duplicates. Twenty studies reported in 22 articles were included. Moderate evidence supported interventions provided jointly for adults with dementia and their informal caregivers using a combination of intervention strategies. Included studies demonstrated high risk of bias, particularly in blinding of outcome assessments.

CONCLUSIONS AND RELEVANCE

Combining individualized interventions framed in client-centeredness can enhance occupational performance for adults with dementia, reduce caregiving burden, and improve informal caregivers' sense of competence. Further research on leisure and home management occupations is warranted.

WHAT THIS ARTICLE ADDS

The findings provide evidence supporting the effectiveness of home-based occupational therapy for people with dementia and their informal caregivers for consideration by funders of services.

Approaches to engaging people with dementia in meaningful occupations in institutional settings: A scoping review

BACKGROUND

People with dementia in institutional settings lack engagement in meaningful occupations, which may cause decreased quality of life. Although many researchers and professionals have proposed approaches to engage people with dementia in these occupations, an overview seems to be missing.

AIM

This scoping review provides an overview by categorizing and describing the characteristics of the approaches.

MATERIAL AND METHOD

A thorough literature search in nine databases identified the studies on approaches. We included 54 studies, and extracted bibliometric data. A content analysis revealed the characteristics of the approaches.

RESULTS

Four categories of approaches were uncovered. First, the literature defined the concept of meaningful occupation in various ways. Second, a category of approaches provided theoretical knowledge of meaningful occupations. The third category focussed on specific themes, such as certain methods. The final described comprehensive multilevel approaches.

CONCLUSION

This review contributes to knowledge of the diversity of approaches to engage people with dementia in meaningful occupation within institutional settings.

SIGNIFICANCE

We suggest that occupational therapy researchers and practitioners consider how the concept of meaningful occupation is embedded in the theoretical landscape. Furthermore, activity programming requires reflexive decision-making at the policy and practice level, as engagement in meaningful occupations is complex.

Developing strategies to improve fidelity of delivery of, and engagement with, a complex intervention to improve independence in dementia: a mixed methods study

BACKGROUND

It is important to evaluate fidelity of delivery and engagement during feasibility trials. However, there is little guidance on how to systematically develop strategies to improve implementation if problems arise. We aimed to: 1) Assess fidelity of delivery and engagement, 2) Identify factors influencing fidelity of delivery and engagement, and 3) Develop strategies to improve fidelity of delivery of, and engagement with, a complex intervention to improve independence in dementia, within a feasibility trial.

METHODS

A mixed methods evaluation of an intervention that aimed to improve independence in dementia. To assess fidelity of delivery and engagement, observation and self-report methods were used: 60% of audio-recorded intervention sessions were transcribed and reliably rated for fidelity. Providers (n = 12) and people with dementia/supporters (n = 34) were asked to complete checklists after each session. Descriptive statistics were used to analyse the data. To identify factors influencing fidelity and engagement, one-to-one semi-structured interviews were conducted with providers (n = 8), people with dementia (n = 7) and supporters (n = 7). Thematic analysis and content analysis were used to analyse data. To develop strategies, we followed four steps proposed by the authors of the Behaviour Change Wheel (1. Understanding the behaviour, 2. Identifying intervention functions, 3. Specifying intervention content, 4. Identifying mode of delivery).

RESULTS

Researcher ratings indicated moderate fidelity and provider/participant ratings indicated high fidelity of delivery. Knowledge, providers' attributes, ease of adaptation of the intervention in relation to participants' needs and logistical considerations influenced fidelity. We developed four strategies to improve fidelity of delivery of PRIDE: 1) showing a video, 2) giving an instruction sheet, 3) giving time to practice and 4) providing continued support. Participants reported high levels of engagement. Participants' attributes, capability and opportunity influenced engagement. We developed four strategies to improve engagement with PRIDE: 1) a session summary document, 2) clear instructions, 3) time to practice activity and 4) providing regular compulsory telephone support.

CONCLUSION

Fidelity of delivery and engagement are complex behaviours. This manuscript provides an example of how the Behaviour Change Wheel can be used during a feasibility trial to systematically develop strategies to improve implementation of complex interventions.

When and how did you go wrong? Characterizing mild functional difficulties in older adults during an everyday task

Mild functional difficulties associated with cognitive aging may be reliably measured by coding "micro-errors" during everyday tasks, like meal preparation. Micro-errors made by 25 older adult and 48 younger adults were coded on four dimensions to evaluate the influence of: 1) poor error monitoring; 2) goal decay; 3) competition for response selection when switching to a new subtask; and 4) interference from distractor objects. Micro-errors made by young adults under a dual task load also were analyzed to determine the influence of overall performance level. Older adults' micro-errors were observed when switching to a new subtask and to unrelated distractors. Slowed error monitoring and goal decay also influenced micro-errors in older adults, but not significantly more so than younger adults under the dual task. Interventions to reduce interference from distractors and to increase attention at critical choice points during tasks may optimize everyday functioning and preclude decline in older adults.

Scope of occupational therapy practice for adults with both Down syndrome and dementia: A cross-sectional survey

INTRODUCTION

Dementia in adults with Down syndrome causes a progressive decline in daily occupations impacting both persons with Down syndrome and their informal caregivers. This study aimed to explore the scope of occupational therapy practice for adults with both Down syndrome and dementia and their informal caregivers living in their homes.

METHODS

A survey was conducted with occupational therapists having clinical experience in providing interventions for adults with Down syndrome. A web-based survey was developed to explore occupational therapy practice for this group of people with Down syndrome and their informal caregivers. Responses to closed-ended questions were analysed descriptively, and inductive content analysis was used for open-ended questions.

RESULTS

Forty-three occupational therapists from Australia, Canada, United Kingdom and the United States of America participated in the survey. Two-thirds were from the United Kingdom, most of whom were employed in the public sector and had at least 10 years of clinical experience. Over 90% of respondents received one or more referrals in a typical month for adults with Down syndrome having dementia, 68% of which were for a decline in activities of daily living. Home environment and activities of daily living were frequently assessed areas, and the commonest interventions were compensatory strategies and environmental modifications. Only half the respondents provided interventions for informal caregivers. Risk and safety and manual handling were frequently addressed domains for informal caregivers. Collaboration and developing clinical expertise were the two key perceived enablers for providing effective occupational therapy services. Fragmentation of services and a lack of client-centred care were the common perceived barriers.

CONCLUSION

Occupational therapists often address decline in activities of daily living for individuals with both Down syndrome and dementia. To support participation in meaningful occupations for these people and support the needs of their informal caregivers, it is essential that services are offered in a collaborative approach.

The Multidisciplinary Approach to Alzheimer's Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment

Background: Alzheimer's disease (AD) and dementia are chronic diseases with progressive deterioration of cognition, function, and behavior leading to severe disability and death. The prevalence of AD and dementia is constantly increasing because of the progressive aging of the population. These conditions represent a considerable challenge to patients, their family and caregivers, and the health system, because of the considerable need for resources allocation. There is no disease modifying intervention for AD and dementia, and the symptomatic pharmacological treatments has limited efficacy and considerable side effects. Non-pharmacological treatment (NPT), which includes a wide range of approaches and techniques, may play a role in the treatment of AD and dementia. Aim: To review, with a narrative approach, current evidence on main NPTs for AD and dementia. Methods: PubMed and the Cochrane database of systematic reviews were searched for studies written in English and published from 2000 to 2018. The bibliography of the main articles was checked to detect other relevant papers. Results: The role of NPT has been largely explored in AD and dementia. The main NPT types, which were reviewed here, include exercise and motor rehabilitation, cognitive rehabilitation, NPT for behavioral and psychological symptoms of dementia, occupational therapy, psychological therapy, complementary and alternative medicine, and new technologies, including information and communication technologies, assistive technology and domotics, virtual reality, gaming, and telemedicine. We also summarized the role of NPT to address caregivers' burden. Conclusions: Although NPT is often applied in the multidisciplinary approach to AD and dementia, supporting evidence for their use is still preliminary. Some studies showed statistically significant effect of NPT on some outcomes, but their clinical significance is uncertain. Well-designed randomized controlled trials with innovative designs are needed to explore the efficacy of NPT in AD and dementia. Further studies are required to offer robust neurobiological grounds for the effect of NPT, and to examine its cost-efficacy profile in patients with dementia.

Leisure as an End, Not Just a Means, in Occupational Therapy Intervention

Leisure is commonly treated as a means instead of an end goal of intervention. This approach, influenced by history and society's past values, does not reflect the fact that leisure is meaningful and unique to its participants and has a significant effect on their health. On the basis of the core values of the occupational therapy profession and its role in the health care system, in this article we advocate that occupational therapists should expand their focus to include leisure as a goal of intervention. Although adopting this proposed approach may not be easy, given that it involves challenges in reimbursement for services, potential competition with other health professions, and a twisting of the deep-rooted existing values of occupational therapists, we believe the proposed solutions address these concerns and shed light on how to make leisure a valued goal of intervention.

Occupational Therapy Interventions for People With Alzheimer's Disease

Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association's (AOTA's) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of a person with Alzheimer's disease. The occupational therapy assessment and intervention process in the home setting is described. Findings from the systematic reviews on this topic were published in the November/December 2017 issue of the American Journal of Occupational Therapy and in AOTA's Occupational Therapy Practice Guidelines for Adults With Alzheimer's Disease and Related Major Neurocognitive Disorders. Each article in this series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical reasoning.

Effectiveness of Environment-Based Interventions That Address Behavior, Perception, and Falls in People With Alzheimer's Disease and Related Major Neurocognitive Disorders: A Systematic Review

OBJECTIVE

This systematic review evaluated the effectiveness of environment-based interventions that address behavior, perception, and falls in the home and other settings for people with Alzheimer's disease (AD) and related major neurocognitive disorders (NCDs).

METHOD

Database searches were limited to outcomes studies published in English in peer-reviewed journals between January 2006 and April 2014.

RESULTS

A total of 1,854 articles were initially identified, of which 42 met inclusion criteria.

CONCLUSION

Strong evidence indicates that person-centered approaches can improve behavior. Moderate evidence supports noise regulation, environmental design, unobtrusive visual barriers, and environmental relocation strategies to reduce problematic behaviors. Evidence is insufficient for the effectiveness of mealtime ambient music, bright light, proprioceptive input, wander gardens, optical strategies, and sensory devices in improving behavior or reducing wandering and falls. Although evidence supports many environment-based interventions used by occupational therapy practitioners to address behavior, perception, and falls in people with AD and related major NCDs, more studies are needed.

Effectiveness of Occupational Therapy Interventions to Enhance Occupational Performance for Adults With Alzheimer's Disease and Related Major Neurocognitive Disorders: A Systematic Review

OBJECTIVE

The purpose of this systematic review was to describe the evidence for the effectiveness of interventions designed to establish, modify, and maintain occupations for adults with Alzheimer's disease (AD) and related neurocognitive disorders.

METHOD

Titles and abstracts of 2,597 articles were reviewed, of which 256 were retrieved for full review and 52 met inclusion criteria. U.S. Preventive Services Task Force levels of certainty and grade definitions were used to describe the strength of evidence.

RESULTS

Articles were categorized into five themes: occupation-based, sleep, cognitive, physical exercise, and multicomponent interventions. Strong evidence supports the benefits of occupation-based interventions, physical exercise, and error-reduction learning.

CONCLUSION

Occupational therapy practitioners should integrate daily occupations, physical exercise, and error-reduction techniques into the daily routine of adults with AD to enhance occupational performance and delay functional decline. Future research should focus on establishing consensus on types and dosage of exercise and cognitive interventions.

Home Health Agency Characteristics and Quality Outcomes for Medicare Beneficiaries With Rehabilitation-Sensitive Conditions

OBJECTIVE

To examine associations between organizational characteristics of home health agencies (eg, profit status, rehabilitation therapy staffing model, size, and rurality) and quality outcomes in Medicare beneficiaries with rehabilitation-sensitive conditions, conditions for which occupational, physical, and/or speech therapy have the potential to improve functioning, prevent or slow substantial decline in functioning, or increase ability to remain at home safely.

DESIGN

Retrospective analysis.

SETTING

Home health agencies.

PARTICIPANTS

Fee-for-service beneficiaries (N=1,006,562) admitted to 9250 Medicare-certified home health agencies in 2009.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Institutional admission during home health care, community discharge, and institutional admission within 30 days of discharge.

RESULTS

Nonprofit (vs for-profit) home health agencies were more likely to discharge beneficiaries to the community (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.13-1.33) and less likely to have beneficiaries incur institutional admissions within 30 days of discharge (OR, .93; 95% CI, .88-.97). Agencies in rural (vs urban) counties were less likely to discharge patients to the community (OR, .83; 95% CI, .77-.90) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.24; 95% CI, 1.18-1.30) and within 30 days of discharge (OR, 1.15; 95% CI, 1.10-1.22). Agencies with contract (vs in-house) therapy staff were less likely to discharge beneficiaries to the community (OR, .79, 95% CI, .70-.91) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.09; 95% CI, 1.03-1.15) and within 30 days of discharge (OR, 1.17; 95% CI, 1.07-1.28).

CONCLUSIONS

As payers continue to test and implement reimbursement mechanisms that seek to reward value over volume of services, greater attention should be paid to organizational factors that facilitate better coordinated, higher quality home health care for beneficiaries who may benefit from rehabilitation.

Supporting Adults With Alzheimer's Disease and Related Major Neurocognitive Disorders and Their Caregivers: Effective Occupational Therapy Interventions

Occupational therapy practitioners play a significant role in supporting adults with Alzheimer's disease and related major neurocognitive disorders, as well as their caregivers, through all phases of the disease process. This editorial highlights the systematic reviews completed in collaboration with the American Occupational Therapy Association's Evidence-Based Practice Project that summarize the evidence for the effectiveness of interventions within the scope of occupational therapy practice for this population. Readers are encouraged to translate and integrate this updated knowledge into everyday practice.

Effectiveness of Interventions for Caregivers of People With Alzheimer’s Disease and Related Major Neurocognitive Disorders: A Systematic Review

OBJECTIVE. The goal of the evidence review was to evaluate the effectiveness of interventions for caregivers of people with Alzheimer’s disease and related major neurocognitive disorders that facilitate the ability to maintain participation in the caregiver role.

METHOD. Scientific literature published in English between January 2006 and April 2014 was reviewed. Databases included MEDLINE, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews.

RESULTS. Of 2,476 records screened, 43 studies met inclusion criteria. Strong evidence shows that multicomponent psychoeducational interventions improve caregiver quality of life (QOL), confidence, and self-efficacy and reduce burden; cognitive reframing reduces caregiver anxiety, depression, and stress; communication skills training improves caregiver skill and QOL in persons with dementia; mindfulness-based training improves caregiver mental health and reduces stress and burden; and professionally led support groups enhance caregiver QOL.

CONCLUSION. Strong evidence exists for a spectrum of caregiver interventions. Translation of effective interventions into practice and evaluation of sustainability is necessary.

Gaps in the evidence on improving social care outcomes: findings from a meta-review of systematic reviews

Adult social care continues to be a central policy concern in the UK. The Adult Social Care Outcomes Framework (ASCOF) is a range of measures nationally available to drive forward improvement on outcomes and quality in local councils. While there is an emphasis on improving transparency, quality and outcomes, drawing on research evidence to achieve these aims is often difficult because the evidence is not easily identifiable, is disparate or of variable quality. We conducted a meta-review to analyse and summarise systematic review-level evidence on the impact of interventions on the four outcomes set out in the ASCOF: quality of life, delaying and reducing the need for services, satisfaction with services and safeguarding of vulnerable adults. This paper focuses on the availability of review-level evidence and the presence of significant gaps in this evidence base. A range of health and social care databases were searched, including MEDLINE, ASSIA and The Cochrane Library in January and February 2012. All systematic reviews evaluating the efficacy of social care interventions for improving ASCOF outcomes for older people, people with long-term conditions, mental health problems or physical and/or learning disabilities were eligible. Two reviewers independently screened systematic reviews for quality and relevance and extracted data; 43 systematic reviews were included, the majority of which examined the impact of interventions on quality of life (n = 34) and delaying and reducing the need for support (n = 25). Limited systematic review-level evidence was found regarding satisfaction with services and safeguarding. There were also significant gaps in relation to key social care interventions and population groups. Research priorities include addressing these gaps and the collation of data on interventions, outcomes and populations more closely related to social care. Overall, a more relevant, comprehensive and robust evidence base is required to support improvement of outcomes for recipients of adult social care.

Non-Pharmacological Approaches to Reducing Negative Behavioral Symptoms: A Scoping Review

The management of negative behavioral symptoms among residents with dementia is a challenge that nursing homes face in delivering quality care. This study examines evidence documenting non-pharmacological interventions that reduce negative behavioral symptoms among nursing home residents with dementia and the role occupational therapy practitioners have in this area. A scoping review was completed for intervention studies published from 1987 to 2014, targeting negative behavioral symptoms among nursing home residents above 60 years of age with dementia. Interventions were categorized based on the American Occupational Therapy Association (AOTA) Occupational Therapy Practice Framework. Twenty-two studies met the inclusion criteria. Four types of interventions were identified: occupation-based interventions, context and environment interventions, exercise interventions, and daily routine-based interventions. The non-pharmacological interventions were found to align with the scope of occupational therapy. This suggests that occupational therapy practitioners can contribute to the development and evaluation of non-pharmacological interventions aimed to reduce negative behavioral symptoms.

[Effectiveness of occupational therapy and other non-pharmacological therapies in cognitive impairment and Alzheimer's disease]

A review is presented on the existing knowledge about the usefulness of the occupational therapy in the non-pharmacological treatment of Alzheimer's disease. After conducting a literature search of the period 2010-2015, 25 articles that met the inclusion criteria were selected. The evidence obtained showed the efficiency and effectiveness of OT in delaying the progression of various disorders, especially when structured home OT programs are used. These programs should include aerobic and strengthening, sensory stimulation, and cognitive and memory training exercises based on learning without mistakes. These have shown benefits in the performance of activities of daily living, cognitive and emotional functioning. The importance is stressed of the combined and individual household level intervention and caregiver education. Finally, the need for more studies on the effectiveness of long-term sensory stimulation is highlighted.

Update on productive aging research in the American Journal of Occupational Therapy, 2013, and overview of research published 2009-2013

In light of the Centennial Vision charge of supporting practice through evidence, this article reviews productive aging research published in the American Journal of Occupational Therapy (AJOT) in 2013 and as a whole from 2009 to 2013. Thirteen such articles were published in 2013, consisting of 4 systematic reviews that identified effective occupational therapy interventions for older adults with low vision; 1 randomized controlled trial that examined changes in occupational therapists' mental health practices with DVD training; and 8 descriptive articles addressing instrument development, practitioner decision making, patient management of medications, and effects of task activities on pain and participation levels. From 2009 to 2013, the quantity and quality of AJOT articles on productive aging increased; 63 articles were published, including 24 effectiveness studies, 14 basic research studies, 15 articles on instrument development and testing, 1 article linking occupational engagement and health, 6 articles on professional education, and 3 articles addressing professional questions.

Occupational therapy and dementia care: a survey of practice in the Republic of Ireland

BACKGROUND/AIM

There is a growing body of research to support the role of occupational therapy in dementia care. However, little is known about the extent to which this research is translated into occupational therapy practice. This study addresses this gap by considering current occupational therapy practice in the field of dementia care in Ireland.

METHODS

A cross-sectional online survey was used to gather data about current practice. Convenience sampling and snowball recruitment techniques were used to recruit occupational therapists. Data were analysed using a combination of descriptive statistics and content analysis.

RESULTS

Forty-seven therapists responded to the survey. The majority of respondents worked in primary care and provided services for people with early stage or mild dementia. Assessment practices were primarily focussed on cognitive screening and functional performance. Limited attention was paid to occupational participation. Interventions typically addressed environmental modification, assistive devices and compensatory strategies. The ability of therapists to apply research evidence to practice appears to be strongly constrained by practice and organisational demands.

CONCLUSION

There is a need for a global occupational therapy strategy to support knowledge translation in dementia care. At present although occupational therapists are aware of research evidence they face significant barriers in applying this evidence in practice.

Behavioural interventions for enhancing life participation in behavioural variant frontotemporal dementia and primary progressive aphasia

Primary progressive aphasia (PPA) and behavioural-variant frontotemporal dementia (bvFTD) are clinical syndromes under the umbrella term 'frontotemporal dementia' (FTD) and are caused by a neurodegenerative disease with an onset most typically in the productive years of adulthood. The cognitive and behavioural impairments associated with FTD interfere with successful engagement in typical life roles, such as parenting, working, and maintenance of interpersonal relationships. There are currently no treatments to stop or slow the degenerative process and there are only very limited medication options for the management of the cognitive-behavioural symptoms. However, alternative, non-pharmacological interventions may offer significant benefit to the quality of life of the diagnosed individual. The goal of this paper is to provide an overview of the approaches available through neurorehabilitation and community-based services that facilitate successful engagement in life activities and promote optimal quality of life for the individuals and families living with FTD. It is hoped that as medical providers become more familiar with behavioural interventions, referrals for services will increase thereby allowing individuals with FTD and their caregivers to learn ways to adapt, adjust, and participate in life to the fullest despite the impairments from this progressive disease.

Update on productive aging in the American Journal of Occupational Therapy 2011

A review of the productive aging articles published in the American Journal of Occupational Therapy during 2011 was conducted and discussed in light of meeting the Centennial Vision charge of supporting practice through evidence. Twelve articles that specifically addressed productive aging were published in AJOT in 2011. The review of these 12 articles found seven Level I studies. Six of the articles were systematic reviews identifying effective interventions for people with Alzheimer's disease and related dementias and their caregivers, and 1 was a randomized controlled trial of fall prevention in community-dwelling older adults. Five were basic research studies. Two of the 5 studies researched professional issues, and 3 addressed client-based issues. The quantity of productive aging research published in 2011 was consistent with the quantity reported in 2009 and 2010. More studies building the body of evidence about the effectiveness of occupational therapy with older adults are needed.